In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

Two identical seeds, cultivated under opposing conditions, would yield two different plants: one tall, robust, and fertile; the other stunted, wilted, and unproductive. The second plant is not diseased: it only lacked the conditions required to reach its full potential. Moreover, if it does develop some sort of plant ailment in the course of its life, it would be easy to see how a deprived environment contributed to its weakness and susceptibility. The same principles apply to the human brain.

Children who suffer disruptions in their attachment relationships will not have the same biochemical milieu in their brains as will their well-attached and well-nurtured peers. As a result their experiences and interpretations of their environment, and their responses to it, will be less flexible, less adaptive, and less conducive to health and maturity. Their vulnerability both to the mood-enhancing effects of drugs and to drug dependency will increase.

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

“A child who is stressed early in life will be more overactive and reactive. He is triggered more easily, is more anxious and distressed. Now, compare a person—child, adolescent, or adult—whose baseline arousal is normal with another whose baseline state of arousal is at a higher level. Give them both alcohol: both may experience the same intoxicating effect, but the one who has this higher physiological arousal will have the added effect of feeling pleasure from the relief of that stress. It’s similar to when with a parched throat you drink some cool water: the pleasure effect is much heightened by the relief of thirst.”26

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. The ability to modify behavior based on negative experiences may be impaired.30

Predictably, stress is a major cause of continued drug dependence. It increases opiate craving and use, enhances the reward efficacy of drugs, and provokes relapse to drug seeking and drug taking.

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.

“The most important finding of research into a genetic role for alcoholism is that there is no such thing as a gene for alcoholism,” writes the addiction specialist Lance Dodes. “Nor can you directly inherit alcoholism.”5

Far from being the autonomous dictators of our destinies, genes are controlled by their environment, and without environmental signals they could not function. In effect, they are turned on and off by the environment;

children whose mothers were stressed during pregnancy are vulnerable to mental and behavioral problems like attention deficit/hyperactivity disorder (ADHD) or to being anxious or fearful.

if a phenomenon like addiction is determined mostly by biological heredity, we are spared from having to look at how our social environment supports, or does not support, the parents of young children and at how social attitudes, prejudices, and policies burden, stress, and exclude certain segments of the population and thereby increase their propensity for addiction.

it’s not the activity or object itself that defines an addiction but our relationship to whatever is the external focus of our attention or behavior.

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.

addictions, substance related or not, share states of mind such as craving and shame and behaviors such as deception, manipulation, and relapse. On the neurobiological level, all addictions engage the brain’s attachment-reward and incentive-motivation systems, which, in turn, escape from regulation by the “thinking” and impulse-control areas of the cortex.

Junk foods and sugar are also chemically addictive because of their effect on the brain’s intrinsic “narcotics,” the endorphins. Sugar, for example, provides a quick fix of endorphins and also temporarily raises levels of the mood chemical serotonin.

Not only are the identical incentive-motivation and attachment-reward circuits impaired in the brains of overeaters and drug addicts, but so are the impulse-regulating functions of the cortex. “Some

Compulsive shoppers experience the same mental and emotional processes when engaged in their addiction. The thinking parts of the brain go on furlough.

Addictions are often interchangeable—a

the addiction process was active and looking for more and more external trophies to capture.

Withdrawal consists of irritability, a generally glum mood, restlessness, and a sense of aimlessness. No doubt it has its chemical components: I’m experiencing the effect of diminished dopamine and endorphin levels. Other nonsubstance addicts experience similar symptoms after abruptly stopping whatever behavior they were bingeing with. The journey from addictive self-indulgence to depression is rapid and inexorable.

Oddly enough, the addiction really isn’t over until I can see the emptiness (in a Buddhist sense) of the behavior: not good, not evil, and certainly not exciting, just an outside “thing” I’ve been using unintelligently to dull the suffering edge of life.

There is no such thing as a good addiction. Everything a person can do is better done if there is no addictive attachment that pollutes it. For every addiction—no matter how benign or even laudable it seems from the outside—someone pays a price.

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—

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

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 something without her actions being automatically dictated by that feeling. She can be aware of other, conflicting feelings or of thoughts, values, and commitments that might run counter to the feeling of the moment. She can choose. In the addict this experience of “mixed feelings” is often lacking. Emotional processes rule the addict’s perspective: whatever she is feeling at the moment tends to define her view of the world and will control her actions.

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.

When infants are anxious or upset, they are offered a human or a plastic nipple—in other words, a relationship with either a natural nurturing object or something that closely resembles it. That’s how emotional nourishment and oral feeding or soothing become closely associated in the mind. On the other hand, emotional deprivation will trigger a desire for oral stimulation or eating just as surely as hunger will. Children who continue to suck their thumbs past infancy are attempting to soothe themselves; it’s always a sign of emotional distress. Except in rare cases of physical disease, the more obese a person is, the more emotionally starved they have been at some crucial period in their life.

The obesity epidemic demonstrates a psychological and spiritual emptiness at the core of consumer society. We feel powerless and isolated, so we become passive.

It’s as if after a full meal you were left starving and had to immediately turn your efforts to procuring food again. In a person with addictive behaviors, the orbitofrontal cortex and its associated neurological systems have been tricked from childhood onward into valuing false wants above real needs

Stressed parents have difficulty offering their children a specific quality required for the development of the brain’s self-regulation circuits: the quality of attunement. Attunement is, literally, being “in tune” with someone else’s emotional states. It’s not a question of parental love but of the parent’s ability to be present emotionally in such a way that the infant or child feels understood, accepted, and mirrored. Attunement is the real language of love, the conduit by which a preverbal child can realize that she is loved.

The lack of an emotionally attuned and consistently available parenting figure is a major source of stress for the child. Such a lack can occur when the parent is physically present but emotionally distracted—a situation that has been called proximate separation. Proximate separation happens when attuned contact between parent and child is interrupted due to stresses that draw the parent away from the interaction. The levels of physiological stress experienced by the child during proximate separation approach the levels experienced during physical separation.7 The development of the brain’s neurotransmitter and self-regulating systems and, in particular, the stress-control circuits is then disrupted, and once entrenched, these physiological dysfunctions increase the risk for addictions.

unhappiness. As a rule, whatever we don’t deal with in our lives, we pass on to our children.

The addict is never satisfied. His spiritual and emotional condition is one of impoverishment, no matter how much he achieves, acquires, or possesses. In the hungry-ghost mode, we can never be satiated.

conditional or contingent self-esteem: it depends on circumstances. The greater the void within, the more urgent the drive to be noticed and to be “important,” and the more compulsive the need for status. By contrast, genuine self-esteem needs nothing from the outside. It doesn’t say, “I’m worthwhile because I’ve done this, that, or the other.” It says, “I’m worthwhile whether or not I’ve done this, that, or the other. I don’t need to be right or to wield power, to amass wealth or achievements.”

Self-esteem is not what the individual consciously thinks about himself; it’s the quality of self-respect manifested in his emotional life and behaviors.

To pose that question is to answer it. We despise, ostracize, and punish the addict because we don’t wish to see how much we resemble him.

Of all the groups affected by the forces of dislocation, none have been worse hit than minority populations, such as the Australian aborigines and North American Native peoples mentioned by Dr. Dupont and the descendants of black slaves brought to North America. Among the latter, people were separated not only from their places of origin, their cultures, and their communities but often also from their immediate families. Long after the abolition of slavery, racial oppression and prejudice, along with economic deprivation, have continued to produce intolerable pressures on family life among many African Americans—and the link to addiction is obvious. Equally obvious is the enticement of the drug trade to jobless and undereducated young black men excluded from the economic promises of the “American dream.”

Of any group in North America, whether in the United States or Canada, none can be said to be more psychologically and socially oppressed than Native women.22

the addiction process takes hold in people who have suffered dislocation, whose place in the normal human communal context has been disrupted—whether they’ve been abused or emotionally neglected or whether they’re inadequately attuned children or peer-oriented teens or members of subcultures historically subjected to exploitation.

To know the true nature of a society, it’s not enough to point to its achievements, as leaders like to do. We also need to look at its shortcomings. What do we see, then, when we look at the drug ghetto of Vancouver’s Downtown Eastside and similar enclaves in other urban centers? We see the dirty underside of our economic and social culture, the reverse of the image we would like to cherish of a humane, prosperous, and egalitarian society. We see our failure to honor family and community life or to protect children; we see our refusal to grant justice to Native peoples; and we see our vindictiveness toward those who have already suffered more than most of us can imagine. Rather than lifting our eyes to the dark mirror held in front of us, we shut them to avoid the unsavory image we see reflected there.

The drug addict is today’s scapegoat. Viewed honestly, much of our culture is geared toward enticing us away from ourselves, into externally directed activity, into diverting the mind from ennui and distress. The hard-core addict surrenders her pretense about that. Her life is all about escape. The rest of us can, with varying success, maintain our charade, but to do so, we banish her to the margins of society.

Dead eyes, broken spirits: in a phrase this compassionate man summed up the fate of the abused child. Yet there is a bitter irony in his words. 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. Their fate continues to be a concern for the police and the courts, but by then they are no longer heartbreakingly sweet, no longer vulnerable looking. They lurk on the social periphery as hardened men with ravaged faces; as thieves, robbers, shoplifters; as done-up prostitutes selling backseat sex for drugs or petty cash; as street-corner drug pushers or as small-time entrepreneurs distributing cocaine out of cheap hotel rooms.

In 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. Or they become what the military calls collateral damage.

Norm Stamper, former police chief of Seattle, who after his retirement has become an advocate of decriminalizing drugs. Chief Stamper writes, Think of this war’s real casualties: tens of thousands of otherwise innocent Americans incarcerated, many for 20 years, some for life; families ripped apart; drug traffickers and blameless bystanders shot dead on city streets.… 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

Drugs do not make the addict into a criminal; the law does.

As Judge Grey documents in his persuasive critique, subtitled A Judicial Indictment of the War on Drugs, most of the social harm related to drugs does not come from the effects of the substances themselves but from legal prohibitions against their use.

The War on Drugs fails—and is doomed to perpetual failure—because it is directed not against the root causes of drug addiction or of the international black market in drugs, but only against some drug producers, traffickers, and users. More fundamentally, the war is doomed because neither the methods of war nor the war metaphor itself is appropriate to a complex social problem that calls for compassion, self-searching insight, and factually researched scientific understanding. The question is not why the War on Drugs is being lost, but why it continues to be waged in the face of all the evidence against it.

In a society that habitually seems to find an enemy to loathe and fear, the addict serves as an ever-present candidate for the role. Given also the heavily disproportionate representation of minority peoples in prisons in almost all Western societies and most particularly in the United States, a punitive legal stance on drugs may also be seen as a form of imposing heavy-handed social control over disenfranchised and disaffected populations.

Decisions that we may believe to be freely made can arise from unconscious emotional drives or subliminal beliefs. They can be dictated by brain mechanisms programmed early in childhood and determined by events of which we have no recollection. The stronger a person’s automatic brain mechanisms and the weaker the parts of the brain that can impose conscious control, the less true freedom that person will be able to exercise in her life. In OCD, and in many other conditions, no matter how intelligent and well-meaning the individual, the malfunctioning brain circuitry may override rational judgment and intention. Almost any human being, when overwhelmed by stress or powerful emotions, will act or react not from intention but from mechanisms that are set off deep in the brain, rather than being generated in the conscious and volitional segments of the cortex. When acting from a driven or triggered state, we are not free.