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A history of addiction in ‘The Urge’

Psychiatrist Carl Erik Fisher explores his problem, and ours

Deena So Oteh for The Boston Globe

As a psychiatrist in training, Carl Erik Fisher knew he had a problem. He was showing up to his rounds hungover or still drunk from the night before, lying to his superiors about his alcohol abuse. This couldn’t be happening to him. He was the doctor, not the patient. Surely, he could handle this, whatever “this” was, on his own.

We can all be thankful that eventually Fisher sought help. His new book, “The Urge,” is one of those hybrid history/memoirs that illuminates an important subject through personal experience. Fisher digs deep into the history of addiction. He uses sociology, literature, criminology, and, yes, psychology, to explore how societal attitudes have fluctuated through the centuries, from condemning addicts as deadbeats to treating addiction as a disease. Doggedly researched, layered with empathy, “The Urge” pulls back multiple curtains at once in examining an ailment that will likely never go away.


Fisher recalls showing an intern how to measure the size of an alcoholic patient’s liver. It was like looking into a mirror. “I knew my own alcohol intake had shot way into the unhealthy range,” Fisher writes. “Some mornings, I imagined that I could feel my own swollen and aching liver.” Instead of seeking long-term help, he started taking Adderall and smoking marijuana to counteract the booze. “My eye twitched if I went too long between drinks,” he writes. “Even on nights I didn’t want to drink, I joylessly downed a few shots of whiskey to put my body to sleep.”

Fisher doesn’t overload the text with such “physician, heal thyself” moments; he provides just enough to make us want more. Instead, he’s generally more interested in looking outward. He goes back to the ancient Greeks, who had a word, “philopotês,” that means “lover of drinking seasons.” There’s Teng Cen, a Chinese poet of the Song dynasty, who made a pact with the gods to stop drinking, only to rationalize his relapse by convincing himself that it was in his “true nature” to drink.


Addicts are masters of rationalization. As a writer and recovering alcoholic, I used to tell myself that excessive drinking was part of the job. Or that if I didn’t keep liquor in the house I’d be just fine. Addiction ties the brain in knots in the service of feeding the urge. Its lies always feel like the truth.

Addiction rarely exists in isolation; it often serves larger, pernicious motives of classicism and racism. Fisher cites the 18th-century British “Gin Craze” as “the first urban drug epidemic,” a flood of distilled rotgut booze. As Fisher writes, “the victims were mostly old, mostly poor, all women, and all thoroughly alcohol-soaked.” Instead of asking what unique challenges this demographic faced, the distilling industry launched a campaign of blame-the-victim: “A favorite tactic was to put the onus of responsibility on the bad behavior of the poor — the problem was bad drinkers, not a bad drink.”

The United States would borrow this tactic as Chinese immigrants, many of them escaping the opium wars of their own country, began to unwind from often fatal labor (digging mines, building railroads) in opium dens. The Chinese were hardly the only ones smoking the drug, but they filled a role for American alarmists: “The stereotypical opium den, and the opium inside, perfectly encapsulated a fear of contagion: a frighteningly exotic place full of unsavory, dangerous characters, all using a drug that threatened to infect the rest of society.”


Lest you think “The Urge” is bereft of hope, Fisher devotes several pages to the subject of recovery (his own included). His treatment of Alcoholics Anonymous is concise, evenhanded, and even novel in whom it brings into the picture. Most have heard of Bill Wilson, the co-founder and spiritual lodestar of AA. But Fisher gives equal time to Margaret “Marty” Mann, a public relations wiz who used AA as a launching pad for the National Committee for Education on Alcoholism (NCEA), which would eventually become the National Council on Alcohol and Drug Dependence (NCADD). By the second half of the 20th century, addiction was seen largely as a disease, rather than a failure of character, although strategic demonization would continue, as in the kneejerk racism that accompanied the crack epidemic.

“The Urge” contains a wealth of such research and insight, rendered with a gimlet eye and a physician’s care. Addicts who make it to the other side often feel they have survived to fulfill a higher purpose. “The Urge” qualifies as just such an accomplishment, an inspired dive into a condition that, in one way or another, touches us all.

The Urge: Our History of Addiction

By Carl Erik Fisher

Penguin Press, 400 pages, $30

Chris Vognar, a former Nieman Fellow at Harvard, is a freelance cultural critic.