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

You can also find this episode on Spotify, or wherever you get your podcasts.

Carl Erik Fisher is 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.