In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

The infants of stressed or depressed parents are likely to encode negative emotional patterns in their brains.

We know that the majority of chronically hard-core substance-dependent adults lived, as infants and children, under conditions of severe adversity that left an indelible stamp on their development. Their predisposition to addiction was programmed in their early years. Their brains never had a chance.

To various degrees, in all addicted persons these systems are out of kilter. The same is true, we will see, of the fourth brain-body system implicated in addiction: the stress-response mechanism.

“In these experiments,” writes Dr. Steven Dubovsky, “loss of an important attachment appears to lead to less of an important neurotransmitter in the brain. Once these circuits stop functioning normally, it becomes more and more difficult to activate the mind.”2

rat pups deprived of their mother’s presence for only one hour a day during their first week of life grew up to be much more eager than their peers to take cocaine on their own.

Such sensory stimulation is so necessary for the human infant’s healthy biological development that babies who are never picked up simply die. They stress themselves to death.

Humans hold and cuddle and stroke; rats lick. A 1998 study found that rats whose mothers had given them more licking and other kinds of nurturing contact during their infancy had, as adults, more efficient brain circuitry for reducing anxiety.

People who have difficulty forming intimate relationships are at risk for addiction; they may turn to drugs as social lubricants.

Maternal deprivation and other types of adversity during infancy and childhood result in chronically high levels of the stress hormone cortisol.

Another major stress chemical that’s permanently overproduced after insufficient early maternal contact is vasopressin, which is implicated in high blood pressure.11

Studies of drug addicts repeatedly find extraordinarily high percentages of childhood trauma of various sorts, including physical, sexual, and emotional abuse.

Subjects with five or more ACEs had seven to ten times greater risk for substance abuse than did those with none.

Those experiencing both physical and sexual abuse were at least twice as likely to be using drugs than those who experienced either abuse alone.”16 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.

It’s just as many substance addicts say: they self-medicate to soothe their emotional pain—but more than that, their brain development was sabotaged by their traumatic experiences. The systems subverted by addiction—the dopamine and opioid circuits, the limbic or emotional brain, the stress apparatus and the impulse-control areas of the cortex—just cannot develop normally in such circumstances.

Nine years later, no longer epileptic, she revealed to me that her seizures had begun during a period of repeated sexual abuse by a family member. Typically for sexually abused children, she felt there was no one to turn to for help, so she “absented” herself instead.

suggests the very intriguing possibility that our “negative” views of a person are stored in one hemisphere and our “positive” responses in the other. The lack of integration between the two halves of the brain would mean that information from the two views, negative and positive, is not melded into one complete picture. As a result, in intimate relationships and in other areas of life, the afflicted individual fluctuates between idealized and degraded perceptions of himself, other people, and the world.

Extreme circumstances breed extremist brains.

Early trauma also has consequences for how human beings respond to stress all their lives, and stress has everything to do with addiction.

Stress is a physiological response mounted by an organism when it is confronted with excessive demands on its coping mechanisms, whether biological or psychological. It is an attempt to maintain internal biological and chemical stability, or homeostasis, in the face of these excessive demands. The physiological stress response involves nervous discharges throughout the body and the release of a cascade of hormones, chiefly adrenaline and cortisol.

At a conference in 1992 at the U.S. National Institutes of Health, researchers defined stress “as a state of disharmony or threatened homeostasis.”23 According to such a definition, a stressor “is a threat, real or perceived, that tends to disturb homeostasis.”

Early stress establishes a lower set point for a child’s internal stress system: such a person becomes stressed more easily than normal throughout her life.

“A child who is stressed early in life will be more overactive and reactive. He is triggered more easily, is more anxious and distressed.

On the other hand, situations or activities that for the average person are likely to bring satisfaction are undervalued because, in the addict’s life, they have not been rewarding—for example, intimate connections with family.

Neglect and abuse during early life may cause bonding systems to develop abnormally and compromise capacity for rewarding interpersonal relationships and commitment to societal and cultural values later in life. Other means of stimulating reward pathways in the brain, such as drugs, sex, aggression, and intimidating others, could become relatively more attractive and less constrained by concern about violating trusting relationships.

Addiction is a deeply ingrained response to stress, an attempt to cope with it through self-soothing.

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.

Our brains are resilient organs: some important circuits continue to develop throughout our entire lives, and they may do so even in the case of a hard-core drug addict whose brain “never had a chance” in childhood. That’s the good news, on the physical level. Even more encouraging, we will find later that we have something in or about us that transcends the firing and wiring of neurons and the actions of chemicals. The mind may reside mostly in the brain,

We are conversing about our personal experiences of addiction and the hidden emptiness at the core, which our very different addictions always promise—but always fail—to fill.

Popular lore has it that the addict has to hit bottom before gaining the motivation to give up his habit. That may be true in some individual cases, but as a general rule it fails because what constitutes the lowest point is highly personal to each addict.

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.

I’ve been as willing to sell my soul as they, only I charge a higher price. They settle for a bug-infested room on Hastings; my workaholism has bought me a lovely home. Their object of addiction goes up their veins to be excreted by their kidneys or permeates their lungs and vanishes into the air; my shelves are lined with CDs, many of them unheard, and with books, many unread. Their addictions land them in jail; my obsessive striving for recognition and driven work habits have gained me admirers and a handsome income.

No human being is empty or deficient at the core, but many live as if they were and experience themselves primarily that way. Attempting to obliterate the sense of deficiency and emptiness that is a core state of any addict is like laboring to fill in a canyon with shovelfuls of dust. Energy devoted to such an endless and futile task is robbed from one’s psychological and spiritual growth, from genuinely soul-satisfying pursuits, and from the ones we love.

“I’ve spent too much time on external things,” he says, “bouncing off other people … makes my teeth hurt, the work of pulling back from all those outside things and looking inside myself.”

This is a credo of discouragement and defeat that many of us share: a child may be completely in the present moment, but an adult can get there only with artificial assistance.

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.

Because self-regulation is a developmental achievement, we reach it only if the conditions for development are right. Some people never attain it; even in advanced adulthood they must rely on some external support to quell their discomfort and soothe their anxiety.

A person with inadequate self-regulation becomes dependent on outside things to lift his mood and even to calm himself if he experiences too much undirected internal energy. In my own case, I’ve binge-shopped CDs when I’ve felt down or restless or bored—but also when I’ve felt overly elated and didn’t know what to do with myself.

Impulse control is one aspect of self-regulation. Impulses rise up from the lower brain centers and are meant to be permitted or inhibited by the cerebral cortex. A salient trait of the addiction-prone personality is a poor hold over sudden feelings, urges, and desires. Also characterizing the addiction-prone personality is the absence of differentiation.3 Differentiation is defined as “the ability to be in emotional contact with others yet still autonomous in one’s emotional functioning.” It’s the capacity to hold on to ourselves while interacting with others. The poorly differentiated person is easily overwhelmed by his emotions; he “absorbs anxiety from others and generates considerable anxiety within himself.”4

Lack of differentiation and impaired self-regulation reflect a lack o...

Psychological maturation is the development of a sense of self as separate from inner experience—a capacity entirely absent in the young child. The child has to learn that she is not identical with whatever feeling happens to be dominant in her at any particular moment. She can feel ...

The same applies in the realm of relationships: for maturation the child must become unique and separate from other individuals. She has to know her own mind and not be overwhelmed by the thoughts, perspectives, or emotional states of others.

The individuated, well-differentiated person can respond from an open acceptance of his own emotions, which are not tailored either to match someone else’s expectations or to resist them. He neither suppresses his emotions nor acts them out impulsively.

perspective of health and stress, are worlds apart. 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. Some of my Portland patients functioned reasonably well until, say, their marriages fell apart; then they spiraled rapidly into substance use.

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. When we come to address healing, a key question will be how to promote maturity in ourselves or in others whose early environment sabotaged healthy emotional growth.

By comparison, the possibilities for behavioral addictions are almost infinite.

Aviel Goodman,

“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.”

related some of this history in Scattered Minds: Two days after the Germans marched into Budapest, my mother called the pediatrician. “Would you come to see Gabi,” she requested, “he has been crying almost without stop since yesterday morning.” “I’ll come, of course,” the doctor replied, “but I should tell you: all my Jewish babies are crying.” Now, what did Jewish infants know of Nazis, World War II, racism, genocide? What they knew—or rather, absorbed—was their parents’ anxiety.… They inhaled fear, ingested sorrow. Yet were they not loved? No less than children anywhere.