In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

It is commonly thought that peer affiliation leads to drug use because kids set bad examples for each other. That’s part of the picture, but a deeper reason is that under ordinary circumstances, adolescents who rely on their peers for emotional acceptance are more prone to being hurt, to experiencing the sting of each other’s immature and therefore often insensitive ways of relating. They are far more stressed than are children who are well connected to nurturing adults.

“It’s a subtle thing, freedom. It takes effort; it takes attention and focus to not act something like an automaton. Although we do have freedom, we exercise it only when we strive for awareness, when we are conscious not just of the content of the mind but also of the mind itself as a process.”

We may say, then, that in the world of the psyche, freedom is a relative concept: the power to choose exists only when our automatic mental mechanisms are subject to those brain systems that are able to maintain conscious awareness.

“Addicts become addicts because they develop these habit structures which become totally focused on nontraditional rewards, drug rewards. They get hooked and they can’t break out of that psychological imprisonment.”

Addicts, all but the very few completely sociopathic ones, are deeply self-critical and harsh with themselves. They are keenly sensitive to judgmental tones in others and respond with withdrawal or defensive denial. Worse, morally judging others clouds our eyes not only to their needs, but to our own true needs as well.

If we are to help addicts, we must strive to change not them but their environments. These are the only things we can change. Transformation of the addict must come from within, and the best we can do is to encourage it. Fortunately, there is much that we can do.

addictive habits are too deeply entrenched in the brain of the hard-core substance user to be overcome by a simple act of will.

When you’re operating in the habit mode you are feeling, but those feelings are not being reflected upon. They are too powerful, they are too habitual. So, the treatment of addiction requires the island of relief where a need to soothe pain does not constantly drive a person’s motivation. It requires a complex and supportive social environment.”

If we want to support people’s potential for healthy transformation, we must cease to impose debilitating stress on their already-burdened existence.

The addict is retraumatized over and over again by ostracism, harassment,

Addicts should not be coerced into treatment, since in the long term coercion creates more problems than it solves.

Halsted’s story is revealing not only because it shows that with a morphine addiction the proper maintenance dose can be productive. It also illustrates the incredible power of the drug in question. Here was a man with almost unlimited resources—moral, physical, financial, medical—who tried everything he could think of and he was hooked until the day he died. Today we would send a man like that to prison. Instead he became the father of modern surgery.9

“We really need … and I know it sounds kind of corny … we need to be very loving, very accepting, and very patient with people who have these problems. And if we are, they will have a much higher probability of getting better.”

Among the necessary initial moves toward sobriety is the directing of compassionate curiosity at oneself.

When a person is encouraged to get in touch with and express his deepest feelings in the secure knowledge that he will not be rejected, criticized, nor expected to be different, some kind of rearrangement or sorting-out process often occurs within the mind which brings with it a sense of peace; a sense that the depths of the well of truth have really been reached.

That is, “I fully acknowledge that my cravings and behaviors have been out of control and that my inability to regulate them has led to dysfunction and chaos in important areas of my life. I no longer deny their impact on myself or my coworkers or my loved ones, and I admit my failure to confront them honestly and consistently.”

Finally, whenever I have felt wooden or alienated in the intimate areas of life, I’ve seen myself as deprived, rather than owning the reality that I create the sense of deprivation internally. For example, I have blamed my wife, Rae, for not satisfying my expectations instead of taking responsibility for the burdens I impose on our relationship through poor self-regulation and lack of differentiation (my capacity to hold on to a sense of self while interacting with Rae and others). That leaves me free to use the addictions for self-soothing and to justify doing so by citing my “unmet” needs. In other words, the consequences of my own willful refusal to be a mature, self-regulating adult became my rationale for pursuing addictive behaviors. As I write about this, the image of a whirling puppy snapping at its own tail comes to mind.

Boom.

Healing, then, must take into account the internal psychological climate—the beliefs, memories, mind-states, and emotions that feed addictive impulses and behaviors—as well as the external milieu. In an ecological framework recovery from addiction does not mean a “cure” for a disease but the creation of new resources, internal and external, that can support different, healthy ways of satisfying one’s genuine needs. It also involves developing new brain circuits that can facilitate more adaptive responses and behaviors.

So there are two ways of promoting healthy brain development, and both are essential to the healing of addiction: by changing the external environment and by modifying the internal one.

“The way in which a person directs their attention (i.e., mindfully or unmindfully) will,” they write, “affect both the experiential state of the person and the state of his/her brain.”10

Mindful awareness involves directing our attention not only to the mental content of our thoughts, but also to the emotions and mind-states that inform those thoughts. It is being aware of the processes of our mind even as we work through its materials. Mindful awareness is the key to unlocking the automatic patterns that fetter the addicted brain and mind.

The dominant emotions suffusing all addictive behavior are fear and resentment—an inseparable vaudeville team of unhappiness.

According to the psychologist and memory researcher Daniel Schacter, implicit memory is active “when people are influenced by past experience without any awareness that they are remembering.… If we are unaware that something is influencing our behavior, there is little we can do to understand or counteract it.

Many addicts define themselves through their addictions and feel quite unmoored and lost without them. Substance-dependent people do this, but so do workaholics and other behavior addicts. They fear giving up their addiction not only because of the temporary relief it offers but also because they just cannot conceive who they might be without it.

Yet human beings who are able to direct conscious attention toward their mental processes discover something surprising: it’s not what happened in the past that creates our present misery but the way we have allowed past events to define how we see and experience ourselves in the present.

In step one you label the addictive thought or urge exactly for what it is, not mistaking it for reality.

Step Two: Reattribute “In Re-attribute you learn to place the blame squarely on your brain. This is my brain sending me a false message.”4 This step is designed to assign the relabeled addictive urge to its proper source. In step one you recognized that the compulsion to engage in the addictive behavior does not express a real need or anything that “must” happen; it’s only a belief. In step two you state very clearly where that urge originated: in neurological circuits that were programmed into your brain long ago, when you were a child. It represents a dopamine or endorphin “hunger” on the part of brain systems that, early in your life, lacked the necessary conditions for their full development.

Step Three: Refocus In the refocus step you buy yourself time. Although the compulsion to open the bag of cookies or turn on the TV or drive to the store or the casino is powerful, its shelf life is not permanent. Being a mind-phantom, it will pass, and you have to give it time to pass. The key principle here, as Dr. Schwartz points out, is this: “It’s not how you feel that counts; it’s what you do.” Rather than engage in the addictive activity, find something else to do. Your initial goal is modest: buy yourself just fifteen minutes.

The purpose of refocusing is to teach your brain that it doesn’t have to obey the addictive call. It can exercise the “free won’t.” It can choose something else.

Step Four: Revalue This step should really be called devalue. Its purpose is to help you drive into your own thick skull just what has been the real impact of the addictive urge in your life: disaster.

It’s because of the negative impact that you’ve taken yourself by the scruff of the neck and delayed acting on the impulse while you’ve relabeled and reattributed it and while you have refocused on some healthier activity. In this revalue step you will remind yourself why you’ve gone to all this trouble. The more clearly you see how things are, the more liberated you will be.

Do all this without judging yourself. You are gathering information, not conducting a criminal trial against yourself.

Dr. Schwartz introduces what he calls the two As: anticipate and accept. To anticipate is to know that the compulsive drive to engage in addictive behavior will return. There is no final victory—every moment the urge is turned away is a triumph. What is certain is that with time the addictive drive will be drained of energy if you continue to apply the four steps and also take care of the internal and external environments in the ways suggested in these chapters.

Step Five: Re-create Life, until now, has created you. You’ve been acting according to ingrained mechanisms wired into your brain before you had a choice in the matter, and it’s out of those automatic mechanisms that you’ve created the life you now have. It is time to re-create: to choose a different life.

There are two ways of abstaining from a substance or behavior: a positive and even joyful choice for something else that has a greater value for you or a forced decision to stay away from something you crave and are spontaneously attracted to. This second type of abstinence, while it requires admirable fortitude and patience, can still be experienced in a negative way and contains a hidden danger. Human beings have an ingrained opposition to any sense of being forced, an automatic resistance to coercion that my friend Dr. Gordon Neufeld has called counterwill. It is triggered whenever a person feels controlled or pressured to do someone else’s bidding—and we can generate counterwill even against pressure that we put on ourselves.

The addict hasn’t grown out of the stage of infancy that has been called the narcissistic phase, the period when the fledgling human being believes that everything happens because of her, to her, and for her. Her own selfish needs are her only point of reference. We move through stages of development when the needs we have in each are fully satisfied. Then the brain can let go. The addicted mind never lets go.

My advice to anyone with addictive behaviors is to begin telling the truth. If you are not ready to drop the behavior, then choose it openly. Tell your spouse or friends what you are doing; keep it in the daylight. At the very least, do not compound your inner shame by lying. Better you should look “bad” in the eyes of others than to sink further in your own estimation of yourself.

And I’ve found another, unlooked-for benefit: just as the addiction process permeates every area of your existence, so does sobriety. As you become less attached to your addiction, you also become calmer, less attached to other things that don’t matter nearly as much as you used to believe.

The person attached to his addiction will respond to an attempt to separate him from his habit as a lover would to someone who disparages his beloved: with hostility. Any attempts to shame him will also trigger rage. Until a person is willing to take on the task of self-mastery, no one else will induce him to do so. “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.”1

A1999 study compared confrontation with a method employing a nurturing attitude by the family. “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).

Family, friends, and partners of addicts sometimes have only one reasonable decision in front of them: either to choose to be with the addict as she is or to choose not to be with her. No one is obliged to put up with unreliability, dishonesty, and emotional withdrawal—the ways of the addict. Unconditional acceptance of another person doesn’t mean staying with them under all circumstances, no matter what the cost to oneself; that duty belongs only to the parents of a young child.

A therapist once said to me, “When it comes to a choice between feeling guilt or resentment, choose the guilt every time.”

Leaving the addict or staying in the relationship is a choice no person can make for anyone else, but to stay with him while resenting him, mentally rejecting him, and punishing him emotionally, or even just subtly trying to manipulate him into “reform,” is always the worst course. The belief that anyone “should” be any different than he or she is is toxic to oneself, to the other, and to the relationship.

It requires clarity of purpose: Is my aim here to set my limits and to express my needs, or am I trying to change the other person? You may find it necessary, say, to tell your spouse or adult child about the negative way their actions affect you—not in order to control or blame them, only to communicate what you will accept and what you cannot and will not live with.

If you want to point the addict toward more fulfilling possibilities in his life, drop the self-righteousness. The conversation needs to be opened not as a demand, but as an invitation that may be refused.

AlAnon, the self-help group for the relatives of alcoholics, points out that alcoholism is a family disease—all addictions are—and therefore the whole family needs healing. Addiction represents a family condition not just because the behaviors of the addict have an unhealthy impact on those around him, but more profoundly because something in the family dynamic has probably contributed—and continues to contribute—to the addict’s acting out. While his behaviors are fully his responsibility, the more people around him who can shoulder responsibility for their own attitudes and actions without blaming and shaming the addict, the greater is the likelihood that everyone will come to a place of freedom.

The addict’s childish behaviors and immature emotional patterns virtually invite people around him to take on the role of the stern parent. It’s not a genuine invitation, and anyone who accepts it, no matter how well intentioned, will soon find herself resisted. No relationship can survive in a healthy form when either partner puts himself or herself in a position of being opposed and resented.

“I can find only three kinds of business in the universe: mine, yours, and God’s,” says the self-work teacher Byron Katie in her book Loving What Is, which deserves to be high on the reading list of anyone who is in a close relationship with an addict. “For me,” Katie writes, “the word God means reality. Anything that’s out of my control, your control, and everyone else’s control—I call that God’s business.”

The sparser the innate joy that springs from being alive, the more fervently we seek joy’s pale substitute, pleasure; the less our inner strength, the greater our craving for power; the feebler our awareness of truth, the more desperate our search for certainty outside of ourselves. The greater the dread, the more vigorous the gravitational pull of the addiction process.

As a consequence of that defensive shutdown, says the psychologist and spiritual teacher A. H. Almaas, one or more essential qualities such as love, joy, strength, courage, or confidence may be suppressed. In its place, we experience a hole, a sense of empty deficiency. “People don’t know that the hole, the sense of deficiency, is a symptom of a loss of something deeper, the loss of essence, which can be regained. They think the hole, the deficiency, is how they really are at the deepest level and that there is nothing beyond it. They think something is wrong with them, something is basically wrong.”