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He addresses the spectrum of addictions, including shopping, work, food, nicotine, the Internet, cosmetic surgery, even exercise. It becomes evident that the list of potential addictions engages us all.
This is the domain of addiction, where we constantly seek something outside ourselves to curb an insatiable yearning for relief or fulfillment.
The aching emptiness is perpetual because the substances, objects, or pursuits we hope will soothe it are not what we really need. We don’t know what we need, and so long as we stay in the hungry ghost mode, we’ll never know.
It’s their attempt, I believe, to escape the hell realm of overwhelming fear, rage, and despair.
Our clients are not the “deserving poor”; they are just poor—undeserving in their own eyes and in those of society.
At the Portland Hotel there is no chimera of redemption or any expectation of socially respectable outcomes, only an unsentimental recognition of the real needs of real human beings in the dingy present, based on a uniformly tragic past.
A longtime resident came up to the microphone. He said he didn’t have a poem to recite or anything else creative.… What he shared was that the Portland was his first home. That this is the only home he’s ever had and how grateful he was for the community he was part of. And how proud he was to be part of it, and he wished his mom and dad could see him now.”
“The only home he’s ever had”—a phrase that sums up the histories of many people in the Downtown Eastside of “one of the world’s most livable cities.”1
We do not expect to cure anyone, only to ameliorate the effects of drug addiction and its attendant ailments and to soften the impact of the legal and social torments our culture uses to punish the drug addict.
their suffering is made worse every day by social ostracism—by what the scholar and writer Elliot Leyton has described as “the bland, racist, sexist, and ‘classist’ prejudices buried in Canadian society: an institutionalized contempt for the poor, for sex-trade workers, for drug addicts and alcoholics, for aboriginal people.”
“When I get on the bus in this outfit, people just know. They move away from me. Some stare; most don’t even look in my direction. You know what that feels like? Like I’m an alien. I don’t feel right till I’m back here; no wonder nobody ever leaves.”
All of us who are called to this work are responding to an inner pull that resonates with the same frequencies that vibrate in the lives of the haunted, drained, dysfunctional human beings in our care.
Others offer themselves because their compassionate hearts know that here is where love is most needed.
Some are lured by the magnetic force of addictions because they haven’t resolved, or even recognized, their own addictive tendencies.
Yes, they lie, cheat, and manipulate—but don’t we all, in our own way? Unlike the rest of us, they can’t pretend not to be cheaters and manipulators.
addiction. That isn’t much by the straight world’s standards, but there’s a paradoxical core of honesty wrapped in the compulsive deceit any addiction imposes.
Portland. “They share food, clothing and makeup—anything they have.” People tend to each other through illness, report with concern and compassion on a friend’s condition, and often display more kindness to someone else than they usually give themselves.
are unimpressed with titles, achievements, worldly credentials.
What they care about is my presence or absence as a human being. They gauge with unerring eyes whether I am grounded enough on any given day to coexist with them, to listen to them as persons with feelings, hopes, and aspirations that are as valid as mine.
They can tell instantly whether I’m genuinely committed to their well-being or just trying to get them out of my way. Chronically unable to offer such caring to themselves, they are all the more sensitive to its presence or absence in those charged with caring for them.
people jeopardize their lives for the sake of making the moment livable.
“I’m not afraid of dying,” a client told me. “Sometimes I’m more afraid of living.”
“Nothing bothers me when I’m high. There’s no stress in my life,”
drugs have the power to make the painful tolerable and the humdrum worth living for.
the drug as emotional anesthetic; as an antidote to a frightful feeling of emptiness; as a tonic against fatigue, boredom, alienation, and a sense of personal inadequacy; as stress reliever and social lubricant.
Far more than a quest for pleasure, chronic substance use is the addict’s attempt to escape distress. From a medical point of view, addicts are self-medicating conditions like depression, anxiety, post-traumatic stress, or even attention deficit/hyperactivity disorder (ADHD).
Addictions always originate in pain, whether felt openly or hidden in the unconscious.
When people speak of feeling “hurt” or of having emotional “pain,” they are not being abstract or poetic but scientifically quite precise.
The research literature is unequivocal: most hard-core substance abusers come from abusive homes.
The majority of my skid row patients suffered severe neglect and maltreatment early in life.
Almost all the addicted women inhabiting the Downtown Eastside were sexually assaulted in childho...
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As children they were obliged to witness the violent relationships, self-harming life patterns, or suicidal addictions of their parents—and often had to take care of them.
“Our difficulty or inability to perceive the experience of others … is all the more pronounced the more distant these experiences are from ours in time, space, or quality,” wrote the Auschwitz survivor Primo Levi.
Not all addictions are rooted in abuse or trauma, but I do believe they can all be traced to painful experience. A hurt is at the center of all addictive behaviors. It is present in the gambler, the Internet addict, the compulsive shopper, and the workaholic.
As we’ll see, the effects of early stress or adverse experiences directly shape both the psychology and the neurobiology of addiction in the brain.
Cathy reveals that when she wasn’t using, she missed not only the effect of the drugs but also the excitement of drug seeking and the rituals the drug habit entails. “I just didn’t know what to do with myself. It felt empty.”
When we have nothing to occupy our minds, bad memories, troubling anxieties, unease, or the nagging mental stupor we call boredom can arise.
Boredom, rooted in a fundamental discomfort with the self, is one of the least tolerable mental states.
The addict’s reliance on the drug to reawaken her dulled feelings is no adolescent caprice. The dullness is itself a consequence of an emotional malfunction not of her making: the internal shutdown of vulnerability.
The automatic repression of painful emotion is a helpless child’s prime defense mechanism and can enable the child to endure trauma that would otherwise be catastrophic. The unfortunate consequence is a wholesale dulling of emotional awareness.
The drug restores to the addict the childhood vivacity she suppressed long ago.
Emotionally drained people often lack physical energy, as anyone who has experienced depression knows,
energy. Flooded with artificially high levels of dopamine triggered by external substances, the brain’s own mechanisms of dopamine secretion become lazy. They stop functioning at anywhere near full capacity, relying on the artificial boosters instead.
Only long months of abstinence allow the intrinsic machinery of dopamine production to regenerate, and in the meantime, the addict will experience extremes of physical and emotional exhaustion.
“Strange, the cocaine calms me down.9 And the pot. I smoke five or six joints a day. That relaxes me, too. It takes the edge off. At the end of the day I just lay back with it. That’s just what happens, that’s my life. I smoke a joint and I go to sleep.”
No less a figure than the young Dr. Sigmund Freud was enthralled with cocaine for a while, relying on it “to control his intermittent depressed moods, improve his general sense of well-being, help him relax in tense social encounters, and just make him feel more like a man.”10 Freud was slow to accept that cocaine could create a dependence problem.
“It makes me talk, it opens me up; I can be friendly,” says one young man wired on crystal meth. “I’m never like this normally.”
It’s not a matter here of common shyness but of a deep psychological sense of isolation experienced from early childhood by people who felt rejected by everyone, beginning with their caregivers.
the addict sees no other possible existence for himself. His outlook on the future is restricted by his entrenched self-image as an addict. No matter how much he may acknowledge the costs of his addiction, he fears a loss of self if it were absent from his life. In his own mind, he would cease to exist as he knows himself.
That may sound bizarre, but Carol’s perspective is that drug use helped her escape an abusive family home, survive years of street living, and connect her with a community of people with shared experiences.
