Pulling The Thread with Elise Loehnen

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

Dec 11, 2023

Addiction psychiatrist, Carl Erik Fisher, challenges the addiction binary and discusses the history of addiction and the language used by addiction supply industries to individualize suffering. The podcast also explores the complexity of addiction, the importance of therapy and addressing personal pain, the limitations of traditional addiction treatment, the impact of sleep deprivation on women, the role of psychedelics in addiction treatment, and Carl's book 'The Urge' which offers creative solutions to addiction.

01:00:54

Episode guests

Carl Erik Fisher

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Episode notes

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Quick takeaways

Addiction is not solely a personal failing but also a consequence of social and economic systems that weaponize suffering.

The history of addiction reveals the flawed notion of blaming individuals and emphasizes the need for a compassionate understanding.

Medications like suboxone and methadone play a crucial role in harm reduction and saving lives, and wider access to them is needed.

Deep dives

Understanding the Complexity of Addiction

The podcast episode delves into the complex nature of addiction, challenging the binary view of addiction as a compulsive behavior or a choice. The host is joined by an addiction MD who shares personal and professional insights. They emphasize the need to move away from the stigmatization and essentialist view of addiction, recognizing that the journey to recovery is not straightforward and varies for each individual. The episode explores the important role of medications like methadone and suboxone in harm reduction and saving lives, highlighting the need for their wider access and acceptance as part of the recovery process.

Introduction

2min

Exploring Addiction: History, Perspectives, and Complexity

10min

Simplifying Meal Planning and Prep with Hungry Root

2min

The Complexity of Choice and Compulsion in Addiction

13min

The Importance of Therapy and Addressing Personal Pain

2min

Exploring the Limitations of Traditional Addiction Treatment

19min

The Impact of Sleep Deprivation on Women

6min

Exploring the Role of Psychedelics in Addiction Treatment

6min

Exploring Addiction Beyond the Binary

3min

“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?”