In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

I’ve made so many promises in the past that it’s meaningless to make another one. So, more practically: On Monday I’ll be there at 9:30. I’ll be bringing ten signed, undated checks for $100.00 each, made out to the Portland Hotel Society. Any day I’m even one minute past 9:30, you date the check and deposit it. Should those ten run out, I’ll bring in another ten. Thanks again. I deeply regret the hassle and frustration I’ve caused you and the inconvenience to our clients. That e-mail exchange took place in late September. As of May 2007, Susan has had to cash nine of the checks. The atmosphere in the clinic has been transformed. I’ve had the pleasure of facing my clients without shame clouding my eyes and of working alongside colleagues who no longer have to compensate for my tardiness and disguise their resentment. Sweet are the rewards of sobriety. The prewritten checks are not a form of self-punishment, but a way of building a structure that helps keep me sober. They would not be necessary if I possessed sufficient self-regulation; I would just show up on time. They serve me as the sponsor serves the twelve-step novice: when in the morning an urge arises to stay writing by my computer or to keep pedaling on my exercise bike, the thought of the lost income reminds me of my responsibilities and helps to regulate my insufficiently active prefrontal impulse-control brain circuits. Creating such structures is part of establishing an external environment that supports mental ...