In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

What is addiction, really? It is a sign, a signal, a symptom of distress. It is a language that tells us about a plight that must be understood.

This is the domain of addiction, where we constantly seek something outside ourselves to curb an insatiable yearning for relief or fulfillment. 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.

We may (and do) hope that people can be liberated from the demons that haunt them and work to encourage them in that direction, but we don’t fantasize that such psychological exorcism can be forced on anyone.

Much as I want to accept them, at least in principle, some days I find myself full of disapproval and judgment, rejecting them and wanting them to be other than who they are. That contradiction originates with me, not with my patients. It’s my problem—except that, given the obvious power imbalance between us, it’s all too easy for me to make it their problem.

people jeopardize their lives for the sake of making the moment livable. Nothing sways them from the habit—not illness, not the sacrifice of love and relationship, not the loss of all earthly goods, not the crushing of their dignity, not the fear of dying. The drive is that relentless.

Like patterns in a tapestry, recurring themes emerge in my interviews with addicts: the drug as emotional anesthetic; as an antidote to a frightful feeling of emptiness; as a tonic against fatigue, boredom, alienation, and a sense of personal inadequacy; as stress reliever and social lubricant.

Dismissing addictions as “bad habits” or “self-destructive behavior” comfortably hides their functionality in the life of the addict.1 VINCENT FELITTI, MD

Far more than a quest for pleasure, chronic substance use is the addict’s attempt to escape distress. From a medical point of view, addicts are self-medicating conditions like depression, anxiety, post-traumatic stress, or even attention deficit/hyperactivity disorder (ADHD).

Addictions always originate in pain, whether felt openly or hidden in the unconscious. They are emotional anesthetics.

The question is never “Why the addiction?” but “Why the pain?”

Not all addictions are rooted in abuse or trauma, but I do believe they can all be traced to painful experience. A hurt is at the center of all addictive behaviors.

When we have nothing to occupy our minds, bad memories, troubling anxieties, unease, or the nagging mental stupor we call boredom can arise. At all costs, drug addicts want to escape spending “alone time” with their minds.

Boredom, rooted in a fundamental discomfort with the self, is one of the least tolerable mental states.

The meaning of all addictions could be defined as endeavors at controlling our life experiences with the help of external remedies.… Unfortunately, all external means of improving our life experiences are double-edged swords: they are always good and bad. No external remedy improves our condition without, at the same time, making it worse. THOMAS HORA, MD Beyond the Dream: Awakening to Reality

Addictions, even as they resemble normal human yearnings, are more about desire than attainment. In the addicted mode, the emotional charge is in the pursuit and the acquisition of the desired object, not in the possession and enjoyment of it. The greatest pleasure is in the momentary satisfaction of yearning.

The fundamental addiction is to the fleeting experience of not being addicted. The addict craves the absence of the craving state. For a brief moment he’s liberated from emptiness, from boredom, from lack of meaning, from yearning, from being driven or from pain. He is free.

If in doubt, ask yourself one simple question: given the harm you’re doing to yourself and others, are you willing to stop? If not, you’re addicted. And if you’re unable to renounce the behavior or to keep your pledge when you do, you’re addicted.

My relationship with Rae loses vitality. Because my internal world is dominated by obsession, I have little to say, and what I do say rings hollow in my own ears. Because my attention is pulled inward, the interest I offer her becomes dutiful, rather than genuine. When I’m in one of my addictive cycles, it’s almost as if I were engaged in a sexual affair, with all the attendant obsession, lying, and manipulation. Above all, I’m absent. It’s impossible to be fully present when you’re putting up walls to keep from being seen. Intimacy and spontaneity are sacrificed. Something’s got to give, and it does—sometimes for days, sometimes for weeks and months.

“An addict continues to use a drug when evidence strongly demonstrates the drug is doing significant harm.… If users show the pattern of preoccupation and compulsive use repeatedly over time with relapse, addiction can be identified.”

Addiction is any repeated behavior, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others. Addiction involves: compulsive engagement with the behavior, a preoccupation with it; impaired control over the behavior; persistence or relapse despite evidence of harm; and dissatisfaction, irritability, or intense craving when the object—be it a drug, activity, or other goal—is not immediately available.

“Dependence” can also be understood as a powerful attachment to harmful substances or behaviors, and this definition gives us a clearer picture of addiction. The addict comes to depend on the substance or behavior in order to make himself feel momentarily calmer or more excited or less dissatisfied with his life.

In the cloudy swirl of misleading ideas surrounding public discussion of addiction, there’s one that stands out: the misconception that drug taking by itself will lead to addiction—in other words, that the cause of addiction resides in the power of the drug over the human brain.

“Addiction is a human problem that resides in people, not in the drug or in the drug’s capacity to produce physical effects,” writes Lance Dodes, a psychiatrist at the Harvard Medical School Division on Addictions.4 It is true that some people will become hooked on substances after only a few times of using, with potentially tragic consequences, but to understand why, we have to know what about those individuals makes them vulnerable to addiction. Mere exposure to a stimulant or narcotic or to any other mood-altering chemical does not make a person susceptible. If she becomes an addict, it’s because she’s already at risk.

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

Dopamine receptor availability is also reduced in alcoholics, as well as in heroin and crystal meth addicts.

“Recent studies have shown that repeated drug use leads to long-lasting changes in the brain that undermine voluntary control,”

That’s it—the neurobiology of addiction in a nutshell. Attacking energy, expressed as tantrums or aggression, rapidly erupts from a young child because the brain circuits that would allow him to resolve his frustrations in other ways are as yet unformed. The impulse-control circuitry isn’t connected yet, either.

Peer-reared monkeys separated from their mothers in laboratory experiments have lower lifelong levels of serotonin than do monkeys brought up by their mothers. In adolescence these same monkeys are more aggressive and are far more likely to consume alcohol in excess.

Alcohol consumption has a similar pattern: those who had suffered sexual abuse were three times more likely to begin drinking in adolescence than were those who had not. For each emotionally traumatic childhood circumstance, there is a two- to threefold increase in the likelihood of early alcohol abuse. “Overall, these studies provide evidence that stress and trauma are common factors associated with consumption of alcohol at an early age as a means to self-regulate negative or painful emotions,”17 write the ACE researchers.

Exposure to stress is the most powerful and reliable experimental manipulation used to induce reinstatement of alcohol or drug use,” one team of researchers reports.

as dopamine function decreases.34 The research literature has identified three factors that universally lead to stress for human beings: uncertainty, lack of information, and loss of control. 35 To these we may add conflict that the organism is unable to handle and isolation from emotionally supportive relationships

We human beings don’t like feeling responsible: as individuals for our own actions; as parents for our children’s hurts; or as a society for our many failings. Genetics—that neutral, impassive, impersonal handmaiden of Nature—would absolve us of responsibility and of its ominous shadow, guilt. If genetics ruled our fate, we would not need to blame ourselves or anyone else.

People are susceptible to the addiction process if they have a constant need to fill their minds or bodies with external sources of comfort, whether physical or emotional. That need expresses a failure of self-regulation—an inability to maintain a reasonably stable internal emotional atmosphere.

Functional differentiation refers to a person’s ability to function based on external factors. The less basic differentiation a person has attained, the more prone he is to rely on relationships to maintain his emotional balance. When relationships fail to sustain such people, they may turn to addiction as the emotional crutch.

These, then, are the traits that most often underlie the addiction process: poor self-regulation, lack of basic differentiation, lack of a healthy sense of self, a sense of deficient emptiness, and impaired impulse control.

The addictive personality is a personality that hasn’t matured.

How, then, is the “choice” made? Why self-improvement or blogging in my son’s case and why sex or gambling for someone else? Why does buying compact discs set my dopamine circuits into action and why compulsive work? I put that question to Dr. Aviel Goodman, the authority on sexual addictions I’ve mentioned in earlier chapters. “It has a lot to do with which experience brings relief from whatever pains us,” he said. “For a lot of people something like compact discs would not be high on the list, but my guess is that music means something deep for you, that for you it’s a profound emotional experience.”

When, owing to internal demons arising from their own childhoods or to external stressors in their lives, parents are unable to regulate—that is, keep within a tolerable range—the emotional milieu of the infant, the child’s brain has to adapt: by tuning out, by emotional shutting down, and by learning to find ways to self-soothe through rocking, thumb-sucking, eating, sleeping, or constantly looking to external sources of comfort. This is the ever-agitated, ever-yawning emptiness that lies at the heart of addiction.

The small child’s natural response to overwhelming emotional loss is a defensive shutdown. I’ve had a lifelong resistance to receiving love—not to being loved or even to knowing intellectually that I am loved, but to accepting love vulnerably and openly on a visceral, emotional level. People who cannot find or receive love need to find substitutes—and that’s where addictions come in.

Music is a source of beauty and meaning outside myself that I can claim as my own without exploring how, in my life, I keep from directly experiencing those qualities. Addiction, in this sense, is the lazy pilgrim’s path to transcendence.

Except in rare cases of physical disease, the more obese a person is, the more emotionally starved they have been at some crucial period in their life.

Invariably, people who eat too much have not only suffered emotional loss in the past but are also psychically deprived or highly stressed in the present.

“Replacing a negative emotion with a positive one is the core of addictive behavior.”2

A person with good self-regulation will not experience rapidly shifting extremes of emotional highs and lows in the face of life’s challenges, difficulties, disappointments, and satisfactions. She does not depend on other people’s responses or external activities or substances in order to feel okay. The person with poor self-regulation is more likely to look outside herself for emotional soothing, which is why the lack of attunement in infancy increases addiction risk.

Proximate separation happens when attuned contact between parent and child is interrupted due to stresses that draw the parent away from the interaction.

The addict is never satisfied. His spiritual and emotional condition is one of impoverishment, no matter how much he achieves, acquires, or possesses. In the hungry-ghost mode, we can never be satiated. Scruples vanish in the face of the addictive “need”—hence the ruthlessness. Loyalty, integrity, and honor lose meaning.

Addicts respond with rage toward anyone who tries to deprive them of their drug, and that rage is fueled by intense frustration.

Addiction is always a poor substitute for love.

“What characterizes an addiction?” asks the spiritual teacher Eckhart Tolle. “Quite simply this: you no longer feel that you have the power to stop. It seems stronger than you. It also gives you a false sense of pleasure, pleasure that invariably turns into pain.”1

“Peer affiliation,” in the words of a review article in the journal Drug and Alcohol Dependence, “is possibly the strongest social factor in predicting the onset and early escalation of adolescent substance use.”