The Urge

Our History of Addiction

By: Carl Erik Fisher

Narrated by: Mark Deakins

Length: 11 hrs and 20 mins

Publisher's Summary

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.

©2022 Carl Erik Fisher (P)2022 Penguin Audio

Critic Reviews

One of The New Yorker’s Best Books of 2022

“An artfully combined personal narrative and genealogy of the title concept . . . [Fisher’s] authorial voice is clear and gentle. Brimming with common sense and wisdom, a salmagundi of history, science, and informed opinion, The Urge should ignite the urge for invigorated conversation and debate.”—The Los Angeles Review of Books

"[A] marvelous gift of hope . . . Fisher’s work is a challenge and an invitation to discard narrow conceptions, abandon punitive strategies, and 'free ourselves to look instead at the full variety of interventions available to help.' . . . We are fortunate that his book is here, now, within reach of policymakers, prosecutors, family members, people who are suffering from addiction, and those in recovery."—American Scholar

“A compelling history. . . . Fisher, an addiction physician and a recovering addict, illustrates the ‘terrifying breakdown of reason’ that accompanies the condition by drawing on patients’ anecdotes and on his own experience.”—The New Yorker

The Best Addiction/Recovery Book

Fisher, busts many societal negatives about addiction through history, while opening up addiction to a overall human experience. While doing this he opens up opportunities for addicts, not to distress over, specific recovery practices. He stresses the importance of further medical studies, while not relying any quick fix. As with any problem, each of us are unique, but all share a human commonality of reacting to the disappointments of life. He suggests continually learning how to do it in a uniquely better way.

Nailed it

I’ve been podcasting on a addiction for nearly 8 years and love approach this book takes. To wage war on addiction is to wage war on our nature as humans. It’s part of us.

Great book.

Fellow Ames professional in recovery..

Not very impressed w/ Dr Fisher’s book…
It is neither a riveting personal story of transformation (as recovery is for many..) nor a highly scientific or thorough historical analysis of addiction over time.

I wish him best in his own recovery and thank him for his help to fellow addicts and alcoholics attempting or already in recovery, but I will not recommend it to my fellow medical professionals, friends in recovery or sponsees.

Fascinating deep dive into the (mostly western) history of addiction

I particularly enjoyed the discussion of the disease model of addiction and whether or not it is a distinct disease or a compilation of related symptoms. Also the history of the war on drugs and it's impact on the recovery industrial complex. It does leave out the role od people of color in thr harm reduction movement. Overall very well written and researched.

Everyone should read this.

Until now, I’ve never read an articulate description of addiction from someone who has been there. Without hyperbole, melodrama, or mystery, the author unpacks his own experiences as both an alcoholic and a psychiatrist in a way that I found fascinating and helpful. I’m in a better position now to support friends who are struggling. Our world would be a much better place if this book was required reading at every high school and college.

a bit more than I wanted to know

About 80-90% of this book is devoted to a detailed history of addiction - to drugs, alcohol and more - and how people and governments tried to deal with the problem. The focus is largely on the US and mostly covers the 20th C to the present. The beginnings of each chapter describe the author's personal experience with addiction.

There were lots of interesting nuggets of information in the history sections, but I would have preferred a bit less history and more memoir. That's just me, and I think most people attracted to the title would be happy with the thoroughness of the history. I appreciated the author's deep dive into the racism behind how addiction is treated in poor, minority communities. I wish he had presented an equivalent feminist interpretation of the prevalence of addiction in women, especially from the mid-19th to mid-20th centuries.

The narrator was from the newscaster school of reading... just the facts, ma'am. This worked for the history, but it was not ideal for the memoir part. The memoir was already presented at a certain remove - one 'watched' the author's addiction unfold - a difficult story for a medical student to tell - but never got close to 'feeling' the experience.