235. The Urge: The Shaping of Addiction & Mental Health with Carl Erik Fisher

According to the National Center for Drug Abuse Statistics, since 2000, the United States has experienced over 700,000 deaths due to drug overdose. Addiction and substance use disorders are at the root of this enormous loss, and about half of people who struggle with substance use disorder will experience some mental health disorder during their life. And vice versa—many individuals struggling with mental health disorders also struggle with various forms of addiction.

Carl Erik Fisher, author of The Urge: Our History of Addiction, has expertise in law, ethics, and policy related to psychiatry and neuroscience. His personal struggle with addiction in combination with his professional expertise converges to help us understand the forces that have shaped addiction throughout our history. On this episode of POTC, Carl and Yael discuss the social contingencies and historical contexts that lead to addiction, substance use disorder, and co-morbid mental health issues. Join us in this episode to learn more about commonly held beliefs about addiction, prescribers’ blind spots to certain medications, and much much more!

Listen and Learn:

  • Yael and Debbie discuss the importance of contextualizing human behavior
  • How society tends to neglect the historical context of addictive behaviors (and why it’s so important to overcome this neglect)
  • The issues that come with treating addiction differently than other mental health disorders
  • Practical advice for clinicians and patients working with co-morbid addiction and other mental health disorders
  • Carl provides insights on how addiction has been weaponized to serve corporations and politicians
  • An important, historical example of what happens when scientists and researchers rigidly adopt a particular view (read: biases) but find information that conflicts with that view
  • The expert-approved definition of harm reduction
  • Carl answers commonly held beliefs about addiction (e.g., is addiction a brain disease?)
  • How Carl, a practicing psychiatrist with an in-depth knowledge of the history of addiction and mental health, approaches prescription by balancing values, change, and harm reduction 
  • Things consumers should know about prescribers’ blind spots to certain medications
  • Carl’s personal story of addiction and recovery
  • What to consider when balancing evidence- and RCT-based treatments with clients’ individuality and choices
  • Practical advice for helping those who are in denial of their substance abuse problem


About Carl Erik Fisher:

Carl Erik Fisher (USA), psychiatrist and author of The Urge: A History of Addiction, New York, May 24, 2021. Photograph © Beowulf Sheehan

Carl Erik Fisher, M.D., is an addiction psychiatrist, bioethics scholar, and author of The Urge: Our History of Addiction. He is an assistant professor of clinical psychiatry at Columbia University, where he studies and teaches law, ethics, and policy relating to psychiatry and neuroscience. He received his B.A. in Music (vocal performance) and Biology from the University of North Carolina, his M.D. from the Columbia University College of Physicians and Surgeons, and completed psychiatric residency at Columbia University. He then completed fellowship training in forensic psychiatry in the Columbia/Cornell Residency in Psychiatry and the Law. Carl’s scholarly work addresses the role of neuroscience and psychiatry in society, primarily as reflected in ethics, law, and policy. His clinical work focuses on applications of meditation and mindfulness, especially techniques arising from the Buddhist and Yogic traditions. Learn more about Carl on Twitter, LinkedIn, and Instagram!

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Episode 235