The Urge: Our History of Addiction, by Carl Erik Fisher, a psychiatrist, is really two books in one.  It is a comprehensive history of addiction from ancient times to the present day.  It is also a memoir of the author’s own struggle with addiction and an attempt “to understand how I went from being a newly minted physician in a psychiatry residency program…to a psychiatric patient” (p.ix).  

Fisher has grown up with two alcoholic parents.  Even as his mother’s drinking “suppresses her blood counts and causes her to miss the chemo sessions I have worked so hard to arrange” (p. 294), she does not stop.  Fisher’s own first drink, in high school, is a revelation.  He blows his interview for his first-choice college when he shows up late and hung over. His intelligence enables him to get by, but eventually the problem catches up with him as he begins to use Adderall and marijuana to counteract the effects of alcohol.  After sleeping through and missing his residency orientation, he is under scrutiny.  Finally, he has a drug-induced manic episode that results in his being tasered by the police, and he is forced into treatment.    

In the historical sequences of the book, we discover that one of the oldest known examples of addiction is found as far back as the Rig Veda (1000 BC).  From there we move through time, learning how Native American populations were devastated by alcohol, how Alcoholics Anonymous achieved prominence, and about the multiple challenges that persist to the present day. 


The author of The Urge has gone through some tough times.  When he reaches his nadir, he asks himself “How did I get here, and what exactly had gone wrong in me” (p. xii).  Admittedly, he comes from a privileged background and, unlike others, is lucky in having been given a second chance.  However, he uses this chance to “immerse myself in the field, studying the psychology and neuroscience of addiction” (ibid), and in the process becomes a more compassionate doctor.   

Mental health providers will relate to Dr. Fisher’s observations about how substance abuse disorders are marginalized even within psychiatry.  He tells of a situation in which a patient in need of treatment for anxiety was rejected because of his drinking:  “My supervisor that morning was a well-meaning, seasoned clinician…But to her, a substance use disorder was …just not in our job description” (p. 287).  Perhaps some of us need to consider how preconceptions affect our attitude towards patients.   

It is the author’s opinion (although he himself is abstinent) that total abstinence from substances may not be a desirable or possible outcome for all.  He describes the role that bias plays in limiting access to maintenance therapies (e.g., Methadone, Buprenorphine) and provides evidence for their effectiveness. 

Repeatedly, the reader is aware of how Fisher’s life experiences have given him special insight.  The Urge deftly and seamlessly interweaves personal vignettes and world history.  But in the final analysis, although the erudition of the historical journey may be impressive, it is the author’s personal journey that makes this book especially worth reading.          


Penguin Press

Place Published

New York



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