‘Fossil Fuel Use Disorder’ Is Killing Us

During my addiction medicine rotation, I learned the DSM criteria for substance use disorders. I found that tobacco use, alcohol use, and opioid use disorders cost the U.S. health care system $225 billion, $250 billion, and $90 billion a year, respectively.

More recently, I learned that the impact of another addictive substance is expected to exceed all the above substance use disorder costs combined, to the tune of over $800 billion a year in direct medical expenses. Fossil fuel use disorder is destroying the climate and killing us.

How can it be that the most severe, consequential addiction in human history is not in DSM? I humbly, and only mildly facetiously, propose that DSM-6 include “fossil fuel use disorder.” Based on current DSM-5-TR criteria, representative criteria could look like this:

In the past year, have you

The presence of at least two of these symptoms indicates fossil fuel use disorder, with severity dependent on symptom number. I myself have fossil fuel use disorder, severe.

The chemical basis for this disorder is rooted in the energy density of fossil fuels. My Toyota Prius gets 52 miles per gallon. It would take me six months walking 25 miles a day with a 75-pound backpack to move an equivalent weight that far. This energy density has ensured that fossil fuels are dependence forming; if we come to terms with the dependence, however, viable alternative energy forms are available.

The socioeconomic basis that let this disorder grow into a crisis is rooted in the human response to economic incentives within the context of the largest market failure in human history (market failure is a technical economic term, which in this case refers to the fact that the pollution costs are not captured in fossil fuel prices). The five largest private sector oil companies made $200 billion in profits in 2022. It is no surprise that the industry has been fighting for decades to protect its cash cow from CO2 and methane emissions regulation.

To expand their markets in the early 20th century, the oil industry found a “killer app” in automobiles. Standard Oil, the parent organization of Chevron and Exxon, helped eliminate the electric streetcar industry to increase car ownership. When John Rockefeller, founder of Standard Oil, was asked, “How much is enough?,” he reportedly answered, “Just a little bit more.” These efforts contributed to enormous economic growth and cheap mobility, enabling the development of suburbs and commuter lifestyles.

To extend its run of profits, the industry has hired lobbyists and funded think tanks to inject a false sense of climate science uncertainty into public discourse. They have successfully delayed any meaningful action. Interestingly, several key individuals orchestrating these disinformation campaigns also previously worked with big tobacco to inject uncertainty into the now-laughable “debate” about health impacts of smoking.

In summary, human greed and the profit imperative inherent to capitalism, intertwined in a century-long market failure, are at the root of the climate emergency. This emergency is expected to result in more than 250 million climate refugees in the next 30 years. The number of deaths remains to be determined although extended heat wave events paired with power grid failures portend mass casualty events.

Effective treatment entails two actions: adaptation and mitigation. Both are essentially forms of harm reduction, considering that we will be reliant on fossil fuels for decades to come.

Adaptation includes strategies such as strategic retreat from coastlines, preparing for mass climate migration, bioengineering crops to survive in a warmer world, and implementing strategies to dim sunlight to give us more time to try to dig ourselves out of this catastrophic mess. These geoengineering projects represent a form of codependency, extending our addiction and withdrawal process.

Mitigation involves reducing greenhouse gas emissions. Examples include replacing fossil fuel power plants with renewables, developing “greener” steel and cement, capturing carbon, electrifying the transportation sector, retrofitting buildings, and engaging politically to effect change. The list is endless.

Individual efforts are useful for role modeling (and, for some, virtue signaling) but have at most a muted impact. More importantly, it is essential that we overcome our denial and fear and begin talking about this addiction daily. It is essential that we advocate for change by writing to our politicians and leaning in rather than hanging out. It is essential that we all decide to do something, today, tomorrow, and the next day for the rest of our lives. Addiction is a relapsing-remitting condition and it must always be on the front burner (pardon the natural gas pun). If we do not do so, we choose surplus suffering.

Suffering is self-explanatory, especially to those who follow the news on a regular basis. The more mitigation and adaptation we do, the less suffering we will collectively experience.

My goal over the next few years is to reduce my fossil fuel use disorder from severe to moderate. As an environmental psychiatrist, I also am prepared to assist my patients with the emotional complexity associated with the climate emergency.

What is your goal? This challenge requires all hands on deck. To paraphrase Ben Franklin, we must all hang together or most assuredly we will all broil alone. ■