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'The Urge' says calling addiction1 a disease is misleading
Carl Erik Fisher, psychiatrist3 and author of The Urge: A History of Addiction.
Beowulf Sheehan/Beowulf Sheehan
Just after graduating from medical school, Carl Erik Fisher was on top of the world. He was winning awards and working day and night. But a lot of that frantic5 activity was really covering up his problems with addiction.
Fisher – who says he comes from a family with a history of addiction – descended6 into an alcohol and Adderall binge during residency. A manic episode led to his admission to the Bellevue Hospital Psychiatry7 ward4 in New York, where just years ago, he'd interviewed for residency.
"Because I was a doctor, because I'm white, because when the NYPD came to get 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 of services I was able to get."
Today, Fisher is in recovery and an assistant professor of clinical psychiatry at Columbia University. His new book The Urge: Our History of Addiction – part memoir9, part history – looks at the importance of careful language when talking about addiction, and how treatment has historically ignored its complex socio-cultural influences.
On why it matters whether addiction is considered a disease
I think addiction is not a disease. To call it a disease is misleading. Now, I say that with the understanding that for some people, the word "disease" is really powerful and liberating10. It [can] provide an organizing framework for making sense of their struggles and a feeling of safety. And I would never want to police an individual's understanding of the word. But on balance, when we look at it as a socio-cultural phenomenon, I think the notion of disease can be misleading because it takes focus away from the forces of racism11 and other forms of oppression that are so often bound up in addiction. Initially12, the word disease was introduced to try to force open the doors of hospitals and otherwise get medical treatment for people with addiction. That's because the medical profession had largely abandoned its duty to take care of people with addiction. So those advocacy efforts were absolutely necessary. But people still struggle with getting access to care. People still struggle with stigma13. People still struggle to get insurance benefits for problems with addiction. There is a useful version of the word "disease" when talking about addiction that says therapy and medications can save lives. But the term is messy, and it also locates all of the causes in biology and overlooks some of the other determinants of people's health.
On how racism has historically influenced addiction treatment
For centuries, people have tried to divide folks according to good drugs and bad drugs, to say that certain drugs are dangerous, they're infectious, or that they lead inexorably to vices8 and social problems. Often that kind of stark14 exaggeration of the harms of one drug and the supposed benefits of other drugs rebounds15 to hurt everybody. A great example from the turn of the 20th century: there were all of these powerful efforts to criminalize certain drugs because they were associated with certain racist16 and xenophobic panics, like the panics associated with Chinese opium17 use or with Black cocaine18 use. Even just the urban poor was a major development around that time and an association with heroin19 drove a lot of those attitudes. At the same time, a sort of entitlement allowed the continued use of certain drugs. At first, things like morphine and more tightly regulated opioids and then later stimulants20, which were only shortly thereafter invented. And white people and privileged people were harmed by those sorts of entitlements, too. So, drugs are such a powerful example of how racism rebounds to hurt all of us that whenever we create those sorts of separations and to try to assign the good and bad categories to different forms of drugs, we invariably wind up causing widespread harm.
On how the medical model should change to get more people into recovery
One simple pivot21 we could do is to shift our focus away from controlling people's use to meeting people where they are and helping22 them with what matters most in their life. For too long, medicine has been dominated by an abstinence-only model. Now, I myself am in an abstinence model. I don't think I should drink or use again. And for many people, that's necessary and lifesaving. But addiction is also profoundly diverse, and we have emerging evidence that there are some folks who can really improve their functioning even when they have a substance problem without totally cutting out use. Or they could be in a sort of partial abstinence when they stop using heroin. I don't think that it's wise to be cavalier about drug use, especially if somebody has had a problem before. But there are a lot of people who don't want treatment because their current treatment system is really domineering. For example, it's a crisis that people are discharged from treatment because of continued use. One definition of addiction is continued use despite negative consequences. So, I think it's imperative23 that as medical professionals, we work harder to work with people where they are while also recognizing the profound dangers of addiction.
On the approach he uses with his own patients
The bottom line in working with my own patients is — they're in charge. The main insight that looking at the history and looking at the science behind addiction recovery has given me is a respect for the many different pathways there are for recovery. That's something I felt myself — I had a lot of shame around thinking I wasn't recovering in the right way or thinking that I could be doing a better job. And I think a lot of people carry that shame. That if they're not doing recovery in the traditional sense, then maybe it's not as good. And you know, I think that can be a real distraction24 and unnecessary because there are lots of opportunities to grow and improve and to work toward resolving the kinds of severe substance problems that we're working with.
This story was edited for radio by Jeevika Verma and Reena Advani and was adapted for the web by Jeevika Verma and Barbara Campbell.
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1
addiction
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| n.上瘾入迷，嗜好 | |
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transcript
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| n.抄本，誊本，副本，肄业证书 | |
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psychiatrist
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| n.精神病专家；精神病医师 | |
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ward
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| n.守卫，监护，病房，行政区，由监护人或法院保护的人（尤指儿童）；vt.守护，躲开 | |
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frantic
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| adj.狂乱的，错乱的，激昂的 | |
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descended
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| a.为...后裔的，出身于...的 | |
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psychiatry
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| n.精神病学，精神病疗法 | |
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vices
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| 缺陷( vice的名词复数 )； 恶习； 不道德行为； 台钳 | |
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memoir
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| n.[pl.]回忆录，自传；记事录 | |
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liberating
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| 解放，释放( liberate的现在分词 ) | |
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racism
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| n.民族主义；种族歧视(意识) | |
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initially
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| adv.最初，开始 | |
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stigma
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| n.耻辱，污名；(花的)柱头 | |
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stark
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| adj.荒凉的；严酷的；完全的；adv.完全地 | |
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rebounds
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| 反弹球( rebound的名词复数 )； 回弹球； 抢断篮板球； 复兴 | |
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racist
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| n.种族主义者，种族主义分子 | |
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opium
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| n.鸦片；adj.鸦片的 | |
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cocaine
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| n.可卡因，古柯碱（用作局部麻醉剂） | |
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heroin
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| n.海洛因 | |
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stimulants
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| n.兴奋剂( stimulant的名词复数 )；含兴奋剂的饮料；刺激物；激励物 | |
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pivot
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| v.在枢轴上转动；装枢轴，枢轴；adj.枢轴的 | |
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helping
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| n.食物的一份&adj.帮助人的，辅助的 | |
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imperative
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| n.命令，需要；规则；祈使语气；adj.强制的；紧急的 | |
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distraction
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| n.精神涣散，精神不集中，消遣，娱乐 | |
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