Breaking the Addiction Binary (Carl Erik Fisher, M.D.): ADDICTION

“I want to say that it's not just some idea about suffering, it's also a function of social and economic systems that are deliberately weaponizing an individualized view of suffering as a technique, as a strategy. I found across eras and eras and eras in the book is that addiction supply industries, which is what one scholar calls them, like the alcohol industry, the tobacco industry, they constantly come back to this hyper individualization in saying, you know, like, the problem is not in the bottle, the problems in the person. If so many people can drink, quote unquote normally, that means the problem is really with these sick people over here. And that happened with tobacco. And then very directly and deliberately, things like the processed food industry and other modern addiction supply industries have used the same language.”

So says Carl Erik Fisher, an addiction psychiatrist, bioethics scholar, author, and person in recovery. Carl is also an assistant professor of clinical psychiatry at Columbia University, where he teaches law, ethics, and policy relating to psychiatry and neuroscience, particularly where they converge with substance use disorders and other addictive behaviors. He hosts a podcast called Flourishing After Addiction and is launching a Substack, where he’ll organize his thinking around treatment paths and modalities. Most pertinent to our conversation today, he’s the author of The Urge: Our History of Addiction, which is a fascinating deep dive into our long cultural fascination with addictive substances, interlaced with his own story, and stories from his practice: In fact, the book opens in Bellevue where Carl is not functioning as a doctor—in this case, he’s the patient, after suffering an addiction-induced manic episode that put him into recovery. Carl is brilliant and kind, and also fluent in all the prevailing science about addictive behavior…science that hasn’t really ruled the day until recent years. Instead, the addiction space has been one of binaries—you’re compulsive, or you exercise choice; you’re normal, or an addict; you have no control to stop, or you have all the control and refuse to use it; and on and on and on.

MORE FROM CARL ERIK FISHER:
The Urge: Our History of Addiction
Carl’s Podcast: Flourishing After Addiction
Carl’s Website
Follow Carl on Instagram
Carl’s Newsletter
Carl’s Substack

Further Listening on Pulling the Thread:
PART 1: Holly Whitaker, “Reimagining Recovery”
ADDICTION: Anna Lembke, M.D., “Navigating an Addictive Culture”
TRAUMA: Gabor Maté, M.D., “When Stress Becomes Illness”
BINGE EATING DISORDER: Susan Burton, “Whose Pain Counts?”

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