In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

Dr. Koran was puzzled and disappointed to find in a recent study that this “biological disorder” did not respond to treatment with escitalopram, an SSRI antidepressant.4

The lives of abused children do not end when they are rescued—if they are rescued, as most never are. Many become teenagers with spirits not mended and reach adulthood with eyes still dead.

any war there must be enemies. In the War on Drugs the enemies are most often children like the ones Detective-Sergeant Gillespie could not rescue or rescued too late. They are not the generals, of course, the masterminds, or the profiteers. They are the foot soldiers, the ones who live in the trenches—and as in all wars, they are the ones who suffer and die.

believe that if all of us as individuals and as a society were “smart intelegent enough” to make our own decisions, we would not punish the addict or wage a war in which human beings like Celia, Lisa, Shawn, and Raymond are treated as the enemy. We would seek peace. As Lisa suggests, we all make mistakes. The War on Drugs is one of them, as we’ll next see.

“The single most conspicuous feature of wars is violence,” writes Bruce Alexander in his book Peaceful Measures: War mentality cleaves the world into noble allies and despicable enemies … [and] justifies any measures necessary to prevail, including violence to innocent bystanders.… In essence, war mentality suspends normal human compassion and intelligence.1

The WHO has no statistics for those suffering pain owing to a host of other causes, from injuries to diseases of all sorts. The problem? An exaggerated fear of addiction. “Pain relief hasn’t been given as much attention as the war on drugs,”

The U.S. government aggressively promotes its view of drug addiction internationally and brings enormous pressure on other countries to fall in line with its own opinions.

As we’ll see in Chapter Twenty-eight, U.S. interference makes it very difficult for other countries, including Canada, to establish enlightened drug policies.

The United States has, through its war on drugs, fostered political instability, official corruption, and health and environmental disasters around the globe.3 In truth, the U.S.-sponsored international “War on Drugs” is a war on poor people, most of them subsistence farmers caught in a dangerous no-win situation.4

The United States contains less than 5 percent of the world’s population but houses nearly a quarter of the world’s prisoners.

European critics, according to the New York Times: Indeed, said Vivien Stern, a research fellow at the prison studies center in London, the American incarceration rate has made the United States “a rogue state, a country that has made a decision not to follow what is a normal Western approach.… The U.S. pursues the war on drugs with an ignorant fanaticism.”7

If the War’s aim is to end or even curtail the international drug trade, it has failed there, too. If it is to suppress the cultivation of plants from which the major substances of abuse are derived, then once again: abject failure. In Afghanistan the production of opium increased nearly 50 percent from 2005 to 2006. Truth,

Behaviors, especially compulsive behaviors, are often the active representations of emotional states and of special kinds of brain functioning.

If we are to help addicts, we must strive to change not them but their environments.

In the previous chapter I presented evidence that addictive habits are too deeply entrenched in the brain of the hard-core substance user to be overcome by a simple act of will.

“The only way they can escape drug addictions is if their pain is alleviated, their emotions are brought back toward healthy balance, so they have a chance to think about it,”

“Free choice only comes from thinking; it doesn’t come from emotions. It emerges from the capacity to think about your emotions.

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.”

Addicts are locked into addiction not only by their painful past and distressing present but equally by their bleak view of the future as well.

They are unable to develop compassion toward themselves and their bodies while they are regarded as outcasts, hunted as enemies, and treated like human refuse.

If we want to support people’s potential for healthy transformation, we must cease to impose debilitating stress on their already-burdened existence. Recall that uncertainty, isolation, loss of control, and conflict are the major triggers for stress and that stress is the most predictable factor in maintaining addiction and triggering relapse.

have quoted a report in the Journal of the American Medical Association that showed that a history of childhood abuse increases physiological stress reactivity for a lifetime, a reactivity that is “further enhanced when additional trauma is experienced in adulthood.”6 The addict is retraumatized over and over again by ostracism, harassment, dire poverty, the spread of disease, the frantic hunt for a source of the substance of dependence, the violence of the underground drug world, and harsh chastisement at the hands of the law—all inevitable consequences of the War on Drugs.

The findings of stress research suggest that the issue is not control over others, but whether one is free to exercise control in one’s own

In relegating the addict to the bottom of the social and moral scales and in our contemptuous rejection of him as a person, we have created the exact circumstances that are most likely to keep him trapped in pathological dependence on drugs.

The War on Drugs expresses a split mind-set in two ways: we want to eradicate or limit addiction, yet our social policies are best suited to promote it, and we condemn the addict for qualities we dare not acknowledge in ourselves.

The indispensable foundation of a rational stance toward drug addiction would be the decriminalization of all substance dependence and the provision of such substances to confirmed users under safely controlled conditions. It’s important to note that decriminalization does not mean legalization.

Decriminalization refers only to removing from the penal code the possession of drugs for personal use. It would create the possibility of medically supervised dispensing when necessary. The fear that easier access to drugs would fuel addiction is unfounded: drugs, we have seen, are not the cause of addiction.

Not having to spend exorbitant amounts on drugs that, in themselves, are inexpensive to prepare, addicts would not be forced into crime, violence, prostitution, or poverty to pay for their habits. They would not have to decide between eating or drug use or to scrounge for food in garbage cans or pick cigarette butts out of sidewalk puddles. They would no longer need to suffer malnutrition.

And, very much to the point, most young people who become hooked on crystal meth are self-medicating other conditions: most commonly attention deficit/hyperactivity disorder (ADHD), but also depression, post-traumatic stress disorder, or the effects of emotional and social dislocation.

Many people fear that the decriminalization and controlled dispensing of drugs will lead to widespread substance use among people who are now deterred from becoming addicts only by existing legal prohibitions. Like other tenets of the War on Drugs, this view is entirely lacking in supporting evidence. Any data on the subject point to the opposite prediction.

That is not surprising, given that addiction is a response to life experience, not simply to a drug.

The call for the decriminalization of drugs for personal use does not imply legal acceptance of drug dealing.

Addicts should not be coerced into treatment, since in the long term coercion creates more problems than it solves. On the other hand, for those addicts who opt for treatment, there must be a system of publicly funded recovery facilities with clean rooms, nutritious food, and access to outdoors and nature. Well-trained professional staff need to provide medical care, counseling, skills training, and emotional support.

To expect an addict to give up her drug is like asking the average person to imagine living without all his social skills, support networks, emotional stability, and sense of physical and psychological comfort.

Many of us are addicted to being right, even if facts do not support us. One fixed image we cling to, as iconic in today’s culture as the devil was in previous ages, is that of the addict as an unsavory and shadowy character given to criminal activity. What we don’t see is how we’ve contributed to making him a criminal.

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. The addict shoplifts, steals, and robs because it’s the only way she can obtain the funds to pay the dealer.

According to a front-page report in the Globe and Mail, the study found that “law enforcement consumed by far the largest chunk (73 percent) of the [national] drug strategy’s annual $245 million budget, with no demonstrated impact on curbing the use of illegal drugs. At the same time, 14 percent is spent on treatment, 7 percent on research, and 3 percent each for addiction prevention and harm reduction.”11

Few harm reductionists who know their stuff recommend a market-led free-for-all in drugs like heroin and cocaine and the amphetamine stimulants. But there is now an undisputable body of evidence that demonstrates that developing mechanisms to make safer forms of these drugs available to those with an intractable need brings enormous benefits to both the drug user and the society around them. Thus both Holland and Switzerland and parts of Germany have changed policies and seen an enormous drop in the levels of drug-related crime. The average age of hard-drug users is rising there, indicated that fewer young people are taking up such an activity. The real obscenity here is the shocking lack of funding for treatment and care and harm-reduction initiatives that have been shown to work. The U.K. National Treatment Outcome Survey (known as NTROS) showed that for every one pound invested in treatment and care, three pounds came back in health care and enforcement savings. If such a return was available in the financial markets, we’d all rush to take advantage.

Harm reduction is often perceived as being inimical to the ultimate purpose of “curing” addiction—that is, of helping addicts transcend their habits and heal. People regard it as coddling addicts, as enabling them to continue their destructive ways.

The issue in medical practice is always how best to help a patient. If a cure is possible and probable without doing greater harm, then cure is the objective.

So long as society ostracizes the addict and the legal system does everything it can to heighten the drug problem, the welfare and medical systems can aim only to mitigate some of its effects. Sad

If our guiding principle is that a person who makes his own bed ought to lie in it, we should immediately dismantle much of our health care system. Many diseases and conditions arise from self-chosen habits or circumstances and could be prevented by more astute decisions.

No cardiologist, respiratory specialist, orthopedic surgeon, or psychiatrist would refuse treatment on the ground that the problem was self-inflicted.

Although we are all responsible for our lives, no human or medical principle dictates that we refuse to help others whose own decisions have brought trouble upon their heads—unless we believe that in trying to help them, we are perpetrating greater harm.

practicing harm reduction, we do not give up on abstinence—on the contrary, we may hope to encourage that possibility by helping people feel better, bringing them into therapeutic relationships with caregivers, offering them a sense of trust, removing judgment from our interactions with them, and giving them a sense of acceptance. At the same time, we do not hold out abstinence as the holy grail, and we do not make our valuation of addicts as worthwhile human beings dependent on their making choices that please us.

“but it’s actually evangelism that underlies most of the politics against needle exchange. To give someone a needle or methadone is seen as giving up on the idea that they can be ‘saved,’ and as a moral failure for both drug user and care provider.

In the end, the government decided to shut down Insite and was stopped only by a British Columbia Supreme Court judgment that the facility served a genuine medical need that the government was constitution-bound to maintain.

In the United States, too, harm reduction measures are gaining support despite federal opposition. “On

We have seen that addicts lack differentiation—the capacity to maintain emotional separateness from others. They absorb and take personally the emotional states of other people. Their diminished capacity for self-regulation leaves them easily overwhelmed by their automatic emotional mechanisms. They are prone to experience themselves as demeaned and abandoned by authority figures and caregivers, for reasons we have explored.

There would be much less confrontation and more effective care, I am convinced, if medical and allied staff all took some mindfulness training and if we practiced observing, with awareness and curiosity, our mind-states and our reactions to these unconventional people.