In his revealing book “The Urge: Our History of Addiction”, author and doctor Carl Erik Fisher states addiction is not a purely medical or scientific issue, but rather a culturally contingent function of unprocessed pain, “a brain disease, a spiritual malady, the romantic mark of artistic sensibility, a badge of revolution against a sick society, and all of these things at once” (2022, p. xiv).

Fisher traces addiction’s early roots with alcohol and drugs such as morphine through and including the nineteenth-century Temperance movement, twentieth-century Prohibition, Alcoholics Anonymous, and the War on Drugs, up to the current Opioid epidemic. The social stigma attached to addiction continues to be the biggest hurdle to a compassionate response in its treatment, where sufferers are seen as morally corrupt people often with a genetic predisposition to the addictive effects of various substances (2022, p. 124).

The early twentieth-century Harrison Act in the United States led to hard enforcement through regulation and a corresponding increased use of harder drugs, which themselves fell both into categories of “narcotics” associated with minorities and the poor, and into regulated “medicines” which often included prescribed versions of the same substances for consumption by the rest of society. The pejorative moniker “junkie” ascribed to destitute urban addicts who scoured junkyards for scrap metal in order to purchase street drugs, worked both on this literal level, and as a reference to how “respectable” society viewed them as human trash (2022, p. 145).

The pharmacologizing of psychiatry, which appeared to have “cracked the biological code of mental illness” with a growing panoply of medications, changed its scientific model from electrical neurotransmission, to efforts at altering chemical neurotransmission with pills that could ostensibly provide the solution to a wide range of mental health issues (2022, p. 234). In terms of drug tolerance, can the numbing effect of medicines quell physical and mental pain over the longer term, and how does this relate to addiction?

Only recently has the study of addiction been willing to consider whether behavioural adaptations, including to power, sex, eating, exercise, gambling, and the internet in general, qualify as falling within its sphere. Critics of this broad-brush view claim that over-pathologizing behavioural addictions can wind up adversely classifying them as mental disorders “merely because we like doing them a lot and miss them a lot when we stop” (2022, p. 117).

Certain approaches of addiction treatment favour abstinence, while newer research suggests “too rigid a focus on abstinence can cause an ‘abstinence violation effect’ wherein resuming substance use after a period of self-imposed abstinence, those who experience guilt, shame, and hopelessness are more likely to return to harmful use” (2022, p. 249).

In a report titled “A Hole In The Head: Can a Brain Implant Treat Drug Addiction?” (September 2022), author Zachary Siegel examines the implications of a surgical technique originally developed to treat chronic pain known as Deep Brain Stimulation (DBS) in addiction treatment. He observes that 6-inch long ‘metal chopsticks’ inserted through a nickel-sized skull hole and into a patient’s nucleus accumbens can deliver continuous electrical impulses which in theory give people with addictions more control over their impulses. After reporting on this research, Siegel concludes it is not a panacea, and that “Addiction might be more a symptom than a disease, a powerful compulsion generated by a matrix of pain and conflict within us” (September 2022, p. 32). Carl Erik Fisher echoes this sentiment in the closing words of his book:

“Addiction is profoundly ordinary: a way of being with the pleasures and pains of life, and just one manifestation of the central human task of working with suffering. If addiction is part of humanity, then, it is not a problem to solve. We will not end addiction, but we must find ways of working with it: ways that are sometimes gentle, and sometimes vigorous, but never warlike, because it is futile to wage a war on our own nature” (2022, p. 300).

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Fisher, C. E. (2022) “The Urge, Our History of Addiction”. Canada: Allen Lane – Penguin Random House Canada

Siegel, Z. (September 2022), “A Hole In The Head: Can A Brain Implant Treat Addiction?” in Harper’s Magazine, Volume 345, Number 2068 (pp. 25 – 32). New York, United States: John R. MacArthur / Harpers.org