Carl Erik Fisher - The Urge: Our History of Addiction

Im lying in bed when I hear the commotion. I peer through the doorway of my room, and right outside, the new guy is getting in Ruizs face. Theres a phone right outside the door, one of those sturdy metal payphonesit looks like its been carried in from the streetand Ruiz, a gentle older man with shoulders stooped by the demoralization of his nth relapse and hospitalization, is just trying to talk to his family. But the new guy has been manic and pacing since he arrived a few hours ago, and he wont take no for an answer.

I watch the new guy stalk the other way across the doorway, muttering to himself, menacing even in retreat. Then a warning shout echoes from much too far in the distance, and he appears once againflying, near horizontalto tackle Ruiz, dragging him off the phone.

The staff quickly take him down; thankfully, no one was seriously hurt. Shaken, I try to focus on my journal, but my mind races. My roommatea burly middle-aged guy with a scar down the side of his head, attesting to the brain injury thats brought him back here over and over againturns to me laconically and says, There goes dinner.

Im twenty-nine years old, writing in my journal in a sloppy felt-tip pen (no ballpoints are allowed), trying to understand how I went from being a newly minted physician in a psychiatry residency program at Columbia University to a psychiatric patient at Bellevue, the citys notorious public hospital. Bellevue is synonymous with the most challenging, chronic mentally ill cases, and now Im locked on the dual diagnosis ward on the twentieth floor, near the top of the building, where they put people who have both substance use problems and other mental disorders. Ive already recognized some of the faculty from when I applied here for residency, and I know from the tour I took as an applicant that the special prison ward, protected by a guardhouse with bulletproof glass and thickly barred gates, is a floor below us.

I need that phone those two men were fighting over. Its my only way to reach the outside world, that other plane of reality where I was once a psychiatry resident. Im having trouble accepting that I belong here, not there. Day by day, it seems more likely that what the doctors have been telling me is correctthat, just like the new guy, I too have had a manic episode, in my case induced by weeks of stimulants and alcohol. But Im still not sure what I should do.

The next day, I meet with the whole treatment teamhalf a dozen psychiatrists, therapists, and counselors facing me across a massive table in one of those windowless hospital conference rooms. For the first time, I truly let my guard down and recount my whole drinking history. How I grew up with two alcoholic parents and swore to myself Id never be like them. How, even as I finished medical school at Columbia, I had the creeping sense that my drinking was out of control. How the blackouts got more and more frequent, but I didnt reach out for help, and I didnt accept the help that friends, colleagues, and supervisors had all offered, then implored me to take.

I tell them everything, even the one time that I woke up on the floor of the hallway in my building, shirtless, my skin sticking to the tacky linoleum, locked out of my own apartment. It was only by getting up to the roof and climbing down the fire escape that I made it in to work that day at all. I was late again, and so ashamed and scared by what it said about me. It was obvious that something was wrong, but I never told anyone about it, because to do so would be to acknowledge what I had long suspected.

They ask me about my family, and I tell them about my fathers four rehabs and the bottles of wine my mother secreted around the house. I describe my parents as alcoholics, as I usually do, but I also finally give voice to that dangerous suspicion about myself:... And Im starting to realize that Im an alcoholic, too, and I break down crying.

Despite all this, later that weekend, I call my friend Ravi from that payphone, looking down the disorientingly long hallway that stretches the whole length of the ward. Hes helping me with all the logistics, setting up disability insurance, getting my rent paid, and generally making it possible for me to go to rehab: a place I dont quite want to go to but Im told that I need.

We talk about how itll be good for me, and how Ive struggled for so long. His voice is strained. Its clear hes worried about me. So I hesitate for a momentI have the clear sense of telling myself, this is a truly ridiculous question, dont ask him thisbut then ask him anyway, even as I keep one eye down the hallway for any potential assailants: Do you really think I can never drink again?

Im supposed to be headed to some specialized rehab for doctors, but I know nothing about it. I want to go, but not really. I need help, but maybe I can do it on my own, or at least find a better way. Why is this so hard?

I did go to that rehab for doctors, and in time, I returned to the residency program at Columbia. For years afterward, I was in supervised treatment. At a moments notice, I had to be prepared to run across the medical center or across town to my urine monitor, a woman who would watch me urinate to make sure I didnt try to pass off someone elses bodily fluids as my own. As I slogged through half a decade of this, I got more curious. I knew that the addiction treatment system was broken, having experienced it firsthand, but the why was mystifying: Why was there a totally separate system for addiction treatment? Why do we treat addiction differently from any other mental disorder? If everyone seems to know that the system is broken, why isnt anyone changing it?