EP #69

"The Urge: Our History of Addiction" with Dr. Carl Erik Fisher

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In this episode of the Alcohol Minimalist podcast, Molly introduces an interview with an Assistant Professor of Clinical Psychiatry at Columbia University, delving into the professor’s book on the history of addiction. The conversation touches on various aspects, including the political and legal dimensions of addiction, the impact of Portugal’s drug policy, and the one-size-fits-all approach of traditional recovery systems like AA. Watts shares personal experiences and insights, emphasizing the importance of understanding addiction as a spectrum and challenging self-limiting beliefs. The episode underscores the need for a more nuanced and individualized approach to address underlying issues and offers hope to those seeking to transform their relationship with alcohol. Watts concludes by encouraging listeners to recognize their own agency in reshaping their habits and promoting well-being.

Hey, it’s Molly from alcohol minimalist. What do you do in this October? I would love to have you join me in my more sober October challenge. What do I mean by more sober October, it simply means that we’re going to add in more alcohol free days than you currently been doing, whether that’s one or two or 31. It’s up to you, you get to set your own goal and that’s why it’s more sober October. You can check it out and learn more at get got sunnyside.co/molly It’s totally free. I’ve got prizes, I’m going to be going live every week to announce the prize winners, and it’s just going to be an awesome event. So I would love to have you join me. You can learn more at get.sunnyside.co/molly and you can get registered today. Welcome to the alcohol minimalist podcast. I’m your host Molly watts. If you want to change your drinking habits and create a peaceful relationship with alcohol, you’re in the right place. This podcast explores the strategies I use to overcome a lifetime of family alcohol abuse, more than 30 years of anxiety and worry about my own drinking and what felt like an unbreakable daily drinking habit. Becoming an alcohol minimalist means removing excess alcohol from your life. So it doesn’t remove you from life. It means being able to take alcohol or leave it without feeling deprived. It means to live peacefully, being able to enjoy a glass of wine without feeling guilty and without needing to finish the bottle. With Science on our side will shatter your past patterns and eliminate your excuses. Changing your relationship with alcohol is possible. I’m here to help you do it. Let’s start now. Well hello and welcome or welcome back to the alcohol minimalist podcast with me your host Molly Watts coming to you from a gray foggy cloudy Oregon looks a little damp out to this after two really beautiful days this weekend. So I really can’t complain too much and won’t. It’s the end of spring. What can I say May is on its way and I’m really hopeful for some drier sunnier weather. Today on the podcast. I am just so excited to share this episode with you. I am speaking with Dr. Carl Eric Fisher. Dr. Fisher is an addiction psychiatrist, bioethics scholar and author. 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, especially issues related to substance abuse disorders and other addictive behaviors. That from his bio, of course, he is the author of a book called The urge our history of addiction. And it was that book that led me to him and wanting to talk with him. He’s also the host of a podcast called flourishing after addiction. He brings a very interesting perspective. He is not only someone who studies addiction, being a psychiatrist and and bio ethicist, but he also is a recovering alcoholic himself. So his book is a combination of both a rich historical perspective on addiction but also his personal stories from both his own personal experience and his patients weaved in. So I know you’re going to love the book, I enjoyed our conversation because as you will hear, he is also an adult child of an alcoholic like myself. So we had a lot of things to talk about. It’s not often I get someone on the show who is a child of an alcoholic who has struggled with their own drinking who is interested in neuroscience. So obviously, I loved being able to talk with him and just hear what he had to share. Here is my conversation with Dr. Carl Eric Fisher. Good morning, Carl, thank you so much for being on the alcohol minimalist podcast. I was so excited to connect with you and to have you actually say yes to coming on the show and talking about your book, The urge our history of addiction. Such a very interesting and strong topic. And as I shared with you before we jumped on. I also just have so much to talk with you about because we have a lot of shared connections in terms of our history. And you have some an interesting personal journey that goes into the writing of this book. In and of itself. So, welcome to the show. And thank you for being here. Thanks so much, Molly. It’s good to meet you. Yeah. Nice to meet you, too. And give just so we could tell people a little bit about this. Before we even get started on this. I’m talking to you today. It’s early in the morning here in Oregon, and you are in Portugal. And tell me about why you’re there even in Portugal right now. Sure thing? Well, yeah, I’m in Lisbon, Portugal, for a variety of reasons. Honestly, the major professional reason is because Portugal is world famous for its drug policy. Yeah, they had a massive problem with very public drug issues and drug related disorder in the capitol primarily in the 1990s. And then they enacted this really momentous piece of legislation where they decriminalize drugs for personal consumption. So you couldn’t drive up to the Lisbon port with a boat full of heroin or cocaine. But if it was a small quantity that someone could use for personal consumption, it was not criminalized at all. And even if somebody was recurrently, causing problems in the public space, they would get access to treatment. And in the worst case, that would be brought before a noncriminal. committee that will try to help connect them with services that would help them with their problems. There’s a lot more we can say about that if you’re interested. But I was interested to see it firsthand. I wanted to be on the ground. Because frankly, everyone trots out Portugal as an example of their preferred position. People on one side of the spectrum say but you know, Portugal shows that we should do this or that. And on the other side, people say, Oh, no, no, Portugal doesn’t say that. What they actually say is this. And I wanted to get what the book, what the urge taught me about these topics is it was really useful to get into the intellectual and the cultural history, to get a sense of the deep history across multiple fields of study across multiple ways of understanding a phenomenon. And I wanted to do a little of that with Portugal. But I also have a six year old son, I wanted to make sure he had a international experience. It was a good time with COVID. People are more comfortable with video psychotherapy. Yeah. So it just felt like a good time to go and to have that experience as a family. So that’s a big part of it, too. How awesome. How awesome. Yeah, and I love the fact so yeah, you you kind of wove it in there perfectly. The real so let’s talk about the the urge and the history of our addiction and kind of give me your what you really wanted to accomplish in terms of writing this book and what you hoped it would accomplish for the world, you know, for putting it out there into the world. What give me the, the, the show, I know it’s not easy, because there is just as you said, it’s multi generational, it’s multicultural, it’s multi disciplinary, you know, there’s just a lot of things that kind of come into addiction. So how were you trying to what was your goal in terms of writing the book? Well, it was pretty simple. In terms of the goal. It was it was personal. It was the book that I wanted for myself, but I couldn’t find there are lots of great books about addiction have benefited from a lot of them. But when I was in early recovery from addiction, I would say about like a year in, I had the sense that I was relatively stable. I wasn’t worried about like relapsing that day or that week. But I still had this big question in May. I went to medical school, and then psychiatric residency at Columbia University. And around the time I graduated med school, and then went on to further training as a doctor. I was living a double life, basically, on the surface. I was on top of the world, I had won multiple graduation awards and gotten into my preferred program, which according to some metrics is the best psychiatry training program in the country. And I just thought I was on the way to academic superstardom. But part of that was also me trying to put up a strong front in me trying to prove to the world that I was okay because I was also really struggling with alcohol, and then a little later with stimulants like Adderall and cocaine. And so throughout the early years of my residency, I had increasing problems with staying out late coming in late mouthing off to my supervisors, to the point where my program stage to sort of quasi intervention and these people that I had known for years and years because of my medical training. They basically said Hey, Carl, we you know, we can tell that something is wrong. Long like WHAT IS IT guy? How can we help? Like, do you need to go into treatment and I said, I lied and said, It’s not alcohol. I know what this looks like. But really, I’m just, you know, I’m having trouble with the adjustment, whatever. So there’s more we can say about the problems. But fast forwarding to the solution is I had a manic and psychotic episode that was fueled by alcohol and Adderall. And then I wound up in this sort of funny, unique program called a physician health program, in most states, but not all states have this where if a physician is having problems with substance use, they get into a sort of voluntary monitored program where there’s monitor treatment and monitored urine screens. So I got I went to a specialized rehab for doctors, and I got to do all of that. And part of that was, in large part because of my own privilege, and just the luck of being a physician, having the resources to be able to do all of that. So I got out of the program, and I was feeling relatively safe. And like I said, I wasn’t I wasn’t feeling like I was going to relapse that day. But I still had this big question to me that was basically Well, what the heck could just happen to me? What is this thing called addiction. So I went to the scientific and in the medical literature, and I found that it was really sort of hard to make sense of it was polarized, and everybody was seizing on the one small piece of the puzzle. Some people say it’s a brain disease, some people say, Oh, we should use behavioral economics to figure it out. So forth and so on. There’s one book that has 30 different theories of addiction. And I just had this intuition that taking a broader view, and looking at things like history, philosophy, arts and culture, so forth, would just be helpful to me, it would be helpful to answer that question what had gone wrong in me and what had gone wrong? In my family as well. And so that’s what got me started on the whole project. Yeah, so just so because this show, my podcast is not dedicated to people in recovery, I myself was a habit drinker. But one of the things that I share in common is being an adult child of an alcoholic. So the I called my habit oxymoronic because it seemed to make no sense to me after my mother had been in treatment, my mother never, never recovered. She went she she passed away of as the result of an alcoholic binge at the age of 81, which is almost unheard of, as you know, because most alcoholics simply don’t live that long. But so to say that it’s been an ever present part of my life, I think is not an understatement. And so when I developed my own disordered use of alcohol, I, like I said, it was it was, I guess, I, I only call it oxymoronic, because it just seemed to make no logical sense. I had so many reasons to not turn towards alcohol. And yet I did. But I also had a lot of stories in my head about the fact that I was genetically predisposed all of this stuff that I thought that just made it natural for me to desire alcohol more. So one of the things that and and in my journey, like I said, I never reached the point of being physically dependent on alcohol. But one of the things that I’ve come to believe in, I’d love to hear your thoughts on this is that before someone develops a physical dependence on alcohol, they, they did develop a psychological dependence on it. So whether the, you know, that you really don’t get to the point where you’re physically dependent, until you’ve created a psychological dependence. And I think that people do want to, you know, we take whether we take the word addiction to its, you know, what I love about your book, too, is the fact that addiction from earlier cultures didn’t mean necessarily mean physical dependence. Right. So let’s talk about that. But what do you think about that? Do you think that people it’s, it’s a psychological problem before it becomes a physical problem, and that I guess, would fit into what you present what you’ve learned about the history of addiction? Yeah, I think it’s important to be very, very careful about those types of distinctions. And in many ways, we’ve overemphasized the distinction between a so called physical and psychological addiction. I thank you for sharing your story. And I totally respect and agree with your perspective that the problematic substance use exists on a spectrum. And there’s one group of alcohol researchers who are working as early as the 70s and 80s. Who said that it’s the people who fall short of the extreme and stereotypical addiction who are the underserved majority. Right? That’s so many people who have problems with drinking, or where their drinking or their other drug use is causing problems at work or causing problems in their personal life or causing harm. was in their health. But it doesn’t feel like that kind of extreme powerlessness and loss of control. So I think it’s really important, really useful to recognize the whole spectrum and to acknowledge that people can have problems, and many points along that curve. But, you know, I’m cautious about the physical versus psychological distinction, because, you know, for one thing, like you said, the notion of addiction, as it comes to as deep in our culture, from philosophers and from theologians 100 years ago, is that addiction is something universal to the human condition. These are the problems that people like Aristotle, like St. Augustine, and many, many others have struggled with for millennium. Actually, we have plenty of examples of deadly dangerous addictions, which have nothing to do with the ingestion of mind altering substance, right. Gambling is one of the most fatal addictions, it has an incredibly high suicide rate. Somebody with a gambling addiction can completely devastate their family’s finances and cause massive, multi generational problems. And when I looked at the historical record, a case of gambling addiction was the first that I found really, you know, in a case from the Rig Veda, which is the ancient hymns and texts of Sanskrit, of South Asian Indian spiritual practice. And there’s a poem that describes a really beautiful poem that describes the case of a gambler who loses everything loses his beloved wife and his and his family and his connections. And even though he doesn’t want to go back, he feels himself pulled back to the dice. So it was only later when we really medicalized this notion of addiction as if it was the brain being hijacked by a wayward chemical. And also, I should mention, the pharmaceutical companies really leaned into this notion of physical versus psychological dependence, because because then they can fix it. Because well, and also, and also the purveyors of the addiction supply industry is the purveyors of potentially harmful products like alcohol, and like tobacco, and like others could say, oh, our thing and the opioid manufacturers did this as well. They said our stuff is not really physically addiction is only psychologically addiction that happened with stimulants as well as early as the 1920s. It’s a move this happened over and over again, ours is not a bad drug versus a good drug, there’s bad drugs over there, they cause real physical addiction, ours is only psychologically addiction. So I have to be really careful about how those stories are used. It’s fabulous that I love that. I’m gonna quote this from I’m gonna read this from the book, because this is kind of what we’ve just been talking about. But it’s because I think that the, one of the, the problems we have as society is because we have, you know, just demonized the word addiction so much, right. So that so that everybody that feels like if you say, you’re an addict, or if you were addicted to something, you’re you’re a criminal, you’re, you know, you’re just an absolute, you’re obviously a worthless human being right. These are all the things that we have associated with it. So here’s from the book, The urge the history of our addiction. From the beginning, the word addiction was not a narrow description of a medical problem, but an immensely rich and complicated term used to gesture toward core mysteries of the human condition. It was not just about drugs, but about willing an agency, being someone who chooses, and the related, timeless puzzle of our seeming inability to control ourselves. It is crucial to be clear in speaking about addiction, but it is also crucial to embrace the paradox around it far better to welcome its capriciousness and flexibility than to fight against 500 years of culture. We could look at addiction as a big mistake, a word so vague and variable, that it is meaningless and misleading. Or we could look at it as a finger pointing at the moon, something gesturing towards something mysterious confounding, but ultimately human. I prefer the latter. I love that. I love that your course the writing is brilliant, folks, if you haven’t, so I’m just sharing that with you so you can understand it. But but really, that’s what I love about that is, again, you know, I do I think in what I’m going to read another quote a bit about something that you said about, about your parents. But I think for people that especially grew up as potentially a child of an alcoholic like I did, there was I say this in my own book, being able to point at my mother and put her in a box, as you know, as an as someone who was addicted right, who whether I chose to. Sometimes I say this when I was feeling more compassionate, I would choose the disease model. Right, she’s sick. And when I was less compassionate, I would see her as a just as a deviant as someone who was selfish, and you know, out of control, right, all of those things, but as if I kept her behavior in that box, I could separate it from my own. Right. And so I think that’s one of the things that your book, you know, was really helpful and valuable for me to see is how this division of keeping people in silos really, you know, keeps us all from solving the real issues at hand and those those issues go beyond just you know, they’re there when you talk about all of those things we just talked about tobacco and and gambling and alcohol and all of it right? People are, people are always going to seek out these mind altering behaviors. And so we need to figure out how to do this in a way that doesn’t demonize it but also doesn’t perpetuate a or you know, helps us solve a problem that that does cost, money and death and you know, a lot of issues in the world. Hey, everyone, just a quick break here on the show to talk with you about Sunnyside. Sunnyside has partnered with me and I am super excited to share this company with you. I’ve actually had the founders on the show before and I will link that in the show notes. So you can hear a little bit from them. Sunnyside is an app that helps you cut back on your drinking or simply build healthier drinking habits. I have watched the company grow over this last year and I’m so impressed. They are deeply mission driven. And they are building a service to help millions of people create a healthier relationship with alcohol. And they’re doing it without the pressure to quit or feel guilty. So of course, you know it aligns with everything I talk about here at alcohol minimalist. Think of Sunnyside as a digital coach that helps you set the plan for the week, and provides tools to track your drinks and measure your progress. All while using proven behavior change techniques to create a lasting habit change. It’s super easy to start super easy to stick to. And it includes a 15 day free trial. So you can test it out. Really it’s worth checking out. Head on over to sunnyside.co/minimalist to get started today. Thank you for sharing that Molly. Hey, you know, I can see why you identified with portions of the book because I had a similar process going on even within my family where both my parents were alcoholics. And my mother who was a high functioning University professor would pointed my father and say I’m not an alcoholic. Look at your father. He’s the one who’s been rehabbed four times. He’s the one that is getting the DUIs. I’m different. And I looked at both of them. And I said, I’m different from both of you. And in a way that us versus them process was reinforced in my medical training, would you get medicine is a tremendous and valuable tool. It’s helped me immensely. I’d like being a psychiatrist. I think there’s a lot that psychiatry has to offer. But there were other elements of my training that reinforce that US them dichotomy. And I start the book, when I’m in the psychiatric ward, in the middle of my alcohol and stimulant induced mania. That was the beginning of my journey, when I started to see that there wasn’t so much of a distinction between myself and my patients, that I can look at the other people, the other co travelers in the dual diagnosis word and start to see that, you know, the lines dividing me from, say people who had struggled for a long time there. Were not so established, they were not so clear. And there’s tremendous hope and opportunity for change in recognizing that porousness and flexibility and the the false construction of that us versus them dichotomy. So I am i That’s something that I think is a daily struggle in a way to to not hold on too tightly to some notion of who I am. You know, now I’m 12 years sober in my case. So that means that should be here, I should have accomplished that or they shouldn’t be angry anymore due to some other nonsense. It’s all it’s all part of the same suite of like that, quote, describes the timeless struggle of self control. Yeah, I know that you think you did go through or you’ve done a a or you’re part of I don’t know, I know you talked about a in the book and I never want to in a positive light is what I should say. And I don’t want to ever I never want to, I always say, if AAA is helping someone, and AAA has helped you, then I am nothing but 100%. Onboard grateful. And I know, obviously, the program has helped 1000s. So if not millions by now, my, but I think it’s important to understand, and I share this in my book about the history of the AAA program, at least in the United States, I can’t speak to across the world, but the powerful political and legal system, push that AAA got, which sort of then has made the 12 step program, the, you know, the gold standard for treatment and recovery here in the United States. And I, the thing that I have always struggled with, and in terms of AAA, and I would have never gone to an AAA meeting myself, because I, you know, again, my mom was over here, those people over there, I wasn’t like that I in fact, I was somebody who didn’t like to even get, I didn’t like to drink to the point of being altered, I just drink, I just drink routinely and habitually on a daily basis, I believed I needed to drink to take the edge off, you know, it’s like it was way beyond the limits of, you know, would have been would have been considered heavy risk, heavy drinking heavy use in the, by the alcohol use disorder spectrum. But the thing that I’ve struggled with in terms of AAA is this is the disease model itself. And the idea that you are powerless. And that when you, you know, because I and as a psychiatrist, I’m very interested to hear your take on this. Because, for me, once I understood how powerful my brain was in creating the feeling of desire in and of itself, just by of retraining my brain to think, think through things differently, and to see alcohol in a different way to really understand it to educate myself on the science of alcohol. And once I really started to understand that, you know, that, that being genetically predisposed, did not mean that I was on a, you know, that I didn’t have to drink alcohol. There, there was a lot of stories that I held on to self limiting beliefs that really fueled my drinking habit for 30 years. And once I understood all that, I understood, I also had the power to change those stories and power to change my relationship with alcohol. So you are somebody who has come through recover, you have come through, and you’re 12 years sober, and you are clearly a an intelligent, and, you know, highly trained physician and somebody that’s, that’s well versed on the brain. So, you, you, I mean, I also know you have a spiritual, you know, you have a spiritual compound component to your recovery. True, yes, but he’s not invoked. But do you believe that you are power less? Or do you believe you are powerful in your own your own brain? I think it’s both. It’s such an important set of questions and confusions you bring up that something I struggled with to myself is ideas about disease and ideas about this thing that I supposedly had. And if there’s any sort of primal sin of the medical perspective on addiction, we could trace it back to the American Revolution. And perhaps even earlier, I would say it’s making addiction, some sort of thing, as if it’s like a bug, like it’s a virus or a bacterium that you catch. And there’s jargon term for that, which is essentialism. Which is to say that it’s an essence it’s like a thing separate from me. There’s more we could say about that. But you brought you talked about the way that our treatment system has become de facto, one size fits all day. When most people go for alcohol or or other drug treatment. They wind up in a 12 step based program. And they are told that there is usually it is changing a little bit but usually they’re told there’s one way if you don’t go to AaA After this, you won’t make it if somebody has legal problems that can be mandated to your court ordered right to this and there and there are differently because part of my scholarly work is on ethics and law as it relates to psychiatry and neuroscience. There are different court interpretations about whether that’s even legal but it still It happens every day. So, you know, one really fascinating discovery I made in the book that I never learned about in medical school and I never learned about in my own recovery was the complicated relationship between the treatment industry and AAA are the 12 steps to such, the early founders of of the 12 steps said, We’ll Bill Wilson in particular said we don’t think that alcoholism should be described as a disease. The disease model was something that grew up sort of in relationship to, but not from the notion of the 12 steps. And there was this sort of treatment industrial complex and the words of one senator who was actually in recovery, who was part of this move, and then later had concerns about it. Or there’s just Cimon industrial complex that grew up sort of adjacent to AAA, but it wasn’t quite a lot of people were in AAA who were in the treatment programs administering the care. But, you know, the the treatment program itself wasn’t technically part of the 12 steps, it gets very complicated. But the point of all this is to come back to your question about powerlessness. And I think there’s a way that the notion of powerlessness has been institutionalized in certain treatment settings, as a method of coercion, and control, and a one size fits all model that doesn’t always serve everyone. In a way, it was worse in the 80s and 90s. When I have one quote from the book from the head of a major Treatment Center in the 80s, who said, I can tell you, I can guarantee you if you don’t go to AAA, after you leave here, you’ll never make it. We just know that’s not true. And even worse, we knew back then, that it wasn’t true. And when I say we, I mean the medical and research enterprise, there was good research on the fact that people with alcohol problems and many different pathways of recovery, and some people recovered through at NASA space program, but others didn’t. And we do people a tremendous disservice when we elide the those differences, and we obscure that diversity. So I’m not trying to dodge your question I, for me, personally, I my addiction was about a feeling of powerlessness, for sure. I had an experience of constantly working to discipline myself, and reading self help books and embarking on these individualistic projects of self improvement. And it just did not work for me. And what I needed was more humility, and more help from the outside, I needed other people, I needed to, in a way to use a spiritual term to surrender more to that sort of system. But there are a lot of people who are not privileged white men who don’t need that don’t need to downsize their ego in themselves. And they might need a different set of ideas, or considerations. But I think powerlessness is ultimately a spiritual concern. And it depends on one’s spiritual commitments. It’s not it’s not really a medical idea. So the 12 steps are very, like I said, they’re very, they’re, they’re more religious base and God based in terms of spirituality, I don’t frown down on an spirituality because I think that spirituality is a big part and of being in, you know, a more positive cognitive mental state in general, right, I think that you have to, in the book, I don’t know if you’re familiar with the abstinence myth, if you’ve ever read, read Dr. de jofy. But he talks about the whole idea of basically addiction being, you know, different levels, whether it’s medical, and spiritual, and psychological, all of these, you know, different facets of addiction, but also that, again, that the recovery system has focused on the idea that we have to be abstinent that that’s the you know, that the focus is on the substance as, as opposed to treating the underlying issues of why someone’s to turning to mind altering drug in the first place, right, we have to understand and we have to be able to find out what’s going on, that’s making us want to drink in the first place. In your book, you said people use drugs for reasons, the banality of that statement is matched only by our constant lack of mindfulness to it, the message screams from the pages of addiction memoirs. So again, it’s like we have to understand we have to get at the core reason and that’s really why I’m doing what I’m doing. As I’m talking to people, before they get to the point where they you know, whether again, we don’t need to worry about whether or not there’s they need treatment or in their recovery, or if they’re just they’ve just got a habit that doesn’t serve them and they’re using alcohol. And this is what I talk about a lot. Using alcohol to try to buffer away emotions and trying to solve emotional issues with alcohol is not something that is ever going to lead to a peaceful relationship with alcohol or a healthy if if you know whether it’s or any other type of mind altering behavior. You have to be able to, you know, to solve your emotions in a in a way that and I talked about doing it with You know, really understanding the connection between how my own thinking causes my how I feel about things was really pivotal for me. I never really understood that cognitive I call it cognitive behavioral therapy to some degree. But that whole idea I never connected the dots, I always wanted to look outside blame the circumstances of my life, for how I was feeling as opposed to understanding that I had a choice every day to make about applying my own judgment to the circumstances in my life. And how I applied that judgment was really is really how I feel, right is it determines how I feel in the world. And so that whole idea of really understanding the underlying core values of why someone turns to a drug turns to alcohol. Do you believe that that’s really, for you was understanding? Because you’re obviously Yeah, you were, you know, from the outside, you look like somebody that had everything in the world going for you, right everything in the world. So understanding what was driving you to turn to try to change how you were feeling with the drug. One, one thought that comes to mind is that I did do a lot of work on understanding and even went into pretty intensive psychotherapy with the well regarded fancy Ivy League psychotherapist, and we concocted all of these existential explanations for why I was drinking. And it didn’t help me that much. So the why is not always useful. But I do think it is really useful to change our yardstick, you know, or, as you said, our yardstick for how someone is doing in whatever you want to call it, whether it’s recovery, or resolving a substance problem, has been abstinence. And that’s really misguided. And it’s only very, very recently that the head of the National Institute of Drug Abuse, for example, has come out and said that this is not the only yardstick and we need to do better research. And we need to find other ways of measuring human flourishing, and how people are actually doing in their lives. So what if we, for example, made our yardstick someone’s happiness is their functioning at work or their relationships, and that in a way, that’s, that’s an important individual treatment, change that I think the medical field is only now starting to do. And there’s a lot of inertia working against that. And it’s an important societal change that is starting to happen in our commonly held cultural ideas about what it means to resolve a problem with substances. And also in our policy decisions and things like harm reduction, the whole notion of harm reduction, for example, is the idea of saying, rather than controlling somebody’s use, our yardstick is how is someone doing? What would any positive change look like? And it’s, it’s long overdue, because, again, people were doing this work, you know, depending on how you look at it centuries ago. But the I have a lot of hope, for. Looking in a more careful way about what actually matters, what is actually useful to somebody’s life, in treatment in their personal lives, in and otherwise. So it, I think it is really important to get beyond the sort of surface level idea of just controlling use as if that would solve the problem, because it just, it just doesn’t. Yeah, I know. And I know, like I said, I know your work is much more broad spectrum, and you’re talking about all different types of addictions, and all different types of issues and opioids, and, you know, all of that, which is very complicated. It’s a lot of there’s a lot of perspectives and a lot of different forces at will to try to that are trying to steer the ship, you know, so it’s, it does make it a continuing ongoing challenge. It will be I, I suspect, if your book is any indication, I don’t know that 500 years from now, there won’t be somebody else writing about a book about addiction that will cover all of these years, because I don’t know that it’s going away anytime soon. But I couldn’t agree more. Yeah, I couldn’t agree more. I don’t think that addiction is something that ends I don’t think that substance problems are something that ends I think that everybody has some small portion of it, at least everyone has the experience of struggling with self control, can be carbs could be work, could be the Internet can be self esteem, money, you know, choose your poison, but, you know, all of that investigation I did about the broader cultural historical policy questions. I want to mention that I did all that for myself. I did that because it mattered to me because it was actually useful to how I made sense of my own problems that we can see in those broader social responses the way people have struggled with addiction epidemics for hundreds and hundreds of years, if we look at that we can see reflected the way people make sense of self control. And see the way that people make sense of their struggles to control their habits, to control their alcohol, to control their use, to make sense of it in the context of systems of treatment, or economic systems that are producing potentially addictive products. And so that’s why we’ll be in the personal story as well is to is to be rigorous about constantly returning it back to what actually matters. What matters for me, what matters for my patients. Yeah, well, as I said, a beautifully written book. I will link it in the show notes, folks, so you can go find it. And it I think, wow, I just appreciate you having the conversation with me this morning and talking about my all of the offline stuff that is a part of this conversation, because it is, you know, there is a lot to talk about when it comes to this to the human brain and to understanding human behavior and to understanding that across centuries and across cultures, and I think that if anything what I got out of this what I really Yes, I agree the story is hopeful. The the the vision is hopeful. And, you know, for people who are struggling with their alcohol use. There’s you’re not alone, right? This is this is this is a time honored story and you’re not broken, you’re not diseased, you’re not too sick to figure out your own relationship with alcohol. And you know, I just appreciate you, Carl, for being here with me and talking about the urge our history of addiction and your own story as well. Thanks so much, Molly. It’s really been a pleasure. Thank you for listening to the alcohol minimalist podcast. This podcast is dedicated to helping you change your drinking habits and to create a peaceful relationship with alcohol. Use something you learned in today’s episode and apply it to your life this week. Transformation is possible. You have the power to change your relationship with alcohol now, for more information, please visit me at www dot Molly watts.com