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Carl Erik Fisher, psychiatrist and author of The Urge: A History of Addiction. Beowulf Sheehan/Beowulf Sheehan hide subtitle

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Beowulf Sheehan/Beowulf Sheehan

Carl Erik Fisher, psychiatrist and author of The Urge: A History of Addiction.

Beowulf Sheehan/Beowulf Sheehan

Right after graduating from medical school, Carl Erik Fisher was on top of the world. He won prizes and worked day and night. But much of that frenetic activity was really hiding his problems with addiction.

Fisher, who says she comes from a family with a history of addiction, fell into an alcohol and Adderall binge during residency. A manic episode led to his admission to the psychiatric ward of New York’s Bellevue Hospital, where he had interviewed for residency a few years earlier.

“Because I was a doctor, because I’m white, because when the NYPD came to take me out of my apartment, I was living in an upscale neighborhood — I got a lot of treatment and I got a lot of compassion,” he says. . “Sadly, many people with addiction can’t even access services, let alone the kind of quality services that I was able to get.”

Today, Fisher is in recovery and is an assistant professor of clinical psychiatry at Columbia University. His new book The Urge: Our History of Addiction (part memoir, part history) discusses the importance of careful language when discussing addiction and how treatment has historically ignored its complex sociocultural influences.

Highlights of the interview

Why it matters if addiction is considered a disease

I believe that addiction is not a disease. Calling it a disease is misleading. Now, I say that with the understanding that for some people the word “sickness” is really powerful and liberating. this [can] provide an organizational framework to make sense of their struggles and a sense of security. And I would never want to monitor an individual’s understanding of the word. But ultimately, when we look at it as a sociocultural phenomenon, I think the notion of disease can be misleading because it takes the focus away from the forces of racism and other forms of oppression that are often tied to addiction. Initially, the word disease was introduced in an attempt to force open the doors of hospitals and otherwise obtain medical treatment for people with addiction. This is because the medical profession had largely abdicated its duty to care for people with addiction. Therefore, these defense efforts were absolutely necessary. But people still struggle to access care. People still fight the stigma. People still struggle to get insurance benefits for addiction problems. There is a useful version of the word “disease” when talking about addiction that says therapy and medication can save lives. But the term is messy and also locates all causes in biology and overlooks some of the other determinants of people’s health.

About how racism has historically influenced addiction treatment

For centuries, people have tried to divide people into good and bad drugs, to say that certain drugs are dangerous, infectious, or lead inexorably to vice and social problems. Often this kind of wild exaggeration of the harms of one drug and the supposed benefits of other drugs backfires to hurt everyone. A great example from the turn of the 20th century: there were all these powerful efforts to criminalize certain drugs because they were associated with certain racist and xenophobic panics, like the panic associated with the use of Chinese opium or the use of black cocaine. Even just the urban poor was a major development at the time and an association with heroin fueled many of these attitudes. At the same time, a kind of right allowed the continued use of certain drugs. At first things like morphine and the more closely regulated opioids and then stimulants, which were invented shortly after. And whites and the privileged were also harmed by these kinds of rights. So drugs are such a powerful example of how racism rebounds to hurt us all that whenever we create these kinds of separations and try to assign good and bad categories to different forms of drugs, we invariably end up causing harm generalized

About how the medical model should change to get more people into recovery

One simple shift we could make is to shift our focus from monitoring people’s usage to meeting people where they are and helping them with what matters most in their lives. For too long, medicine has been dominated by an abstinence-only model. Now, I am in an abstinence mode myself. I don’t think I should drink or consume it again. And for many people, this is necessary and saves lives. But addiction is also profoundly diverse, and we have emerging evidence that there are some people who can actually improve their functioning even when they have a substance problem without completely eliminating it. Or they could be in a kind of partial withdrawal when they stop using heroin. I don’t think it’s wise to be arrogant about drug use, especially if someone has had a problem before. But there are a lot of people who don’t want treatment because their current treatment system is really dominant. For example, it is a crisis that people are discharged from treatment due to continued use. One definition of addiction is continued use despite negative consequences. So I think it’s imperative that we, as medical professionals, do more to work with people where they are while recognizing the profound dangers of addiction.

About the approach he uses with his own patients

The bottom line from working with my own patients is that they are in charge. The main takeaway from looking at the history and looking at the science behind addiction recovery is a respect for the many different paths to recovery. This is something I felt myself: I was very ashamed to think that I wasn’t recovering the right way, or to think that I could be doing a better job. And I think a lot of people have that shame. That if they’re not doing recovery in the traditional sense, maybe it’s not that good. And you know, I think it can be a real, unnecessary distraction because there’s a lot of opportunity to grow and improve and work to solve the kinds of serious substance problems that we’re working with.

This story was edited for radio by Jeevika Verma and Reena Advani and adapted for the web by Jeevika Verma and Barbara Campbell.

Source: Psychiatrist says calling addiction a disease is misleading: NPR

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