In The Urge, Carl Erik Fisher narrates the social history of addiction in the US, mixed in with his experiences as an addiction psychiatrist and as someone in recovery. The following edited excerpt begins in post-war New York with William Burroughs, one of the leading writers of the Beat Generation. Fisher reflects on Burroughs’ heroin use, and how it came to influence his own literary works as well as popular culture today.

William Burroughs was getting desperate. His Harvard polish was wearing thin under the constant friction of opioid addiction, and not a single doctor in New York City would write him a prescription anymore. He tried forging scripts, but he was quickly busted and caught a low-level charge. He tried stealing from passed-out drunks on the subways, but he was a small, thin, unathletic man – since his boarding school days, more given to reading Baudelaire by candlelight than playing sports – and after barely escaping a beating, he gave that up. He tried kicking the habit, but he kept relapsing on heroin. He tried dealing to support his own supply, but the federal agents were closing in quickly.

“The Urge: Our History of Addiction” was published in 2022 by Scribe UK.

It was New York City in 1947, and it was, if such a thing is possible, a particularly bad time to be addicted to heroin. From roughly the 1920s to the 1960s, the country was dominated by an anti-drug, prohibitionist fervor: strict enforcement, draconian punishments, and almost no treatment options. Just days after the Harrison Act went into effect in 1915, Burroughs’s uncle Horace, a narcotics user, killed himself with a piece of broken glass in a rooming house in Detroit, reportedly because he foresaw how people like him were about to be bereft of their supply, hunted down, and jailed. Now, a few decades later, William Burroughs’s own heroin addiction was reaching a breaking point, and he was running out of options. So, one cold January day in 1948, he drove his car from New York to Cincinnati, then hopped the southbound train to Lexington, Kentucky, to check into the United States Narcotic Farm, or “Narco.”

Narco was a massive prison hospital built on a thousand acres of sprawling Kentucky bluegrass. Even people who had been to Rikers Island or Sing Sing were flabbergasted by its size. On the drive in, you’d pass miles and miles of cow pastures, pigpens, and crops and orchards, then the enormous main building would come into view, sprawling over twelve acres by itself, a central tower rising like an art deco ziggurat, multi-story wings stretching into the distance and wrapping around quads large enough to contain tennis courts and softball fields.

Burroughs didn’t stay long – he just wanted a break from law enforcement and a few days of detox. Once they stopped giving him drugs for withdrawal, he took a cab to Lexington, caught a train back up to Cincinnati, and started buying up paregoric (an over-the-counter opium tincture). But for many others, Narco was a humane refuge, an oasis in the middle of a country obsessed with harsh punishments for drug crimes. It was also a sanctuary for doctors and researchers who believed in more compassionate treatment for addiction, and it was a meeting place, both for those few professionals and for their ideas – where the new sciences of neurophysiology and behaviorism were brought to bear on addiction. Researchers and clinicians got to know their patients with addiction, learning that they weren’t broken or vicious but often well-meaning, with rich inner lives.

Burroughs was following the biases of the top researchers of the time, who dismissed problems with cocaine and other stimulants as only ‘psychic addiction’.

In many ways, though, the work of this era only served to heighten the division between good and bad drugs – and good and bad drug users. An overly reductionist perspective on addiction, one heavily influenced by the biases and prejudices of the time, blinded society to the dangers on both sides of that divide. The result was to further entrench the separate and unequal system that failed people with addiction across the whole spectrum, from the most marginalized to the most privileged.

In 1953, a few years after his stay in Narco, Burroughs published his first book, Junky. It was a major milestone in the countercultural reclaiming of the word “junky” (or “junkie”) – the drug user identity as a badge of membership and a conscious revolt against bourgeois conformity – but though Burroughs was deeply influenced by Romantics like Coleridge, De Quincey, and Baudelaire, the book was also peppered with surprisingly reductionist views on addiction.

“Junk,” he argued, had a way of enslaving the body that was “different from the action of any other drug.” “The use of junk causes permanent cellular alteration,” leading to “junk-dependent cells.” “Junk creates a deficiency so that the body cannot function without more junk at regular intervals… Withdrawal of junk creates a deficiency condition… So far as I know, junk is the only habit forming drug according to this definition.” It is this kind of deterministic reasoning that leads Burroughs to one of his most famous conclusions: “Once a junkie, always a junkie.”

The upshot, Burroughs insisted, was that opioids were uniquely addictive, unlike, for example, cocaine: “There is no tolerance with C…one shot creates an urgent desire for another shot to maintain the high. But once the C is out of your system, you forget about it. There is no habit to C.”

Burroughs was following the biases of the top researchers of the time, who dismissed problems with cocaine and other stimulants as only “psychic addiction.” Two leading scientists, for example, noted that “without abstinence symptoms on withdrawal, a drug can scarcely be considered to produce true addiction.” The dominant assumptions about good drugs and bad drugs were readily reflected in a narrow and biology-based explanation for addiction.

Extracted from The Urge by Carl Erik Fisher, published by Scribe UK

Dr Carl Erik Fisher is an addiction psychiatrist, bioethics scholar, and author. His writing has appeared in publications such as The New York Times, The Washington Post, The Guardian, and Slate.

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