In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

The aching emptiness is perpetual because the substances, objects, or pursuits we hope will soothe it are not what we really need. We don’t know what we need, and so long as we stay in the hungry ghost mode, we’ll never know. We haunt our lives without being fully present.

The research literature is unequivocal: most hard-core substance abusers come from abusive homes.5 The majority of my skid row patients suffered severe neglect and maltreatment early in life. Almost all the addicted women inhabiting the Downtown Eastside were sexually assaulted in childhood, as were many of the men.

As I’ve written elsewhere, it was easy for me to justify all the spending as compensation for the hard work I was doing: one addiction providing an alibi for the other.

Any passion can become an addiction; but then how to distinguish between the two? The central question is: who’s in charge, the individual or their behavior?

Medical evidence has repeatedly shown that opioids prescribed for cancer pain, even for long periods of time, do not lead to addiction except in a minority of susceptible people.

Thus, we might say that three factors need to coincide for substance addiction to occur: a susceptible organism; a drug with addictive potential; and stress.

This is the so-called placebo effect, which, far from being imaginary, is a genuine physiological event. The medication may be inert, but the brain is soothed by its own painkillers, the endorphins.

I didn't know that's how the placebo effect worked! Very interesting.

The brain structures for conscious recall develop during the first years of life, and aspects of the implicit memory system, which stores emotional memories, are present at birth. (And if they are present then, they likely existed before, as well.)

As we became a two-legged species, the human pelvis had to narrow to accommodate our upright stance. At the end of the nine months of human gestation the head forms the largest diameter of the body, the one most likely to get stuck in our journey through the birth canal. It’s simple engineering: any further brain growth in the uterus and we couldn’t be born.

In a very real sense, the parent’s brain programs the infant’s, and this is why stressed parents will often rear children whose stress apparatus also runs in high gear, no matter how much they love their child and no matter that they strive to do their best.

Well that's horrifying.

Far from being the autonomous dictators of our destinies, genes are controlled by their environment, and without environmental signals they could not function.

This was also a new idea for me. I feel like I should read more about the interplay of genetics and environment.

It serves a deeply conservative function: if a phenomenon like addiction is determined mostly by biological heredity, we are spared from having to look at how our social environment supports, or does not support, the parents of young children and at how social attitudes, prejudices, and policies burden, stress, and exclude certain segments of the population and thereby increase their propensity for addiction.

If freedom truly is another word for nothing left to lose, the hard-core hungry ghosts inhabiting Vancouver’s skid row are very free indeed.

If children today are at greater risk for obesity than those of previous generations, it’s not simply because they’re less physically active as a result of being absorbed in TV or computers. It’s primarily because under ordinary peacetime conditions there has never before been a generation so stressed and so starved of nurturing adult relationships.

In a person with addictive behaviors, the orbitofrontal cortex and its associated neurological systems have been tricked from childhood onward into valuing false wants above real needs

In short, the addiction process takes hold in people who have suffered dislocation, whose place in the normal human communal context has been disrupted—whether they’ve been abused or emotionally neglected or whether they’re inadequately attuned children or peer-oriented teens or members of subcultures historically subjected to exploitation.

The War on Drugs fails—and is doomed to perpetual failure—because it is directed not against the root causes of drug addiction or of the international black market in drugs, but only against some drug producers, traffickers, and users.

Moralizing displaces compassion, and prejudice substitutes for inquiry.

I don’t believe that the vested interests of medical professionals are, in this case, consciously selfish or motivated by material considerations; they are the investment we have in maintaining that our way of thinking is right, that the principles and methods we have practiced are sound, and that approaches outside our emotional or intellectual comfort zones are not worth investigating.

For example, for many decades in the United Kingdom, heroin has been dispensed, under legal supervision, to addicts. The same type of program has been offered on a limited basis in other countries as well, and nowhere has it been found that this measure served in any way to entice unaddicted people into addiction. That is not surprising, given that addiction is a response to life experience, not simply to a drug.

The criminality associated with addiction follows directly from the need to raise money to purchase drugs at prices that are artificially inflated owing to their illegality.

we do not make our valuation of addicts as worthwhile human beings dependent on their making choices that please us.

As of this writing, the U.S. government refuses to support needle exchange programs on the grounds that it encourages addiction, as if the addict were just waiting for federally funded clean needles to embark upon and maintain his habit.

A harm reduction program does not “fight addiction”—whatever that means. It only reduces misery and prevents death and disease.

Family, friends, and spouse may feel they are dealing with a double personality: one sane and loveable, the other devious and uncaring. They believe the first is real and hope the second will go away. In truth, the second is the shadow side of the first and will no sooner leave than will a shadow abandon the object whose shape it traces on the ground—not unless the light comes from a different angle.

“There are no techniques that will motivate people or make them autonomous,” psychologist Edward Deci has written. “Motivation must come from within, not from techniques. It comes from their deciding they are ready to take responsibility for managing themselves.”

“More than twice as many families succeeded in getting their loved ones into treatment (64 percent) with the gentler approach than with standard intervention (30 percent).

Before any intervention in the life of another, we need to ask ourselves: How am I doing in my own life?

Around this section there's a strong focus on spirituality as a means of overcoming addiction. There is a lot here that lines up with Christianity and other religions. "Judge not lest ye be judged".

In emergency rooms I have witnessed scenarios get completely out of hand to the point where security personnel are called to escort a hostile addict out of the hospital, and yet my observation was that the escalation could have been averted had some of the hospital staff not allowed themselves to become triggered.

It is often asserted, cynically, that people who act in kindly ways, without any benefit to themselves, are doing so only to feel good. Neuroscience does not support that view: the brain area that lights up as a person performs an altruistic act is not the circuitry activated by pleasure or by the anticipation of reward.

If the prevalence of ADHD and other childhood developmental problems is rising in our society, it is not because of “bad parenting” but because the burgeoning stresses on the parenting environment appear to increase with each successive generation. Parents, and mothers in particular, are getting less and less of the support they need during their children’s early years. The issue is not one of individual parental failure but rather of a social and cultural breakdown of cataclysmic proportions.

As human beings, most of us are far away from attaining perfect saintliness in all our behaviors and interactions, and therefore we can afford to give up the process of moral self-inventory only when they lower us into the ground. Until then, we’ll keep having to do the laundry.