THE URGE

A blend of memoir, critique, and history of the impact of addiction and the struggle to treat it.

Despite the subtitle, this is more than standard history. Fisher, an addiction physician and professor of clinical psychiatry at Columbia, presents an account of his own struggles with addiction; his experience as a psychiatrist treating people with intractable addiction issues; a history of humanity’s struggles with addictive substances; and a scathing critique of government policy toward drugs and drug abuse. Fisher has synthesized an enormous amount of material and is on firm ground when he writes on what he knows. Steeped in the history of medicine, his accounts of how doctors and self-help pioneers have dealt with addiction are vivid and well informed, and his insights into Alcoholics Anonymous and other therapeutic programs are buttressed by vast experience. He shows tremendous empathy for addicts and their challenges, and his personal story, of an addiction that almost derailed his medical career, is powerful and dramatic. However, his critiques of government policy toward addiction are largely one-sided. His chief targets are laws and programs that demand abstinence to ensure recovery, but Fisher skates over the other side: why those programs are popular and why many authorities believe they work. He also filters issues through the lenses of race and class, whether germane or not. For example, writing about a crucial Supreme Court decision on the legality of a Black man's drug arrest, he labels judges of the time “old white men,” suggesting they were racist and out of touch. That may have been true, but their 1962 decision decisively favored more rights for the accused. After robust and sustained criticism of most current approaches to treating addiction, readers will hope for more information about what does work, but recommendations for the “pragmatic and pluralistic perspective” remain general. Readers familiar with the issues will engage; those seeking more insight into what causes this “baffling” human burden—and how they can manage it in their own lives—should look beyond this book.

A useful but flawed personal and professional examination of addiction and how it has impacted humans and baffled experts.