In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

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? It’s possible to rule a passion, but an obsessive passion that a person is unable to rule is an addiction. And the addiction is the repeated behavior in which a person keeps engaging, even though he knows it harms himself or others. How it looks externally is irrelevant. The key issue is a person’s internal relationship to the passion and its related behaviors.

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. There is, of course, a deeper, more ossified layer beneath any kind of addiction: the denial state in which, contrary to all reason and evidence, you refuse to acknowledge that you’re hurting yourself or anyone else. In the denial state you’re completely resistant to asking yourself any questions at all. But if you want to know, look around you. Are you closer to the people you love after your passion has been fulfilled or more isolated? Have you come more truly into who you really are, or are you left feeling hollow?

Passion is generous because it’s not ego-driven; addiction is self-centered. Passion gives and enriches; addiction is a thief. Passion is a source of truth and enlightenment; addictive behaviors lead you into darkness. You’re more alive when you are passionate, and you triumph whether or not you attain your goal. But an addiction requires a specific outcome that feeds the ego; without that outcome, the ego feels empty and deprived. A consuming passion that you are helpless to resist, no matter what the consequences, is an addiction.

In addiction, there’s no joy, freedom, or assertion. The addict lurks shamefaced in the shadowy corners of her own existence.

Addiction is passion’s dark simulacrum and, to the naive observer, its perfect mimic. It resembles passion in its urgency and in the promise of fulfillment, but its gifts are illusory. It’s a black hole. The more you offer it, the more it demands. Unlike passion, its alchemy does not create new elements from old. It only degrades what it touches and turns it into something less, something cheaper.

The hit musical Little Shop of Horrors offers a brilliant metaphorical image of addiction. Seymour, a little nebbish of a flower shop clerk (played most famously in the 1986 film version by Rick Moranis) takes pity on a “strange and unusual” little plant that’s dying of malnutrition. It brings the shop some much-needed business, but there’s a problem. No one can figure out what the plant, named Audrey II after Seymour’s sweetheart, needs for nourishment until one night Seymour accidentally pricks a finger and the plant hungrily swallows the drops of blood dripping from the wound. Only temporarily appeased, the plant wants more, and Seymour dutifully offers up another dose of his precious plasma. The plant then takes on a personality and voice of its own. Piteously the little plant pleads and cajoles, promising to be Seymour’s slave. But then it issues an abrupt command: “Feed me, Seymour!” Terrified, Seymour does as he’s told. The plant thrives and becomes huger and hungrier, and Seymour weakens and becomes anemic—morally, as well as physically. When it looks as if he’s going to be bled (literally) dry, Seymour stumbles on the idea of feeding the plant human corpses and is led into a new part-time vocation: murder. By the finale Seymour is forced to wage a heroic battle against the bloodthirsty Audrey II. Bent on conquest and power, the plant no longer even bothers to feign friendship. So it is with addiction. Beginning with only the few drops of blood you’re ready to dona...

Everywhere I go, I find it an effort to impersonate myself. Nurses at St. Paul’s Hospital ask me how I am. “Fine,” I say. “I’m good.” What I don’t say is, “I’m obsessed. I just blew in from the record store and can hardly wait to get through my work here so I can rush down to the car to listen to this opera or that symphony. Then, unless I go to the store to pick up more stuff, I’ll go home and lie to my wife. And I’m feeling guilty as hell. That’s how I am.” Self-deprecating, pessimistic, or negative comments creep into my conversations. Someone on the ward compliments my work. I attempt a joke: “Oh, you can fool some of the people some of the time.” No joke, that. They look at me strangely and protest that they meant it. Of course they did, but in my shame, I don’t believe I deserve any praise. A secret addiction comes equipped with praise deflectors.

become increasingly cynical about the world—politics, people, possibility, the future. Every morning I get into a hostile argument with the newspaper, resenting it for what it says or doesn’t say. The Globe and Mail, in its news slant, editorials, and choice of columnists, favors corporations, the mainstream parties, and neocon foreign policy makers. But the poor old Globe is just being true to its blue-blooded, capitalist self. It’s still the best paper in Canada, and I’m the one who chooses to fund it with my subscription dollars. So why am I yelling at it over coffee? My negativity stems from my internal dissatisfaction, my harsh self-critique. The Globe doesn’t speak the truth as I see it? Neither do I. The Globe justifies selfish acquisitiveness and exonerates dishonesty? Look who’s talking.

Above all, I’m absent. It’s impossible to be fully present when you’re putting up walls to keep from being seen.

I’ve authored three books and receive letters and e-mails from readers the world over, thanking me for having helped them transform their lives. Yet I have continued to choose patterns that darken my spirit, alienate those closest to me, and drain my vitality.5

I’ve never been hooked on substances. I’ve never tried cocaine or opiates, partly due to the fear that I’d like them too well.

Calling myself an addict in such company may be nothing more than an attempt to excuse my selfishness and lack of discipline.

“We are here to surrender—to let go of the old ideas that keep us stuck.” I don’t do surrender. I’m not even sure what that means.

That’s me. I resist emotional work and I do want immediate results. “A sense of urgency typifies attention deficit disorder,” I wrote in Scattered Minds, “a desperation to have immediately whatever it is that one may desire at the moment, be it an object, an activity, or a relationship.”

“That’s when I got that sobriety is more than just the absence of alcohol. It’s a way of being. It’s living life in its fullness.” Do I have to become an alcoholic, lose everything, puke my guts out, and then get religion before I can experience the fullness of life, whatever the hell that means? I’m resentful. No, I’m anxious, fearful that it will never happen for me. That’s what Elaine would have seen in my eyes. Or saw. Perhaps I was the newcomer she was talking about.

“Forget about your life situation for a while and pay attention to your life,” writes the spiritual teacher Eckhart Tolle. “Your life situation exists in time—your life is now.” I have read his book over and over, have underlined that phrase and understand it intellectually. This woman, Elaine, doesn’t only understand it. She gets it. It’s a truth she’s discovered for herself.

“Surrender is the key,” says Elaine. “Even now, whenever I try too hard, I mess it all up. Don’t try. Just listen to God’s directions.” Fuck. That God thing again. What God? Ever since I was a child, I’ve been shaking my fist at Heaven.

That’s the God I’ve been resisting. If, Jonah-like, I’d rather hide in the stinking belly of a whale than face the truth I know so well, it’s not because of intelligence but because of the refusal to surrender. To surrender, you have to give something up. I’ve been unwilling to do that. And YHWH said to Moshe: “I see this people—and here, it is a stiff-necked people!”

“Tell me something. Do I belong here?” I give the one-minute version of my history. “You do belong.” Sophie explains that the meeting is open to everyone. “If you have addictive behaviors, this is the right place for you. Unless it’s marked with a C for ‘Closed’ in the AA schedule, anyone with a problem is welcome. The C meetings are for alcoholics only.” I will come back, I decide. What I’ve witnessed here are humility, gratitude, commitment, acceptance, support, and authenticity. I so desperately want those qualities for myself.

Recent brain imaging studies have revealed an underlying disruption to brain regions that are important for the normal processes of motivation, reward, and inhibitory control in addicted individuals. This provides the basis for a different view: that drug addiction is a disease of the brain, and the associated abnormal behavior is the result of dysfunction of brain tissue, just as cardiac insufficiency is a disease of the heart. NORA VOLKOW, MD Director, National Institute on Drug Abuse

In the English language addiction has two overlapping but distinct meanings. In our day, it most commonly refers to a dysfunctional dependence on drugs or on behaviors such as gambling or sex or eating. Surprisingly, that meaning is only about a hundred years old. For centuries before then, at least back to Shakespeare, addiction referred simply to an activity that one was passionate about or committed to, gave one’s time to.

The pathological sense of the word arose in the early twentieth century.

But the Romans had another, more ominous usage that speaks to our present-day interpretation: an addictus was a person who, having defaulted on a debt, was assigned to his creditor as a slave—hence addiction’s modern sense as enslavement to a habit. De Quincey anticipated that meaning when he acknowledged “the chain of abject slavery” forged by his narcotic dependence.

In the words of a consensus statement by addiction experts in 2001, addiction is a “chronic neurobiological disease … characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.”1 The key features of substance addiction are the use of drugs or alcohol despite negative consequences and relapse. I’ve heard some people shrug off their addictive tendencies by saying, for example, “I can’t be an alcoholic. I don’t drink that much,” or “I only drink at certain times.”

Many behavioral, nonsubstance addictions can also be highly destructive to physical health, psychological balance, and personal and social relationships.

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.

How does the addict know she has impaired control? Because she doesn’t stop the behavior in spite of its ill effects. She makes promises to herself or others to quit, but despite pain, peril, and promises, she keeps relapsing.

On the biochemical level the purpose of all addictions is to create an altered physiological state in the brain. This can be achieved in many ways, drug taking being the most direct. So an addiction is never purely “psychological”; all addictions have a biological dimension.

And here a word about dimensions. As we delve into the scientific research, we need to avoid the trap of believing that addiction can be reduced to the actions of brain chemicals or nerve circuits or any other kind of neurobiological, psychological, or sociological data. A multilevel exploration is necessary because it’s impossible to understand addiction fully from any one perspective, no matter how accurate.

Addiction has biological, chemical, neurological, psychological, medical, emotional, social, political, economic, and spiritual underpinnings—and perhaps others I haven’t thought about.

But not for a moment do I wish to promote the belief that the disease model by itself explains addiction or even that it’s the key to understanding what addiction is all about. Addiction is “all about” many things.

“Dependence” can also be understood as a powerful attachment to harmful substances or behaviors, and this definition gives us a clearer picture of addiction.

Father Sam Portaro, author and former Episcopalian chaplain to the University of Chicago, said it admirably well in a recent lecture: “The heart of addiction is dependency, excessive dependency, unhealthy dependency—unhealthy in the sense of unwhole, dependency that disintegrates and destroys.”5

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.

Clearly, if drugs by themselves could cause addiction, we would not be safe offering narcotics to anyone.

rheumatic disease.3 We can never understand addiction if we look for its sources exclusively in the actions of chemicals, no matter how powerful they are. “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.

“after Vietnam, use of particular drugs and combinations of drugs decreased to near or even below preservice levels.” The remission (i.e., abatement or reduction of symptoms in illness or addiction) rate was 95 percent, “unheard of among narcotics addicts treated in the U.S.”

“Equally dramatic was the surprisingly high remission rate after return to the United States.”5 These results suggested that the addiction did not arise from the heroin itself but from the needs of the men who used the drug.

What such statistics do show is that whatever a drug’s physical effects and powers, they cannot be the sole cause of addiction.

some people, a relatively small minority, are at grave risk for addiction if exposed to certain substances.

In one sense certain substances, like narcotics and stimulants, alcohol, nicotine, and marijuana, can be said to be addictive, and it’s in that sense that I use the term. These are the drugs for which animals and humans will develop craving and that they will seek compulsively. But this is far from saying that the addiction is caused directly by access to the drug.

There are no known examples of persistently addictive behaviors in the natural world. Of course, we cannot predict exactly what might happen if wild animals had free and easy access to addictive substances in the purified and potent forms administered in laboratories. What has been shown, however, is that conditions in the laboratory powerfully influence which animals will succumb to addiction. Among monkeys, for example, subordinate males who are stressed and relatively isolated are the ones more likely to self-administer cocaine.

emotional isolation, powerlessness, and stress are exactly the conditions that promote the neurobiology of addiction in human beings as well.

In other words, in this “natural” environment a rat will stay away from the drug if given a choice in the matter—even if it’s already physically dependent on the narcotic. “Nothing that we tried,” reported Bruce Alexander, “instilled a strong appetite for morphine or produced anything that looked like addiction in rats that were housed in a reasonably normal environment.” By contrast, caged rats consumed up to twenty times more morphine than their relatively free living relatives.

The Vietnam veterans study pointed to a similar conclusion: under certain conditions of stress many people can be made susceptible to addiction, but if circumstances change for the better, the addictive drive will abate. About half of all the American soldiers in Vietnam who began to use heroin developed addiction to the drug. Once the stress of military service in a brutal and dangerous war ended, so, in the vast majority of cases, did the addiction. The ones who persisted in heroin addiction back home were, for the most part, those with histories of unstable childhoods and previous drug use problems.14

This war, unlike previous ones, quickly lost meaning for those ordered to fight and die in the faraway jungles and fields of Southeast Asia. There was too wide a gap between what they’d been told and the reality they witnessed and experienced. Lack of meaning, not simply the dangers and privations of war, was the major source of the stress that triggered their flight to oblivion.

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.

Addiction is irrational, and at times the behavior of addicts seems mystifying even to themselves. But what if we listen to addicts and hear their life histories as we began to do in Part I of this book?

There are controversies, as we shall see, but everyone agrees that on the basic physiological level, addiction represents “a different state of the brain,” in the words of physician and researcher Charles O’Brien.2 The debate is over just exactly how that abnormal brain state arises.

The drug-addicted brain doesn’t work in the same way as the nonaddicted brain, and it doesn’t look the same when imaged by means of positron-emission tomography (PET) scans and magnetic resonance imaging (MRI), two recently developed, sophisticated imaging techniques that are now yielding new information about brain structure and functioning.