The Chris Voss Show - The Chris Voss Show Podcast – The Urge: Our History of Addiction by Carl Erik Fisher

Episode Date: January 20, 2022

The Urge: Our History of Addiction by Carl Erik Fisher An authoritative, illuminating, and deeply humane history of addiction—a phenomenon that remains baffling and deeply misunderstood despite having touched countless lives—by an addiction psychiatrist striving to understand his own family and himself “Carl Erik Fisher’s The Urge is the best-written and most incisive book I’ve read on the history of addiction. In the midst of an overdose crisis that grows worse by the hour and has vexed America for centuries, Fisher has given us the best prescription of all: understanding. He seamlessly blends a gripping historical narrative with memoir that doesn’t self-aggrandize; the result is a full-throated argument against blaming people with substance use disorder. The Urge is a propulsive tour de force that is as healing as it is enjoyable to read.”—Beth Macy, author of Dopesick Even after a decades-long opioid overdose crisis, intense controversy still rages over the fundamental nature of addiction and the best way to treat it. With uncommon empathy and erudition, Carl Erik Fisher draws on his own experience as a clinician, researcher, and alcoholic in recovery as he traces the history of a phenomenon that, centuries on, we hardly appear closer to understanding—let alone addressing effectively. As a psychiatrist-in-training fresh from medical school, Fisher was soon face-to-face with his own addiction crisis, one that nearly cost him everything. Desperate to make sense of the condition that had plagued his family for generations, he turned to the history of addiction, learning that the current quagmire is only the latest iteration of a centuries-old story: humans have struggled to define, treat, and control addictive behavior for most of recorded history, including well before the advent of modern science and medicine. A rich, sweeping account that probes not only medicine and science but also literature, religion, philosophy, and public policy, The Urge illuminates the extent to which the story of addiction has persistently reflected broader questions of what it means to be human and care for one another. Fisher introduces us to the people who have endeavored to address this complex condition through the ages: physicians and politicians, activists and artists, researchers and writers, and of course the legions of people who have struggled with their own addictions. He also examines the treatments and strategies that have produced hope and relief for many people with addiction, himself included. Only by reckoning with our history of addiction, he argues—our successes and our failures—can we light the way forward for those whose lives remain threatened by its hold. The Urge is at once an eye-opening history of ideas, a riveting personal story of addiction and recovery, and a clinician’s urgent call for a more expansive, nuanced, and compassionate view of one of society’s most intractable challenges.

You wanted the best. You've got the best podcast, the hottest podcast in the world. The Chris Voss Show, the preeminent podcast with guests so smart you may experience serious brain bleed. Get ready, get ready, strap yourself in. Keep your hands, arms and legs inside the vehicle at all times. Because you're about to go on a monster education roller coaster with your brain. Now, here's your host, Chris Voss. Hi, folks. This is Voss here from thechrisvossshow.com. The Chris Voss Show.com.

Hey, we're coming to you with another great podcast. We certainly appreciate you guys tuning in. Thanks for being here. We hope you've been enjoying our wonderful coverage we did. It's almost two weeks old now, the CES show 2021. We went down there and did a ton of interviews. Be sure to check that out. Go to see youtube.com, 4chesschrisvoss.

Hit that bell notification button. And that makes you feel part of a family that doesn't judge you. So there you go. Also go to goodreads.com, 4chesschrisvoss. See everything we're reading and reviewing over there. And you can see my books as well. Go to all my groups, Facebook, LinkedIn, Twitter, Instagram as well. See our big group. It's the name of the show. Just search for it there. And also see our new LinkedIn newsletter. I think it's like killing it. Like people just eating it up. Anyway, guys, thanks for tuning in. We've got another amazing author with a hot, this thing is so hot,

they wouldn't let me touch it without those welder gloves. The thing, I had to have one of those burn shields and everything. It's so hot off the presses, it's not even off the presses yet. It's coming on January 25th, the day before my birthday. So this is going to be pretty cool. Eight days? Yeah. So you can order this baby now. You can pre-order it and be the first one on your blog to say you got a chance to read it. We have on the show with us today Carl Eric Fisher. The name of the book is called The Urge, Our History of Addiction. And like I said, it's going to be coming out here shortly.

Carl is an addiction physician and bioethicist. He might be addicted to that. He is an assistant professor of clinical psychiatry at Columbia University, where he works in a division of law, ethics, and psychiatry. He also maintains a private psychiatry practice focusing on complementary and integrative. Wow. It's Monday morning. Integrative approaches to treating addiction. I have a cord there too from the camera I'm fighting. His writing has appeared in Nautilus, Slate, and Scientific American Mind, among other outlets. He lives in Brooklyn, New York with his partner and son. Welcome to the show, Carl. How are you? I'm great, Chris. Thanks for having me. I'm doing pretty good. I just haven't learned to spell integrative yet, so clearly I went to public school.

Congratulations on the new book. Give us your plug so we can find you on the interwebs. Yeah, sure thing. Easiest is my website, carlerickfisher.com. And I've got information about my book, The Urge, Our History of Addiction, coming out January 25. I should also mention I've got a podcast, too. So if you like podcasts, head over there. It's Flourishing After Addiction.

It's deep dives into addiction and recovery. I get people from medicine, but also writers, architects, Buddhist teachers. Just try to get some interesting folks on there to talk about addiction and recovery. That's pretty cool, Buddhist teachers. So what motivated you to want to write this book? You know, Chris, it was the book I needed myself. It was the book I was looking for, and I honestly couldn't find it early in my own recovery. I got into a lot of trouble with addiction when I was in medical school and then later in residency. And after a little bit of time, I felt secure. I felt stable. I knew my life wasn't in danger. I didn't feel like I was in

any imminent risk of relapse, but I still was confused. I didn't fully understand what happened to me. Also, incidentally, my parents were alcoholics. I didn't fully understand how to make sense of the whole situation. But I really love medicine. I love neuroscience. I didn't fully understand how to make sense of the whole situation. But I really love medicine. I love neuroscience. I did neuroscience research. But I had the sense also there was more to it, that there was more I could learn from the history, the philosophy. And I was surprised by what I found. It's hundreds and hundreds of years of information about addiction out there. Is addiction something that's not widely understood? I know when I came across, I think in my 30s, a girlfriend who had alcohol addiction. And it was weird. She had the sort of same addiction that her father had, where her father was a weekend

alcoholic. It was really weird. He would go to work in the 60s and 70s as a banker. And he had a really good job, functioning alcoholic, I guess you'd call it. And he would work Monday through Friday, no drinking. But at Friday night, he would come home, go down to his, one of those sixties bars that you have in your basement and those days and literally be in the bottle till Monday morning. And, and what was weird is her pattern was the same that she copied. She would, she was fine all week and then Friday and weekend, we'd have to go off the rails. So I didn't understand what was going on at the time. And she was keeping a large part of it hidden in me. She was keeping the alcohol with all the cleaners under the sink, which I never look at because I'm a man. I don't know. Is addiction widely understood as it should

be in today's world? No, I don't think so. That's what I came across, is that there are all these different explanations and different theories about addiction. And addiction is pretty politicized. There's a lot of stigma. People have very strong ideas about it, even within the scientific community. And I think, like you're saying, people have long had this sort of intuition that there's something funny about different kinds of addiction even my mind is going to this guy carl von bruhl kramer who is a german who went to moscow back in around the time of the napoleonic wars back in the 19th century and he had the same idea they're like what you were just saying that there are different like sort of types of addiction some people are binge drinkers some people keep like a slow and

steady burn going their whole life. But even today, we haven't really fully captured that diversity. Just in our medical systems, we have one definition that doesn't really reflect all the heterogeneity and all the diversity that's there. And so, give us an overall arcing of the book and then let's get somewhere in the details of addiction, what the book's about. Yeah, sure thing. So it does start with me.

My story is sort of like the flywheel that pushes the story forward because I wanted to explain why I care. And I didn't want it to be just a book about dry history. I wanted it to be almost a mechanism for me to stay focused on what really mattered, what got me into the project in the first place, and setting me off on the investigation. And I go all the way back to the beginning pretty quickly. So one of the earliest examples of addiction I found in history was back in the Indian Rig Veda. That's thousands and thousands of years before Christ. There's a poem about a gambling addiction. There's a guy who feels like the dice are taking him over and he struggles, but he can't stop and he loses his whole family. And that's from before we had any notion of medicine, really, let alone any sort of like philosophical idea of addiction. So then we go forward from there.

I won't give you every single story in the book, obviously, but we go to the ancients like Aristotle, Plato. And then a lot of it takes place in the States because the United States has a really powerful role to play in the whole story of addiction leading up to the present day, opiate overdose epidemic and problems facing us now. Is there a reason for that or is it just, I don't know, we're a consumerist society? What's the reason for that? Yeah, that's a great question because one of the big surprises for me was that epidemics have happened throughout history, that we've had drug epidemics for over 500 years. It started with Columbus when he brought tobacco back to Europe. There was a massive wave of tobacco use

and some of the writers around that time, like 1530s, 40s, 50s, they talked about it like a plague. And modern societies have faced wave after wave of drug epidemics. And one of the common factors is that everyone is always looking for a villain. They always want to know what is the cause? Is it some bad drug? Or is it the bad pharmaceutical companies that push the drug onto us? And one of the constants that I found over time and time again is that it's always much more complicated than that. There's several different intersecting factors. And if we get attracted to one simple story about one villain, then we've missed the boat

and we've missed the opportunity to actually make it better and to pull ourselves out of the problems we found ourselves in. And we talked a little bit about the show about the difference between like alcoholism, abuse of alcohol. I drank a Mountain Dew for a large part of my life and use it as a crutch, but I wasn't addicted when I decided to stop when I just, I was so sick of being fat, I stopped.

And, but even then, I think we're talking with the show that even then, maybe that's a form of addiction in the pattern of the brain as opposed to your body addiction. Yeah, that's an important distinction is that oftentimes a really severe drug problem or addiction is associated with physical changes like withdrawal, like tolerance. Yeah, definitely. Difficulty stopping just because you start jonesing or you get cold turkey symptoms. One thing I found is that everyone's got a different idea about what addiction is. And so it's really important to get clear on what the notion is, not because it's a language game or a philosophical exercise, but it really matters for how we treat ourselves and how we treat each other.

And one of the big surprises in the book was when the word addiction first entered the English language, it was a totally different understanding than what we call it today. It was a word meaning a strong devotion. It wasn't necessarily negative. You could have an addiction to study, or you could have an addiction to work or to prayer because it came about during a very religious context. But then you could also have a negative addiction. Another important part about that was that it was an action. It wasn't just a thing that happened to you. It wasn't like I became addicted. It was like I addict myself to something else. And I think there's a lot of beautiful nuance. There's a lot of wisdom in that term. And in a way, it's gotten a little too narrow

nowadays. You choose to addict yourself to something you could almost without being like fetishes or something like that, or maybe hobby or not hobbies, but habits, maybe. Yeah. I think one of the key points is the strength. It's not, oh, I'm addicted to Wordle because it's a fun game and I like to play it every day. I don't know if it's Wordle, but it's like this new friend. Yeah, it's like Facebook now. I'm like, oh God. So addiction traditionally, even in that broader sense, meant something really powerful. It meant something about self-control. And that's a puzzle that we've had for ages and ages. There's a confusing middle ground between choice and complete and total compulsion. That's what people were using that word for back then is that

there seems to be a point where you give up some of your control and there's still some choice. Like when I was struggling with my own addiction, I had plenty of experiences where I watched myself making a choice and I told myself I would stop drinking. And then it was almost like I was watching myself walk out the front door, walk down the stairs, walk to the corner store, buy the drink, even while I was telling myself, don't do this, don't do this, don't do this. So I don't think that's a totally free choice, but I also don't think it was like I was hijacked and I was under some compulsion. It was something confusing and in between. Yeah. Yeah. I used alcohol as a gas for some reason for me, I could work longer if I drank, maybe it was the sugar or some sort of, I don't know what the chemical thing is.

I don't pretend to know. But for me, I could go longer doing anything, literally anything, on alcohol. It was the machine. And so I initially used this gas from when I wanted to work late, do work. And I'm an entrepreneur, so our work never ends. And so I could work longer. Everything went longer. I could party longer. And so I could work longer. Everything went longer. I could party longer.

I could have more fun longer. And then it was back in the day when you didn't work with hangovers. But I saw friends, like when I lived in Vegas, you learn what addiction means in Vegas really quickly because I think about a third of the population there, 20% of the population has real bad addiction problems. It's the worst city to move to if you have addiction issues because we have everything for you and it's real easy to get.

And I would see like gambling addicts. I had a couple of gambling addict friends that I, they'd be normal people and they talk about their gambling and you'd be like, okay, dude, you can shut up. Do you have anything else you want to talk about? But when you would go to the gambling hall,

because with them there would be a light that would turn on behind their eyes there would be like a fast there i don't know if the fascination is the right word but there would be you would see it kick in with them and they would be lost and me i go to a casino i look at all the money that's in the casino and i go i'm pretty sure i know who's winning this game here. And I'm not, but I would see the addiction kick in for these people. And you know, these are the people that they're constantly want to borrow money from you. And they're always like, yeah, I've got this winning edge. And you're like, pull out your receipts of losses. And they got like a receipt of losses like this. It seems like why you wrote this book

on the history of addiction. How come we haven't resolved this? How come we haven't squared this peg? Yeah. One interesting component about that story you just told is talking about the house and looking out at the casino and thinking someone's making money here. Yeah. And that's a constant. People have always made money off of addiction. Addiction is totally interwoven with systems of profit

and larger forces. It's not just an individual. From the very beginning, the English recognized that tobacco was a big problem back in the 16th century, but then there was a lot of incentive to lower the taxes, to help the plantations. And the same thing happened with distilleries along the eastern seaboard during the time of the American Revolution. There was massive drinking back then, bigger would drink with lunch, they would drink instead of a coffee break in the afternoon. It was just constant around the clock. You say that like it's a bad thing. It caused problems. People visited the States and there are all these accounts of a French ambassador or British ambassador saying, oh, wow, this is a big problem. These Americans, they've got a real issue here. But the point about those types

of epidemics is that it's not just about some new drug, and it's not just about, say, some problem in society, although that often is part of the picture when people are rootless and disconnected. And you can imagine the early American colonies, all of these men mostly who were removed from their native land and dealing with a lot of adversity. It also has to do with these forces I call addiction supply industries in the book. And these are the companies that sell products that by their very nature, they have a natural hold over us. And there's always been a profit motive that seeks to undermine and hide the negative effects of a drug. We saw it in the amphetamines back in the 1920s and 30s, where basically the drug companies did the exact same playbook as the opioid manufacturers did in the 1990s and the 2000s. It's always the same old strategy of paying off opinion experts to try to say that the drugs don't really have dangers and so forth

and so on. So I think part of the, getting back to the question you asked, part of the reason that we haven't come to a satisfying resolution for addiction, that we still have these rampant problems of addiction year after year is because there are powerful players who make money off of addiction. And as long as that's there, then we'll keep on seeing these waves. Yeah. Even most states still have that archaic post. I forget what it was. We tried to block alcohol in the 20s. And of course, that reversed its order. Did you cover in your book at all? I know that there's a lot of different countries that have taken a different approach to drugs as opposed to just throwing people in prison, throwing away the key and legalizing. And then I think Canada, I think, had some success with their heroin. They would basically create places where people who wanted

to shoot up heroin could go, they could get fresh needles, and they could have a chance to meet with counselors. They give them needles and a clean place to shoot up, but they also have someone who says, hey, are you ready to go into rehab? Do you cover any of that in your book? Yeah, absolutely. And one of the surprising things is that it's found across history too. It's not just a modern development, but people have always banded together to find community and safety, not even for recovery sake, but also for harm reduction sake. Harm reduction, meaning any of the huge variety of things that people do to reduce the harms of using, to use safely.

Like you were just mentioning, overdose prevention sites is one of the words for it. New York has just started a pilot program for those. But those have been going on for ages in Europe. They started in Switzerland in the 1980s, and we can find antecedents even before. But even opium dens are a kind of community drug use site. The classic story about opium dens, because it was very racially charged, was that they were these seedy, dangerous places. It was the source of this infectious evil drug that was spreading across America. And there were places like that. There

were places that were in poorer neighborhoods and they were more challenging and they had seedier practices. But most opium dens in the United States and back in China were more like social clubs. There were places where people could gather to smoke together because people use drugs for reasons. And then they will band together to find community and to find safety and find support. And so I think it's really misguided to try to stamp out addiction, to try to stamp out drugs. It's just a fool's errand. It's not possible. And so a better answer is how do we work with what we do have and how do we meet people where they're at and try to support them in their health and in their healing? Do we need more support mechanisms, more sort of rehabs?

It seems like they have these rehabs you can get into if you have some sort of crazy insurance and they're crazy costly. Do we need more support and education in our public sphere for addiction and rehab help and assistance? The answer is yes and no, because it is true. We don't have enough providers, and it's way too hard for people to access care. Just for the average person on the street, I see it in my clinical practice every day. Where do I go for help? Where can I trust for help? What place is actually going to provide good care rather than just charging me $30,000

and then spitting me back on the street after 28 days and a bunch of lectures? But what we really need most is higher quality care and better varieties of care. It's not rehab's fault. It's not the treatment industry's fault, I would say. Because our current system, as troubled as it is, is there as a result of the medical profession basically abandoning its duty to take care of people with addiction. Way back in the 20s, 30s, 40s, basically, even the American Medical Association put out a statement saying addiction is not a disease, it's a vice. And people got there of their own free will,

and it's their own fault fault and we're not supposed to treat them. And so like our current model of rehab rushed in to fill that vacuum and it's incomplete because it's just based on one model and that's fine, but we need more options for sure. So what are your thoughts from the thing on the book? Is it something that, were they correct in doing that or do we need to open that book back up? I think we need more options. I don't know that anyone was incorrect in that they were doing the best they could with what they had at the time. I think the medical profession was incorrect in abandoning people with addiction

because there's so much that we can do and that we have been able to do as clinicians to help people. There are a lot of medications that are life-saving. Therapy is helpful. The bottom line is that there are multiple pathways to recovery. People recover in different ways. Chris, you and I were talking before the show that some people, they really need the traditional pathway and they get a lot out of traditional 12-step and AA practices and they go to old school rehab and it changes their life. But then other people stop drinking with different kinds of supports. For some people, it changes their life. But then other people stop drinking with different kinds of supports. For some people, it's primarily medical. For some people, they get better on their own, but then they still need some degree of attention and support and personal development. So I think

we need to do a much better job. And there's actually a lot of hope if we could do a lot better job of respecting that diversity and meeting people where they are along the path and helping people to get where they're going to be helped the most rather than try to fit people into a one size all model. What was interesting to me was I watched a lot of shows. If I get depressed, which I probably have clinical depression in our family, but if I get depressed, I'll watch like cops or cheaters because somehow watching other people's car crashes, when I get done watching the shows after about an hour, I'm like, life is fucking great. I don't know why,

but the car crash element of life. But I started watching some of the rehab ones and I think it was a doctor. I was the guy who did the MTV thing with a podcaster back in the day. It was MTV doctor. I can't remember his name, but he had a rehab clinic and they did a show and it was really striking to me. I would watch the show and there was a lot of celebrities. I think there were some of the celebrities I liked on it. It was interesting to me how many people were in those rehabs and suffered from sexual or sexual abuse from their childhood. And they were using, they were using drugs and I imagine after a time they became addicted to them, but they were using drugs. And I imagine after a time they became addicted to them. They were using it to heal those wounds and stuff.

How much of that is a factor in a lot of addiction we see? Because it seems almost everybody at the rehab clinics had some sort of sexual trauma as a child they were medicating with. It's a huge factor. It's really important and increasingly noticed but still overlooked factor is trauma and addiction. And it's another one of those historical parallels. I got a big section of a chapter on the Native American experience. Native Americans around the time of the American colonialism had a lot of problems, right? Rampant disease, poverty, oppression, so forth and so on.

But also exposure to alcohol. Now, the classic myth is called the firewater myth. It was this notion that Native Americans somehow were biologically susceptible to alcohol, that it was something different between Europeans and Americans that made them latch on to alcohol, or they were somehow determined to be more addicted. And we still have those ideas today. But really what was happening was that there was massive upheaval and alienation and trauma within those communities. Individual trauma, collective trauma. And what's amazing about that is that Native Americans in multiple communities independently came up with these precursors to groups like Alcoholics Anonymous. Back in like the 1780s,

there was one guy called Handsome Lake who was literally on his deathbed and then had a vision where he said, we need to leave alcohol by the wayside, but also come together in groups and talk to each other and share about our problems, but also share about our personal development and how we can connect and serve each other. And it's still alive today. We still have these talking circles in upstate New York where people gather together and it's not just about alcohol or addiction, but is rooted in that experience. And I think people have that intuition that we need to heal trauma. We need to come together in a compassionate and caring way in order to properly respond to the problem of addiction. Yeah, because a lot of people are trying to quiet that madman and dealing with trauma from

childhood. And so they go to some sort of crutch to do it. And then it probably eventually becomes an addiction. I saw in 2004 is when I first saw the, was it 2004? Yeah. 2004 is when I first saw the opioid problem. One of my friend's sisters had been in a car accident and she'd been in one of those head cages and almost killed her pretty much. And when she had to move to her mother's house, when she got out of the hospital, she was still in the cage and they were giving her the opioids. And she was really addicted to it. The mother was trying to wean her, and she was constantly asking for the stuff.

And eventually, when she got healed up, there were a lot of fights that went on because she became addicted to it. And then when she finally got physically healed up, she turned to the streets for heroin and started working the streets. And she eventually died of a heroin overdose or addiction or something. But she literally ended up in the streets doing stuff for heroin. And that's when I first saw the opioid thing. And my friend was like, yeah, that stuff is really addictive. And so do you cover that in the book as well? That crisis? Yeah, absolutely. The opioid epidemic is generation defining as far as I'm concerned. At this point, I've lost not just people I've met in recovery, other people who struggle with addiction, but just people from my high school class, my college classes. Nowadays, my friend

who teaches med students at Columbia said they have a class on opioid addiction where they ask everyone, raise your hand if you lost someone to overdose, and everyone is raising their hand right now. The kids who are in, say, their 20s and early 30s nowadays. And it's just pervasive. And one of the important things about covering the epidemic, because a lot of people have covered the opioid overdose epidemic in contemporary times, like Patrick Radden Keefe has this great book on the Sacklers, and I really like Beth Macy's work and all sorts of great angles on it. Barry Meyer did a classic one back around that time. I think it was 2004 in the early days of the opioid epidemic.

What I was interested in was not just where does this come from, but how have we seen this over time? Because history repeats itself. And if it keeps on repeating itself, that must be because we're not learning or the certain crucial lessons. Like we had an opioid epidemic in the States around the time of the Civil War. Oh, really? Most people don't know that. And if you don't know that, you certainly haven't onboarded the lessons that we got from that time around, let alone the second and the third and the fourth and the fifth American opioid epidemic. Was it heroin back then? No, back then it was morphine. Back then it was morphine because it was, you know, the 19th century from 1820, 1830, 1840 was this time of purifying drugs. You know, imagine that

people could only use plant compounds and then some chemist finally distills the actual compound and manages to purify it and put it into a syringe. So that in and of itself is a really powerful stimulus for a lot of people to start using drugs in a really significant way. And just the other epidemics I was talking about, there's no one simple cause. There was a lot of morphine in Europe. There's a lot of morphine in the States. But for some reason, the States had a bigger issue. Why is that? That's funny because we had the Civil War, but Europe had some big wars in the 19th century too. So it wasn't just war.

It also had something to do with the structure of our society and the way we thought about ourselves and American individualism. This notion that you have to pull yourself up by your bootstraps and some of the other like massive explosive changes happening in American society around that time. This is really interesting. My girlfriend, like you mentioned before, history keeps repeating itself. The one quote that I have for me is the one thing man can learn from his history is man never learns from his history. And thereby we just go round and round. My girlfriend at the time that I mentioned that had alcoholism problems, I didn't know what I was getting into. Maybe this is something you should be taught in schools, but I had no idea what was going on, partially because it wasn't a continual thing. It was just like a weekend thing. And it was hidden from me. If I would have seen the bottles and she was chugging a wild turkey,

which was under the sink, I would have been like, oh, I see what's going on. But it was one of those things where I was meeting, she would go through a physiological change where literally her face would become something different and she would become a different person. Dr. Jekyll, Dr. Mr. Hyde sort of thing. Which I got to interrupt you there, Chris, because allegedly Robert Louis Stevenson wrote that on a cocaine binge. Yeah, I think it was down to the he was down to the wire, down for a deadline. And apparently went up to the north of England, got a bunch of coke and just wrote the whole thing in a week. And it was wow. It was the biggest hit. Yeah. Anyway, I'm sorry. You were I couldn't let that pass. You were talking about your girlfriend.

So how much of this is her? Her father clearly had the gene of alcoholism. At least that's the assumption, I guess. I'm not a doctor, so I can't really say that. But he did that pattern all his life. His wife divorced him in the 60s and then remarried him because there wasn't really a singles market in the 60s. And I think she did it for the kids. But how much is the real thing on on hereditary addiction she eventually died technically of alcoholism she died of of

potassium deficiency which comes from alcohol too much alcohol cleaning it out of your body but basically alcoholism how much of it really is about addiction and and how much is that gene related? Yeah, the genetic story has been a really powerful story and it's been oversold at certain points in history. A lot of that came about in the 1980s when there were some good things happening where people were really interested in paying more attention to addiction. It's not totally determined. It's probably about 50-50, meaning that genetics are a really powerful influence. I could never deny that because both my parents were alcoholics and a lot of my ancestors had problems with alcoholism or addiction. I know that just from doing some of the research for this book. And at the same time,

I think that it can be dangerous if we start to think that it's all in the genetics, because then people have a fatalistic idea that I'm born this way. It's never going to change. It's etched into my genetic code because we have tremendous capacity to grow and change and learn. A big part of addiction is a learning process. It's a process of associating different rewards with different triggers. And people, what we know from the research is that a tremendous number of people resolve their problems with drug or alcohol issues. It's nowhere near as stark as say like a sort of like genetic taint would suggest. I know we can program ourselves to become addicted to things, or I don't know if addiction is the right word. Like people with fetishes,

they'll try certain things and then it will become a thing where they can't get arousal without some sort of fetish. Is that like in a, can we program addictions, I guess is what I'm asking. Yeah. I think there's an element of choice and addiction for sure. And we have to be really careful when we use the word choice with addiction, because sometimes people say, oh, it's just a choice or those people are sick just by their own choice. And I think that's misguided. That's dangerous. And that's not true. But I do think that when people repeatedly engage in a behavior or an activity, then they can develop really powerful associations. And I mentioned this before, but it bears repeating.

People use drugs for reasons. People don't use drugs just because they were hijacked, like it was some sort of virus that took over their brain. People use them because they accomplished some sort of task or some sort of benefit in the moment. People might use drugs like alcohol, which is a very strong drug and one of our biggest burdens of disease nowadays. People might use alcohol because they want to feel more comfortable in a social situation or because they have trouble having fun on their own or because they want to even access some sort of spiritual plane just to get a sense of relief and release and a little break from the internal critic nattering away in their head. So I think we have to be really careful to notice people have

the capacity to influence their own behavior. And the really positive and optimistic element of that is that people have tremendous capacity to grow and change by making intentional choices and by practicing with their addictions. It's not just a matter of compulsion. Wow. That's interesting to know. So, in summary of your book, I've known friends that have tried to deal with people, their loved ones that were addicted.

They would go on Al-Anon to try and understand addiction. And sometimes you just have to make a choice whether you need to cut people loose. Do we need maybe more government sort of support with government programs? I know a lot of mental health institutions got shut down during the Reagan administration and it made it really hard for people to get help. Yeah, massively. We've had this problem for so long, not just for addiction, but for general mental health. But even for addiction, it's worse. There's a statistic that only four in 10 people with a general mental health problem are getting treatment. That number for addiction is one in 10. So one in 10 people, I should say substance use disorder because it's a broad category, but only one in 10 people with a substance use disorder are actually getting treatment. And there's so much more we could do. There's so many lives that we're leaving on the table.

Like I was saying before, some of that is a historical legacy. We have to understand where that comes from if we want to have any hope of changing it. Some of it is that the medical profession abandoned its duty, as far as I'm concerned. My profession bears some of the guilt for that. So we have to make amends for that by training enough workers and making sure that we do a good job of educating providers about addiction. But I absolutely think we need more support for the right kinds of treatment, not just more of the same, not just like cookie cutter, a traditional model. That's good for some people, but we also need more diversity, more innovation, more research. And ultimately, we need a recognition that addiction is part of us. Addiction is here to stay. And really, it's about working with our suffering and working with our pain. And as long as we try to make it into some sort of enemy that, oh, maybe we can defeat it if we say, just say no to drugs, or

maybe we can defeat it if we crack down with the DEA enough, or maybe we can defeat it if we say just say no to drugs. Or maybe we can defeat it if we crack down with the DEA enough. Or maybe we can defeat it if we stop opioid prescribing. All of those things are really misguided attempts to defeat a thing that's just not defeatable. Yeah. We've really seen the failure of the war on drugs for 20 years. And, of course, we know it was a racist attack starting with the Nixon administration. But throwing the key away and throwing people away into prisons didn't seem to help because they just come out and they'd still have the same sort of problems. They were

dealing with trauma or whatever they were using addiction for as a way to fix their things. But now it seems like a lot of countries, I think we're starting to turn the page. I think Oregon or Washington legalized, I think they've legalized almost everything, haven't they? Yeah. And I think we're learning that there's a little bit more love and care we need to put into people to really fix the problem as opposed to just slapping you on the hand. Oh, you went wrong driving. Bad slap on hand. Well, we really should address the underlying cause that will keep them from getting caught two or three more times and killing a family. The stigma is really powerful.

And it was a really big barrier for myself. I thought that there was something really bad about addiction. I thought that there was something that was full of blame in something really negative. And that was a major barrier to my own treatment because I had grown up in the 80s and the 90s with D.A.R.E. and all of these really frightening images of addiction. I thought it was something way out here on the extremes of human functioning. And I thought, oh, because I can go to Columbia Medical School and win awards there and go on, that means that I'm not addicted. I kept on trying to prop up all of these explanations for why I was somehow different.

And what I came to learn was that addiction is not that extreme. It's something in all of us. It's a matter of degree for sure. There are clearly people who really suffer in a profound way and need a lot of help. But at the end of the day, what we're talking about when we talk about addiction is something universal to the human condition. And people were talking about it as early as Plato and Aristotle and even earlier. It's just a problem of self-control that all of us have. Because maybe not everyone has that problem of watching themselves walk down the stairs into the corner store to relapse on alcohol. But I think everyone has something like, oh, I want to cut down on eating. I got to lose a few

pounds. It's after the holidays, blah, blah, blah. And then there's a slice of pie in the fridge. And then you watch yourself slowly walking to the fridge. And even as you're telling yourself, don't do it, you open the door and you eat the pie. I found examples of Aristotle describing that from ancient Greek times. And that's a type of addiction. It's not necessarily the thing that lands you in rehab, but I think that's the thing that unites us all. Before we go, let me ask you about social media. Do you write about that in the book?

Because we have some real problems with social media addiction, validation addiction. Definitely. Yeah. People have had this idea of trying to fill a God-shaped hole or trying to fill a hole in the soul for hundreds and hundreds of years. And I think social media is just another manifestation of that. I don't think that there's anything uniquely addictive about social media in the sense that Facebook has somehow hijacked our brains. Sometimes I see it described in this sort of like overly neurosciency way, because I think it's, it sounds slick and it sounds cool to invoke the brain. I don't think it's anything as complicated

as that. It's really more a matter that social media is a way of getting outside of ourselves. It's a way of forgetting that we have a body and just like disappearing into some sort of mindless activity and seeking external validation. And that's not unique to social media. It's not unique to, say, eating or sugar or exercise or any of these other things that can be addictive. But we've always struggled with technologies. Whenever there's a new technology, we have the same problem. People were talking about this new disease of a mismatch of technology and humankind back in the 1860s when we invented the telegram. And later when the telephone came about, people are like, oh, this is breaking our brains

because it's a new technology. It's not just about some technology breaking our brains. It's more at the human level is my position. That's where I landed. That's interesting. Yeah, it's not just about some technology breaking our brains. It's more at the human level is my position. That's where I landed. That's interesting. That's an interesting thought process. And I guess that makes sense. We had an author on from Oxford who wrote about technologies, and every time they come on our thing, on our radars, we struggle with them.

That's really interesting. I see social media and validate. Women process a lot on validation. That's one of the attention is the key to the realm of girl world, as Rollo Tomasi puts it. And you see these people that they're addicted to the likes. You see people that they never look up from their phone and they're addicted to the attention, how much likes they get. I've been guilty of that where you're like, how many likes did my post get back in 2010 when it first started? And you have these people that

I have a rule when we go to lunch or do something with my friends, we put our phones down on the table and we interact like human beings. But I come from a generation where we didn't used to have cell phones, but these new kids, they have no idea outside of this. And they're just locked. And a lot of people blame, like you mentioned, the Facebook algorithms. Oh, it's Facebook playing us and stuff. But really, our brains are broken. It's basically hijacked.

Again, that's taking words and self-responsibility. But it's basically we're allowing it to hijack. Maybe that's a better way to put it. Our brains and some of the things that we seek naturally to a group validation. I don't know. Yeah, I'm skeptical of that notion of hijacking for sure. Sometimes people use the word hijacking to say this outside thing took me over. I have no responsibility over it. My own actions had nothing to do with it.

And I think that's totally misguided. The hijacking idea actually came about in the 1990s when people were really scared about crack cocaine. I body because of the nerves in the stomach. This is like way before neuroscience. But back in the prohibition times, people said they basically just made up a scientific sounding story to fit with their social prejudices. And the hijacking story I have a real problem with, even though it's well-intentioned and even though people are using it to try to bring a compassionate focus to addiction because it takes the human out of the equation yeah it's dehumanizing it says there's other think about what hijacking is hijacking is somebody who's at your car rips you out and they drive you away or taking over a plane it's there's no agency there's no choice there's no self-control and i think that's too one-sided we got to respect

the human factors that play there too maybesided. We got to respect the human factors that play there too. Maybe the better way is to identify like what you said earlier, we needed to identify that we struggle with new technologies and this is one and we need to be self-actualized. That was the wording I was trying to search for there. And we need to take steps. And I've had to do that. I've had to say, okay, we need to get this thing under control. We need to get the notifications under control. But yeah, people, they live on their phones. Like I, it's insane.

And people are just constantly, and I don't know, maybe it's because we're more of a lonely world now. You mentioned earlier the grouping that the Indians did in the early days and AA, of course, and different rehabs. It seems like people do better when they get together and talk about their problems as opposed to sitting home and self-medicating. Maybe that's the real problem. Maybe that's, well, that's not the problem. See there, I'm deferring to an outside party, but maybe that's what we need to do more of is socialize as human beings as opposed to, we're so alone now, especially with coronavirus, it's worse because we're isolated.

Absolutely. Yeah. There's so much power and there's so much hope if we can come together, find connection and support each other. A major factor in addiction is that kind of loneliness, dislocation, alienation. It's a big factor in the current opioid epidemic. It's not just about some bad drugs that took us over. It's also because a lot of people in these places that you hear about like west virginia or other rural areas have lost opportunities for meaningful work for stable work union membership is at an all-time low and jobs are much more like a gig economy thing where there's not a lot of stability you can't count on a pension, an erosion of overall social cohesion and connectedness. And the coronavirus has only intensified that. But we see that in urban areas

too. It's long been a problem in black and brown communities. And in a way, it's one of the key things that we need to respect as part of responding to addiction, for sure. And I think shame probably plays a big part in that and how we've badly addressed the war on drugs for a while, where it was more about shame, don't take drugs or you're whatever, you're a horrible person. I think a lot of people hid or hide their addictions out of shame. And if we can erase some of that shame, that helps as well. I don't know. Absolutely. Yeah. I just had a guy on my own podcast, Owen Flanagan, who's the chair of Duke Philosophy. Brilliant guy who himself is in addiction recovery and a big part of his academic

work is on shame. And he's come to think is that we're a little misguided about shame. In the States, the shame can sometimes be like a blaming mechanism. It's saying like, this is an out group or these people deserve to be put in jail or prison or otherwise oppressed. But there's a different kind of shame. There's a shame that has to do with being awake to internal forces. And I think that this is one of the things that 12-step groups like AA do really well is not in like a blaming way, not in a way of criticizing someone, but to say that there is something about addiction that doesn't feel good insofar as you're hurting other people. It's not just about, oh, I'm going to get self-control. It's also about

being in right relationship with the rest and making amends for past bad behavior. So I think there's a way that can be like a positive approach to shame. It's a sort of optimistic take and focus more on healing and using our own negative experiences as almost like a barometer that point us in the right way. If you feel uncomfortable with your behavior, that probably means that there's something that's off. There's something that's not working for you. And we need to pay attention to our pain because it can point us toward our purpose. Yeah. I got a lot of empathy for people that suffer from especially alcohol addiction because I was trying to get my girlfriend to go to AA. And so we did a deal where I'm like, I'll go with you mainly just to get her to go or to

take her to go. And I went to two AA meetings and that was when I decided that I couldn't do her my life. I had to make a choice. And, but the, what I heard in those AA meetings really floored me and made me have a lot more empathy towards addiction and stuff because I saw people that were good people and, but they were struggling. Like they would go for, they would get cleaned up, they lose everything, their job, their life, their family, everything, live under a Vidoc. They get cleaned up. They'd lose everything, their job, their life, their family, everything, live under a ViDoc. They get cleaned up, get back on the thing, and one day someone offers them a drink, and they're back under the ViDoc. And the stories were heartbreaking, just wrenching. And these were good human beings.

They were trying to square the round peg. And unfortunately, their lives paid for it, and a lot of other people's paid for it. So I think if we can somehow resolve and understand addiction better and stuff and some of the stuff you outlined in your book, we can do better. Anything more you want to plug on your book as we go on? No, not about the book necessarily. I already said I got my website. I got my podcast, Flourishing After Addiction. My name's Carl Eric Fisher. So the website's carlericfisher.com. Rather than a plug, I guess I would just say that these are some really dark and intimidating topics sometimes. And I know it's really hard to get help, to get treatment, to trust that you can get better.

But my own experience has been that there's tremendous freedom in actually accepting for me where I really was in life, that I needed help, that it wasn't just a me job, that I could reach out and count on other people for help and support. And in a way we tell too pessimistic a story about addiction. There's actually tremendous capacity to change and to grow and to recover. So I hope that not just with me, but with other people coming forward and sharing their stories and finding connection and community around addiction can really help a lot of people. There you go. Let's do a little PSA. What's the best way for if someone is struggling with addiction, that's listening to the podcast, or maybe someone knows somebody, a family member, a loved one, what's the best way that they can maybe get some initial outreach to try and make it some resources? Yeah, I'll say two things about that,

because it's different for a family than it is from an individual. If a family member is struggling with somebody with addiction, there are different sorts of resources. Most people know about Al-Anon, which is the 12-step group for family members of people with addiction, and that helps a lot of people. But there are also other alternatives there are official therapy groups and then there are other alternatives like a group named smart recovery which is not an opposition to aa it's just a different alternative that has more of like a traditional psychology bent um but then for individuals who are struggling with addiction, there's even more of a variety. And I'll just say, I couldn't possibly address all the different forms here or even on my website, but I'll say on my website, I have a free guide where if people sign up for the newsletter, they get one of those PDFs.

And mine is about the different varieties of recovery because I thought this was such a common question. And I think there's a lot of value in respecting all the different pathways to recovery, but to outlining here's some traditional 12-step ways. Here's a medical way. Here's other alternatives. Because I think it's good to just have a bit of a roadmap to say, which one feels right to me? Which one do I want to explore? But the key bottom line is to try. Thank you very much for coming on the show, Carl. We really appreciate it.

And this is a great topic because I'm sure there's either a lot of people out in the world either suffering from addiction or maybe they're questioning and maybe they need help or maybe there's family members. I know how hard it is on family members too, because you become part of that, tied to that person's life and their addiction, even though you're not addicted, if you have them as a loved one. Yeah. Thanks a lot, Chris. Thanks for sharing about your own stories and the people in your life too i think you're a great example of how addiction touches us all it's really it's not secret it's not so shameful it's really everywhere when we open up and look yeah thank you for coming on the show thanks for tuning in go to goodreads.com for just chris voss seeing everything we're reviewing and reading over there order the book wherever fine books are sold.

The Urge, Our History of Addiction comes out January 25th, 2022. Carl Eric Fisher. Thanks for tuning in. Go to youtube.com, FortressCrossFast. See everything we're doing over there. All our groups on Facebook, LinkedIn, Twitter, Instagram, and all the stuff we're doing on LinkedIn. Thanks for being here, guys.

Be good to each other. Stay safe, and we'll see you guys next time.