Psychiatrist says calling addiction a disease is misleading : NPR

Carl Erik Fisher, psychiatrist and author of Envy: A History of Addiction.

Beowulf Sheehan/Beowulf Sheehan


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Beowulf Sheehan/Beowulf Sheehan


Carl Erik Fisher, psychiatrist and author of Envy: A History of Addiction.

Beowulf Sheehan/Beowulf Sheehan

Right after graduating from medical school, Carl Erik Fisher was on top of the world. He won prizes and worked day and night. But much of that frenetic activity was really hiding his addiction issues.

Fisher – who says he comes from a family with a history of drug addiction – went on a drinking and Adderall binge during his residency. A manic episode led to his admission to the psychiatric ward at Bellevue Hospital in New York, where just a few years ago he had a residency interview.

“Because I was a doctor, because I’m white, because when the NYPD came to get me out of my apartment, I was living in an upscale neighborhood. I got a lot of care and had a lot of compassion. “, he says. . “Unfortunately, many people with addictions cannot even access services, let alone the kind of quality services I have been able to get.”

Today, Fisher is recovering and an assistant professor of clinical psychiatry at Columbia University. His new book The Emergency: Our History of Addiction — part memory, part history — examines the importance of careful language when discussing addiction and how treatment has historically ignored its complex socio-cultural influences.

Interview Highlights

Why it’s important that addiction be considered a disease

I think addiction is not a disease. Calling it a disease is misleading. Now, I say this knowing that for some people the word “disease” is truly powerful and liberating. This [can] provide an organizing framework to give meaning to their struggles and a sense of security. And I would never want to control an individual’s understanding of the word. But overall, when we think of it as a socio-cultural phenomenon, I think the notion of disease can be misleading because it deflects attention from the forces of racism and other forms of oppression that are so often linked to addiction. Initially, the word disease was introduced to try to force open the doors of hospitals and obtain medical treatment for drug addicts. This is because the medical profession has largely abandoned its duty to care for dependent people. These advocacy efforts were therefore absolutely necessary. But people still struggle to access care. People are still struggling with stigma. People still struggle to get insurance benefits for addiction issues. There is a helpful version of the word “disease” when talking about addiction that says therapy and drugs can save lives. But the term is confusing, and it also locates all the causes in biology and overlooks some of the other determinants of people’s health.

On how racism has historically influenced drug treatment

For centuries people have tried to divide people into good drugs and bad drugs, to say that some drugs are dangerous, that they are contagious, or that they lead inexorably to vices and social problems. Often, this kind of blatant exaggeration of the harms of one drug and the supposed benefits of other drugs affects everyone. A fine example from the turn of the 20th century: there were all these powerful efforts to criminalize certain drugs because they were associated with certain racist and xenophobic panics, such as the panics associated with the consumption of Chinese opium or the consumption of black cocaine. Even the urban poor were a major development at this time and an association with heroin led to many of these attitudes. At the same time, a kind of right allowed to continue to use certain drugs. At first things like morphine and more tightly regulated opioids, then later stimulants, which weren’t invented until a short time later. And white people and the privileged have also been harmed by these kinds of rights. So drugs are such a powerful example of how racism bounces back to hurt us all that whenever we create these kinds of separations and try to assign the right and wrong categories to different forms of drugs, we invariably end up by causing widespread damage.

On how the medical model should change to get more people to recover

A simple pivot we could make is to shift our focus away from controlling the use of people to meeting them where they are and helping them with what matters most in their lives. For too long, medicine has been dominated by an abstinence-only model. Now I am in an abstinence pattern myself. I don’t think I should drink or use again. And for many people, it is necessary and life-saving. But addiction is also profoundly diverse, and we have new evidence that some people can actually improve their functioning even when they have a substance abuse problem without stopping use altogether. Or they could be in some sort of partial abstinence when they stop using heroin. I don’t think it’s wise to be cavalier about drug use, especially if someone has had a problem before. But there are a lot of people who don’t want treatment because their current treatment system is so overbearing. For example, it’s a seizure that people drop out of treatment due to continued use. One definition of addiction is continued use despite negative consequences. So I think it’s imperative that as medical professionals we work harder to work with people where they are while recognizing the profound dangers of addiction.

On the approach he uses with his own patients

The main thing about working with my own patients is that they are responsible. The main insight that reviewing the history and science behind addiction recovery has given me is respect for the many different paths that exist for recovery. It’s something I felt myself – I was very ashamed to think that I wasn’t recovering in the right way or that I could do a better job. And I think a lot of people carry that shame. That if they’re not doing recovery in the traditional sense, then maybe it’s not as good. And you know, I think that can be a real distraction and unnecessary because there’s a lot of opportunity to grow and improve and work on the kinds of serious addiction issues that we work with.

This story was edited for radio by Jeevika Verma and Reena Advani and adapted for the web by Jeevika Verma and Barbara Campbell.

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