Gray Areas in Gambling & Alcohol Use with Dr. Carl Erik Fisher

In this episode of Alcohol Minimalist, Molly speaks once again with Dr. Carl Erik Fisher, an addiction psychiatrist, author, and person in recovery, to discuss the complexities of addiction beyond just alcohol. We explore the fascinating (and often overlooked) intersection between behavioral addictions—like gambling—and substance use disorders.

Dr. Fisher recently penned a compelling piece for The New York Times about the public health consequences of gambling addiction, especially in light of the recent surge in sports betting. He shares insights on why we need to move beyond a binary approach to addiction—where you’re either "an addict" or "fine"—and instead recognize the spectrum of harmful behaviors that can impact anyone.

They also discuss:
✅ How gambling and alcohol addiction share common psychological patterns
✅ Why addiction isn’t just about loss of control but also about societal and environmental influences
✅ The impact of marketing and corporate interests in promoting problematic behaviors
✅ How our cultural narratives around addiction shape recovery and treatment options
✅ Practical ways to rethink our own habits and reduce harm

Dr. Fisher’s expertise and thoughtful perspective challenge conventional ideas about addiction and highlight why we need a more nuanced public health approach to substance use and compulsive behaviors. If you’ve ever wondered where you fit on the spectrum of alcohol use—or how to better navigate your relationship with alcohol—this episode is for you.

About Dr. Carl Erik Fisher:

Dr. Carl Erik Fisher is an addiction physician, bioethicist, writer, and person in long-term recovery. He is an associate professor of clinical psychiatry at Columbia University and author of The Urge: Our History of Addiction, which was named one of the best books of the year by The New Yorker and The Boston Globe. His work has been featured in The New York Times, The Washington Post, The Guardian, and Scientific American Mind. Dr. Fisher also hosts Flourishing After Addiction and runs the Rat Park newsletter on Substack.

Links & Resources:

📖 Dr. Carl Erik Fisher’s Book: The Urge: Our History of Addiction
🎙️ Flourishing After Addiction Podcast: Listen Here
📩 Subscribe to Carl’s Substack, Rat Park: Join Here

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Low risk drinking guidelines from the NIAAA:

Healthy men under 65:

No more than 4 drinks in one day and no more than 14 drinks per week.

Healthy women (all ages) and healthy men 65 and older:
No more than 3 drinks in one day and no more than 7 drinks per week.

One drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor. So remember that a mixed drink or full glass of wine are probably more than one drink.

Abstinence from alcohol
Abstinence from alcohol is the best choice for people who take medication(s) that interact with alcohol, have health conditions that could be exacerbated by alcohol (e.g. liver disease), are pregnant or may become pregnant or have had a problem with alcohol or another substance in the past.

Benefits of “low-risk” drinking
Following these guidelines reduces the risk of health problems such as cancer, liver disease, reduced immunity, ulcers, sleep problems, complications of existing conditions, and more. It also reduces the risk of depression, social problems, and difficulties at school or work.

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