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A Conversation With Carl Erik Fisher About His Book the Urge: Our History of Addiction

I spoke with Carl Erik Fisher over Zoom about his book The Urge: Our History of Addiction. Fisher is an addiction physician and bioethicist. He is an assistant professor of clinical psychiatry at Columbia University’s Division of Law, Ethics, and Psychiatry, and maintains a private psychiatry practice focused on addiction. Fisher’s writing has appeared in The New York Times, Nautilus, Slate, and Scientific American MIND. He hosts the podcast Flourishing After Addiction, an interview series exploring addiction and recovery.

In The Urge, you describe how societal views of addiction and treatment have been cyclical. How do you think studying this history can help us break some cycles?

One of the powerful messages I got out of the cycles of history is that when views on addiction became strongly polarized towards one extreme or another, it caused big problems. It caused problems for people who were trying to deliver treatments, and certainly for people who were suffering with addiction and trying to work towards recovery.

That was definitely true when things were very moralized in the earlier part of the 20th century, when addiction was largely treated like vice. But it also became a problem when addiction treatment was too focused on 12 steps as the only way; it also became a problem when addiction treatment was too focused on therapeutic communities; it also became a problem when it was too focused on methadone to the exclusion of all else. The division of ideas about addiction into those camps was really damaging—and the legacy of those divisions continues today.

I think one of the opportunities we’re faced with is to make a more synthetic set of connections across previously divided camps. This is not my idea; there are multiple thinkers that have pushed for many paths of recovery. But I think that’s one of the big lessons about breaking out of cycles—to stop engaging in the us vs. them mentality that creates the cycles in the first place.

Yeah, I was going to ask how you think we move away from the black-and-white approach that seems to have dominated for so long, but you kind of answered my question.

Yeah, because ideas about addiction itself and ideas about treatment are so strongly linked. Even a third level to that is how we should respond to problems of addiction. In all those different lenses, we can see reflected ideas about the others. I think it’s really important to think humbly about what the underlying characterization is.

You talk in the book about how so many of us with addictions have felt at times that we have free will, and at others that we’re losing control. You also show how we as a society have gone back and forth in viewing it as one or the other. How do you think society’s viewing it as either of those tends to impact policy or treatment?

There are very wise and thoughtful advocates who at times have leaned into what I would call caricatures about the nature of addiction—describing it as completely abolishing free will. And maybe that is helpful in some circles; maybe it helps summon compassion or resources. But I also think all-or-nothing portrayals of addiction—as some sort of free choice on one hand, versus a complete and total hijacking that takes away every shred of someone’s free will—are a double-edged sword. I think it’s better to tell the truth, and to be as clear as possible about these very complicated gray areas.

My experience in addiction—and I think the experience of many of my patients and people I’ve met along the way—has been a push and pull. Sometimes you feel in full control and sometimes it feels totally automatic; you wake up the next morning and are like, “I can’t even describe how I got from point a to point b.” It’s one of the deep mysteries about addiction. In my own work, it’s been a priority to avoid caricatures and work towards more nuance.

Yeah, that’s one thing I really appreciated about your book, and I also liked how you described that there are no “good” or “bad” drugs. Can you explain why that’s the case?

As long as we’ve had drugs, we’ve had powerful social, political, and moralistic forces that have divided them into “good” or “bad.” Which is important, because almost every single human society on the face of the planet has used some sort of mind-altering substance at some point. Usually, the stories about “good” and “bad” drugs are more about people, class, race, and colonialism than they are about the drugs themselves.

Even in recent history, opioids were considered safe and not a real addiction; it was a pseudo-addiction, and it was really crack cocaine that was the bad thing. Then you rewind the clock a little to the crack epidemic, and I have cases in my book about researchers saying, “If my daughter were to use heroin or crack, I would rather she use heroin.” Compare that to today, when people are thoughtful about and aware of the opioid overdose crisis. We’ve gone through these cycles where meth gets demonized, and methamphetamines in the form of prescription drugs are given a free pass as if they’re not mind-altering in any way.

The bottom line is that those divisive stories always come back to hurt all of us. The stories about “bad” drugs are used as a weapon for oppression and domination. The “good” drugs come back to hurt the people who have entitlement to them—people like me who grew up white, middle-class, and privileged. It was my own entitlement—my easy access to Adderall—that really put me over the edge in terms of my addiction crisis, where I truly was no longer able to function.

You wrote in the book about how you wanted to study addiction after experiencing it, but also studying the neuroscience and medicine behind it. What about those experiences made you want to learn the history?

A lot of things. The first is just that the history seemed interesting and it was an untold story. Some of it was a gut sense that maybe it would be helpful. But it was also disillusionment with the existing narratives. There were all these overly simplified, all-or-nothing portrayals: all addiction is trauma, or all addiction is a lack of connection, or all addiction is this or that. Each of those stories are helpful, but don’t tell the full picture. For me at least, they didn’t provide enough depth and careful consideration for what I was experiencing and what I had seen in my family. Going to the history was a way of taking a really broad view over what the phenomenon was. The history is the framework; it’s a way to make sense of it all.

I didn’t do this for fun, because it wasn’t that fun at various points. I didn’t do it because it would be helpful to my academic career, because in most cases writing a book for a general audience is not that helpful for an academic career. I did this because these were questions that were really alive for me. I didn’t know who I was, and I didn’t know how to make sense of the problems that had beset myself and my family.

I started writing the book in early recovery, when I had the sense that I was safe for today; I didn’t feel like I was going to relapse that day or week or month. But I recognized that there was more work to be done. For me, the process of making sense of my identity, my addiction, and my recovery was life or death.

The history was extremely helpful in that way, probably because of the stories about different people across times and places. Even though they had different names for and ways of recovering from it, I had the sense that there was this fellowship; folks I met through historical research had struggled with the same problem. I needed that to make sense of it all and to be comfortable in that identity within myself. To the extent that it’s helpful for anyone trying to make sense of their own or a family member’s addiction—that’s why I wrote the book in the first place.

I told myself I was going to get sober a month in advance, and starting then until now at close to seven years, I’ve read widely about addiction and recovery. And because I agree with you that it’s very nuanced, I’ve read everything I could, listened to everything I could. I tell people I feel like that’s kept me sober—or at least it’s one of the things that has.

Which is interesting, because I was told I should be careful about intellectualization, and that part of the process was to take the cotton out of my ears and put it in my mouth. There’s a kind and wise motivation behind that advice sometimes, but it can also go too far; it can be a tool for coercion and control, where people might say, ‘These totally legitimate questions you have are not worth anything and you should just shut the heck up.’

There are a lot of people I see in my practice and personal life who have really complicated and legitimate questions about the mystery of addiction. ‘What does this mean about me?’ ‘Is it a thing I catch like a virus or bacterium, and if not, how do I make sense of it?’ Questions about mental health are some of the most complicated questions we have in all of psychology. The ways that we describe, make sense of, and recover from addiction are necessarily not going to work for everyone—and there’s a lot of value there.

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As we continue to grow Amatus Health, the need to stay competitive and differentiate ourselves in unique ways is crucial. Building creative approaches to reach more people will take our company to new heights. This is why I am pleased to announce that we are officially rebranding. Our new national name, TruHealing Addiction & Mental Health Treatment, will eventually replace Amatus Recovery Centers.

You may be asking, “Why are we doing this?” This new name will give us national uniformity and help brand ourselves as a whole, which will be done in phases. You will still see our existing facility names co-branded with TruHealing for the time being.

Healing is what we do. Everyone who comes through our doors is in a moment of profound struggle in their lives. We support them through a life-changing process of healing and recovery, and they leave our facilities changed. This new name is a representation of that process. As mentioned above, it also allows us to have a national brand, which will make us a recognizable name in the addiction and mental health field.

In summation, these changes present an excellent opportunity for our organization to develop our mission, vision, and purpose. I look forward to prosperous growth as we head in a new and positive direction.

Sincerely,

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Mark Gold
CEO
Amatus Health

Dr. Adam Cusner, PhD is an organizational psychologist by training and has brought his decade-plus experience to the healthcare field serving as the Executive Vice President of Operations for a 22-facility portfolio of skilled nursing facilities, assisted living and independent living centers across Ohio and Arizona, with an annual revenue over $250MM. While serving in this position, Dr. Cusner brought accelerated growth to these facilities, while increasing employee retention and workflow optimization. Dr. Cusner has a proven track record in the healthcare industry of providing successful leadership through his financial acumen, strategic planning, interpersonal skills, along with his ability to build strong, effective teams.

 

Dr. Cusner’s credentials include a Philosophy Doctorate in Organizational Psychology (PhD) from Cleveland State University, a Master of Arts in Psychology (MA) from Boston College with an emphasis on Psychology of Work, a Bachelor of Science in Psychology (BS) from Boston University with an emphasis in Organizational Behavior in Business and is a board-certified Nursing Home Administrator (LNHA). He has published and presented research articles in the field of organizational psychology at national healthcare conferences. Dr. Cusner is completing a book on organizational psychology in the healthcare field, which is expected to be published late early summer 2022. He is also a member of the American Psychological Association (APA), has served as the APA’s Division 17 communications chair, is a member of the Society for Industrial Organizational Psychologists (SIOP), and was selected as a professional reviewer for national conference research presentations.

 

Dr. Cusner is an advocate for his employees and is drawn to the tie between culture and quality. His extensive strategic and operational skills have delivered a high degree of success across all department levels. Dr. Cusner facilitated the establishment of an in-house financial team to provide billing and collections, accounts payable, vendor management, along with financial reporting. This provided $1.5MM annualized savings. Further, he developed department efficiencies for: Medical Staff recruitment, service-line growth, quality and safety, corporate accountability of budgetary expectations balanced with direct reporting to investor groups.

 

Dr. Cusner coordinated the financial turnaround of a 300 bed CCRC (skilled nursing, assisted living and an independent living center) in Arizona, which has been epitomized as the most financially challenging state to manage CCRC facilities. Dr. Cusner also strengthened the business growth of the Ohio facilities by 12%. He was recognized by the Governor for demonstrating a “care-conscious approach” during COVID, when Dr. Cusner carefully consolidated facility residents to accommodate staff and improve clinical care. Dr. Cusner demonstrates a results-driven culture by delivering a high-quality level of care and employee engagement.

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Yaffa Atias is the Director of Special Projects at Amatus Health. Atias is a leadership professional with a decade of experience in healthcare. She holds a BA in interdisciplinary studies from Thomas Edison State College, and a Master’s in Healthcare Management with a concentration in project management from Stevenson University. She completed her graduate capstone at Mosaic Community Services, now an affiliate of Sheppard Pratt.

 

In her role at Amatus, Atias leads and manages interdisciplinary team projects, creates solutions for any operational gaps, and continually strives for quality improvement in all processes. Atias led the organization’s COVID-19 preparedness strategy, resulting in all facilities remaining operational, and in 600 employees being retained as staff without resigning out of fear. In her role so far, she implemented licensure for three new states.

 

Atias believes Amatus Health and TruHealing stand out because every employee, from corporate to center staff, has a real passion for helping people. Atias shares this passion, “My natural compass always tugged me to behavioral health. I’ve always been fascinated by the human psyche. I have also been intimately privy to those suffering from mental illness and substance use. I later understood that my experiences weren’t unique, and quickly realized how pressing the need really is to effectively prevent and address. Moreover, how life-changing proper intervention truly is.”

 

Atias was born in Los Angeles, California and grew up in Israel and Maryland.

Melissa McCarthy is the Vice President of Business Development at Amatus Health. With a decade of experience in the behavioral healthcare and addiction treatment industry, McCarthy is passionate about recovery. She has her finger on the pulse of marketing trends, with the end goal of helping businesses grow so they can serve more people in need.

 

McCarthy has worked at large enterprise recovery centers across the country spearheading business development teams. She has a wide range of experience, including transforming a third-party digital marketing and client acquisition services company into a full-continuum behavioral healthcare provider, managing several successful rebrands, and growing annual revenue fivefold.

 

As VP of Business Development, McCarthy leads a team of over 20 business development professionals nationwide. She manages client acquisition, coordinates in-service trainings with various referents and hospitals, and presents at conferences on addiction and mental health disorder treatment.

 

“Sadly, many individuals die waiting for access to life-saving behavioral healthcare services,” says McCarthy. “I am in relentless pursuit of better—better access, better care delivery and better outcomes. I consider it a privilege to work in an environment where miracles unfold daily.”

 

McCarthy lives in Maryland with her daughter.

Hometown: Saugus, MA

 

Passions & interests: The greatest passion of mine is being able to dig into the work with men in early recovery. There is nothing better than witnessing and being a part of the change. My journey in long-term recovery has taught me to value the little things in life that I am now able to do. I love to do anything that allows me to be present with my wife, family, and friends. My wife and I enjoy traveling, trying new foods, and taking long motorcycle rides with our friends. If I am not on the road working or with my wife, I am studying or playing softball.

 

The best part of my job is being able to show up for my team and clients; they all mean the world to me. I get to brainstorm and strategize with tons of different personalities. A lot of the team does not know, but I love learning from them. If I am not learning something about our industry or workplace, I am certainly learning how to effectively collaborate with different types of individuals.

 

Together, we can change the narrative and be a part of the solution to better treat those trapped in the problem.

Allison was born in Columbus, Ohio and was raised in South Florida. She graduated from the University of Florida’s College of Journalism and Communications. After college, Allison started working at the largest talent agency in the world, William Morris Endeavor. There, she learned marketing from top leaders specializing in global PR and endorsement campaigns, in both the Latin and English markets.

 

Through strategic public relations and creative campaign concepts, Allison has secured more than 200 national broadcast and print media placements for behavioral healthcare organizations. She brings over 15 years of marketing and PR experience, with a strong background in leading communications strategy for addiction treatment and behavioral healthcare facilities. In her role as VP of Communications, she oversees branding, public relations, social media, marketing, events, and content creation.

 

In her spare time, she loves cooking, boating, yoga, and traveling. She and her husband Bryan reside in Boca Raton, Florida.

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Avi Burstein is VP of Clinical Services at Amatus Health. He manages all therapeutic programming at all facilities nationwide.

 

Avi is originally from New York, and graduated from Ferkauf Graduate School of Psychology. He brings over 13 years of experience in the Behavioral Healthcare Industry, in both the public and private sectors. He is passionate about therapeutic communities and the fellowship they foster between patients. Through his work in LGBTQIA, urban, rural, and religiously observant populations, Avi recognizes that each patient is unique. Therefore, he strives to ensure clinical approaches, staffing, administration, and education meet the expectation of each community Amatus Health serves.

 

“Our work must also include ending the societal stigma surrounding such conditions by building safe and supportive networks that include clients’ families whenever possible,” Avi said. “By valuing change and owning imperfections, we can strive to be better providers and walk through the door of recovery with our clients.”

Avi Burstein is VP of Clinical Services at Amatus Health. He manages all therapeutic programming at all facilities nationwide.

 

Avi is originally from New York, and graduated from Ferkauf Graduate School of Psychology. He brings over 13 years of experience in the Behavioral Healthcare Industry, in both the public and private sectors. He is passionate about therapeutic communities and the fellowship they foster between patients. Through his work in LGBTQIA, urban, rural, and religiously observant populations, Avi recognizes that each patient is unique. Therefore, he strives to ensure clinical approaches, staffing, administration, and education meet the expectation of each community Amatus Health serves.

 

“Our work must also include ending the societal stigma surrounding such conditions by building safe and supportive networks that include clients’ families whenever possible,” Avi said. “By valuing change and owning imperfections, we can strive to be better providers and walk through the door of recovery with our clients.”

Marty Markovits is the Chief Information Officer at TruHealing. He oversees the people, processes, and technologies of the whole organization to ensure the business is running smoothly.

 

Markovits grew up in Brooklyn, NY (which he calls “the greatest city on Earth”) and graduated with a degree in Clinical Psychology from Queens College.

 

Markovits is a veteran in Information Technology within the healthcare field. He ensures that IT processes are simple, cost-effective, and secure. His expertise spans the entire healthcare domain, from billing and claims, to clinical, to Human Resources. He says, “My passion is to provide fully automated and operationally meaningful Business Intelligence analytics, with absolute data integrity.”

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Hometown: Savannah, GA

 

Passions & Interests: I spend my time outside of work with my wife and children and am actively involved in various community needs and causes.

 

The best part of my job is knowing that we are creating a safe, healthy, nonjudgmental environment where people can come and better their lives. There is nothing more satisfying than helping others learn to live again and piece their lives back together as they become strong, productive members of society.

Together, we can bring families back together and promote healing and well-being.

MARK GOLD, CEO OF AMATUS HEALTH BIOGRAPHY

With over 16 years of proven executive leadership and driving company growth, Mark Gold’s momentum for success isn’t slowing down anytime soon. He serves as the CEO of Amatus Health, one of the fastest-growing, behavioral healthcare organizations in the country.

Possessing an excellent handling of clinical compliance and high performance standards, Mark established 14 CARF/JCT accredited addiction and mental health treatment centers and three ancillary healthcare businesses. Mark’s natural leadership skills as well as his creative thought process to generate new revenue strategies make him one of the most sought-after professionals in healthcare. Mark has a track record of leading organizations to outstanding ROI on overall portfolio performance. In addition, his expertise includes workforce planning, growth revenue, high client and investor satisfaction.

Aside from daily business oversight, Mark invests in his staff and helps build their professional development. His commitment to his colleagues and employees toward advancement and inclusiveness helps them achieve goals, builds connections, and provides a competitive advantage in the healthcare field.

Corporate and Charitable Leadership

Mark has been instrumental in building healthy communities and providing access and quality healthcare to underserved populations. His service in the community is a testament to his passion and selfless dedication to the cause of eradicating addictive disorders and stigma.

He launched several prevention and education programs and created the first-ever “Social Justice” scholarship fund of over $750,000.00 to help communities of color into inpatient drug treatment. Mark says, “The best part of my role is the knowledge that what we do impacts countless lives, with far-reaching effects,” he said. “It is incredibly rewarding to be part of a team that guides individuals onto a safe and accessible path to healing and recovery.”

He is a board member of Ahavas Chaim, a non-profit that offers at-risk teenagers crisis intervention and mental health support. He is also a committee member of the organizations Bonei Olam and Chai Lifeline Mid-Atlantic.

Personal and Educational Background

Mark studied Talmudic Law at Yeshiva’s Mir Yerushalayim in Israel. In Mark’s free time, he loves snowboarding, boating, and spending time with his wife and children.