In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

functions. We are forever desiring and longing, or judging and rejecting. Mental hygiene consists of noticing the ebb and flow of all those automatic grasping or rejecting impulses without being hooked by them. Bare attention is directed not only toward what’s happening on the outside but also to what’s taking place on the inside. “Be at least as interested in your reactions as in the person or situation that triggers them,” Eckhart Tolle advises.

The addict seldom questions the reality of the unpleasant mood or feeling she wants to escape. She rarely examines the perspective from which her mind experiences and understands the world around her and from which she hears and sees the people in her life. She is in a constant state of reactivity—not to the world so much as to her own interpretations of it. The distressing internal state is not examined: the focus is entirely on the outside: What can I receive from the world that will make me feel okay, if only for a moment? Bare attention can show her that these moods and feelings have only the meaning and power that she gives them.

Bare attention allows us to take an objective stand outside the ever-moving ebb and flow of thought, reaction, and emotion and to reinforce the part of us that can observe, know, and decide consciously.

Much of the time, it turns out, everyday minds are in a state of reactivity. We take this for granted, we do not question our automatic identifications with our reactions, and we experience ourselves at the mercy of an often hostile or frustrating outer world or an overwhelming or frightening inner one. With bare attention, we move from this automatic identification with our fear or frustration to a vantage point from which the fear or frustration are attended to with the same dispassionate interest as anything else. There is enormous freedom to be gained from such a shift. Instead of running from difficult emotions (or hanging on to enticing ones), the practitioner of bare attention becomes able to contain any reaction: making space for it, but not completely identifying with it. 15 Given that addiction is all about running from difficult emotions or hanging on to enticing ones, bare attention has the potential to dissolve the very motivations that drive the addicted mind.

surprising: it’s not what happened in the past that creates our present misery but the way we have allowed past events to define how we see and experience ourselves in the present.

The greatest damage done by neglect, trauma, or emotional loss is not the immediate pain they inflict but the long-term distortions they induce in the way a developing child will continue to interpret the world and her situation in it.

Addiction confers invulnerability because it allows us to soothe vulnerable emotions like pain or fear or the aching for love with behaviors, objects, or substances whenever we choose. It’s a way to avoid intimacy. Mindful awareness can bring into consciousness those hidden, past-based perspectives so that they no longer frame our worldview.

Mindfulness practice will not by itself cool the addiction-heated mind, but, addicted or not, it is an invaluable adjunct to whatever else we do. It’s a way of working with the most immediate environment, the internal one.

“Mindfulness changes the brain,” psychiatrist and brain researcher Daniel Siegel points out: “Why would the way you pay attention in the present moment change your brain? How we pay attention promotes neural plasticity, the change of neural connections in response to experience.”

Step One: Relabel

When we relabel, we give up the language of need. I say to myself, “I don’t need to purchase anything now or to eat anything now; I’m only having an obsessive thought that I have such a need. It’s not a real, objective need but a false belief. I may have a feeling of urgency, but there is actually nothing urgent going on.”

Essential to the first step, as to all the steps, is conscious awareness. It is conscious intention and attention, not just rote repetition that will result in beneficial changes to brain patterns, thoughts, and behaviors. Be fully aware of the sense of urgency that attends the impulse and keep labeling it as a manifestation of addiction rather than any reality that you must act upon.

The point is to observe it with conscious attention without assigning the habitual meaning to it. It is no longer a “need,” only a dysfunctional thought.

Step Two: Reattribute

“In Re-attribute you learn to place the blame squarely on your brain. This is my brain sending me a false message.”4 This step is designed to assign the relabeled addictive urge to its proper source.

Reattribution is directly linked with compassionate curiosity toward the self. Instead of blaming yourself for having addictive thoughts or desires, you calmly ask why these desires have exercised such a powerful hold over you. “Because they are deeply ingrained in my brain and because they are easily triggered whenever I’m stressed or fatigued or unhappy or bored.” The addictive compulsion says nothing about you as a person. It is not a moral failure or a character weakness; it is just the effect of circumstances over which you had no control.

It is only a thought, an attitude, a belief, a feeling arising from an automatic brain mechanism. You can observe it consciously, with attention. And you can let it go. There are better sources of dopamine or endorphins in the world, and more satisfying ways to have your needs for vitality and intimacy met.

Step Three: Refocus

“It’s not how you feel that counts; it’s what you do.”

Rather than engage in the addictive activity, find something else to do. Your initial goal is modest: buy yourself just fifteen minutes.

The purpose of refocusing is to teach your brain that it doesn’t have to obey the addictive call. It can exercise the “free won’t.” It can choose something else.

Step Four: Revalue

Its purpose is to help you drive into your own thick skull just what has been the real impact of the addictive urge in your life: disaster.

Be conscious as you write out this fourth step—and do write it out, several times a day if necessary. Be specific: What has been the value of the urge in your relationship with your wife? your husband? your partner, your best friend, your children, your boss, your employees, your coworkers? What happened yesterday when you allowed the urge to rule you? What happened last week? What will happen today? Pay close attention to what you feel when you recall these events and when you foresee what’s ahead if you persist in permitting the compulsion to overpower you. Be aware. That awareness will be your guardian. Do all this without judging yourself. You are gathering information, not conducting a criminal trial against yourself.

Dr. Schwartz introduces what he calls the two As: anticipate and accept. To anticipate is to know that the compulsive drive to engage in addictive behavior will return. There is no final victory—every moment the urge is turned away is a triumph. What is certain is that with time the addictive drive will be drained of energy if you continue to apply the four steps and also take care of the internal and external environments in the ways suggested in these chapters. If there are times when it reappears with new force, there is no reason to be disappointed or shocked by that. And accept that the addiction exists not because of yourself, but in spite of yourself. You did not come into life asking to be programmed this way. It’s not personal to you—millions of others with similar experiences have developed the same mechanisms. What is personal to you is how you respond to it in the present. Keep close to your impartial observer.

Step Five: Re-create

place of a life blighted by your addictive need for acquisition, self-soothing, admiration, oblivion, and meaningless activity, what is the life you really want? What do you choose to create?

what activities you can engage in to express the universal human need to be creative. Mindfully honoring our creativity helps us transcend the feeling of deficient emptiness that drives addiction.

The frustration and resistance induced by abstinence in one area often lead to the addiction process erupting somewhere else.

For me personally, sobriety means being free of internal compulsion and living according to principles I believe in. Unlike abstinence, I don’t experience it as a constraint but as liberation. I don’t say I’m fully sober. I do say I recognize and value conscious awareness—another term for sobriety. It excites me more than the fool’s gold of acquisition or ego stroking that I’ve spent much time and energy pursuing in the past.

In choosing sobriety we’re not so much avoiding something harmful as envisioning ourselves living the life we value. What sobriety looks like will vary from person to person, but in all cases it has the individual, rather than the addictive compulsion, in the lead.

the technique of an addict having a sponsor to contact whenever the addictive urge threatens to gain the upper hand—the desire to have a drink or to play cards at the casino. When the addict makes that call, he recognizes his powerlessness over the compulsion—in other words, the relative weakness of the impulse-regulating parts of his cerebral cortex. Until those circuits develop some muscle of their own, the sponsor acts the regulator by talking the addict through his compulsion. Talking it out prevents acting it out.

Although not for everyone—nothing is for everyone—twelve-step programs provide the best available healing environment for many people.

One important warning: if you want to find liberation in your commitments, your word needs to be freely given or not given at all. Don’t make promises to reform out of a sense of duty or to appease someone else. If you don’t know how to say no to other people’s expectations, howsoever well meant or valid those may be, your yes has no authenticity.

Truth-speaking will also make you more aware of the impact of your behavior on others—what the twelve-step programs call taking inventory:

take personal inventory and when we were wrong promptly admitted it,” says step ten. By structuring such responsible but nonjudgmental self-examination into our routine, by owning the impact of our behaviors on others, we diminish our karmic burden. We are lighter and freer. We have less need to escape into addiction.

Establishing the healing environment also entails removing what is toxic—the stresses that enhance the addictive drive and trigger addictive cravings. Once more, we have to move beyond abstinence and view things from an ecological and sustainable perspective.

• Stressors are the external triggers for the physiological stress reaction, a maelstrom of hormonal secretions and nervous discharges that involve virtually every organ and system in the body. • The most potent stressors are loss of control and uncertainty in important areas of life, whether personal or professional, economic or psychological. • Stress interacts powerfully with the biology of addiction in the brain. • Stresses such as emotional isolation or the sense that we are dominated by others change our brains in ways that increase the need for external sources of dopamine—that is, they increase the risk of addiction. • Stress is a major trigger for substance abuse and other addictive behaviors and is the most predictable trigger for relapse. • Stress hormones can themselves become addictive.

The ecological approach to recovery must, therefore, address the stresses in one’s life. It’s impossible to cool the circuitry of the addicted brain if we leave it heated by chronic stress.

To see addiction as the only problem is to leave intact the context that triggered the addiction in the first place.

While it is natural for the loved ones of an addict to wish to reform him, it cannot be done. The counterwill-driven resistance to any sense of coercion will sabotage even the most well-meant endeavor by one human being to change another.

A tremendous step forward, albeit a very difficult one, is for people who are in a relationship with the addict not to take his behaviors personally. This is one of the hardest challenges for human beings—and that is precisely why it’s a core teaching in many wisdom traditions. The addict doesn’t engage in his habits out of a desire to betray or hurt anyone else but to escape his own distress. It’s a poor choice and an irresponsible one, but it is not directed at anyone else even if it does hurt others. Loving partners or friends may openly acknowledge their own pain around the behavior, but the belief that somehow the addict’s actions deliberately betray or wound them only compounds the suffering.

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. We would spare ourselves a lot of tension and stress, and protect our patients from further psychological trauma, if we learned to take responsibility for what we bring to our encounters with them. Five minutes of mindful meditation in the middle of a shift in the context of an emergency ward may seem like an absurd luxury, but the time saved and the bruised and inflamed emotions prevented would be a rich payoff. We may not be responsible for another’s addiction or the life history that preceded it, but many painful situations could be avoided if we recognized that we are responsible for the way we ourselves enter into the interaction. And that, to put it most simply, means dealing with our own stuff.

A barrier for many people when it comes to twelve-step work around addiction is step two, evoking a higher power: {We} came to believe that a Power greater than ourselves could restore us to sanity. The resistance is natural if the Power is identified as the god by whom the child felt betrayed.

We can see the Power in other ways. In the grip of his habit the addict experiences himself as no more than a puny ego that must scratch and grasp and scrounge for every miserable scrap of satisfaction. Honoring the greater power could simply come in the form of finally recognizing the impotence of that small ego, the utter incapacity of its ways to keep a person safe or calm or happy. “I don’t believe in God,” a Narcotics Anonymous member told me, “but at least with step two I’ve accepted that I’m not Her.”

is possible to think of “living father” as religious code for the source of life, a reality that exceeds the powers of language to express directly. I believe all of us human beings, whether we know it or not, are seeking our own divine nature. Divine in this context does not mean anything supernatural or necessarily religious, only the truth of our oneness with all that is, an ineffable sense of connectedness to other people and other beings and to each and every shard of matter or spark of energy in the entire universe. When we cease to remember that loving connection and lose touch with our deep yearning for it, we suffer.

Eckhart Tolle sees as the fundamental source of human anxiety: Basically, all emotions are modifications of one primordial, undifferentiated emotion that has its origin in the loss of awareness of who you are beyond name and form. Because of its undifferentiated nature, it is hard to find a name that precisely describes this emotion. “Fear” comes close, but apart from a continuous sense of threat, it also includes a deep sense of abandonment and incompleteness. It may be best to use a term that is as undifferentiated as that basic emotion and simply call it “pain.”3 Addiction floods in where self-knowledge—and therefore divine knowledge—are missing. To fill the unendurable void, we become attached to things of the world that cannot possibly compensate us for the loss of who we are.

For many people, the higher power concept need not be concerned with a deity or anything expressly spiritual. It simply means rising above their self-regarding ego and committing to serve something greater than their own immediate desires.

It seems that we are wired to be in tune with one another’s needs, which is one of the roots of empathy. “Perhaps altruism did not grow out of a warm-glow feeling of doing good for others, but out of the simple recognition that that thing over there is a person that has intentions and goals. And therefore, I might want to treat them like I might want them to treat myself,”

The golden rule may be inscribed in our brain circuits, not as a commandment but as an essential part of who we are.