In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

The less dope [heroin] I’m doing, the more stuff from the past surfaces. I don’t know how to handle my feelings. With rock I get triggered, more sensitive—incredibly sensitive—to unresolved things in my life. Things I’m hurt about become overwhelming, to the point where I go from being completely devastated to desperate to almost volcanic—it’s terrifying for me.” “So you’ve still been topping up your methadone with heroin. Why?” “Because I want that coma state, where I don’t feel anything.” Reflective, cogent, articulate, Celia speaks slowly, even formally, in her low, husky voice. A gap in her teeth gives her a faint lisp. “What is it you don’t want to feel?” “Every person I ever wanted to trust, I’ve been hurt by. I truly am in love with Rick, but for the life of me I can’t bring myself to believe that he will not betray me. It stems right back to my sexual abuse.”

“You’re hurt.” “I’m devastated. I’ve never felt so unwanted in my whole fucking life.” Yes, you have, I think to myself. You have always felt unwanted. And desperate as you are to offer your baby what you never experienced—a loving welcome into this world—in the end, you’ll give her the same message of rejection.

If only her life-affirming tendencies could be kept active and in ascendance over her rigid, resigned, anxiety-ridden emotional mechanisms.

You yourself once said that you don’t get the best of a person when there’s an addiction. The child needs the best of you, needs you to be emotionally stable and present. Her sense of security depends on it. Her brain development thrives on it. You are no parent when you’re controlled by your addiction. Don’t you understand that?”

Ralph is showcasing the terrible unrest of his soul. The suffering Germans and rapacious Jews in his narrative are projections of his own phantoms. The erratic mishmash he calls history reflects his inner chaos, confusion and fear.

above everything Ralph aches for unity with the eternal feminine caritas—blessed, soul-saving divine love.

when they permit even a slight opening in the hard, prickly shells they’ve built to protect themselves. For that to happen, they must first sense our commitment to accepting them for who they are. That is the essence of harm reduction, but it’s also the essence of any healing or nurturing relationship.

In his book On Becoming a Person, the great American psychologist Carl Rogers described a warm, caring attitude, which he called unconditional positive regard because, he said, “it has no conditions of worth attached to it.” This is a caring, wrote Rogers, “[that] is not possessive, [that] demands no personal gratification. It is an atmosphere [that] simply demonstrates I care; not I care for you if you behave thus and so.”1

isolation is in the very nature of addiction. Psychological isolation tips people into addiction in the first place, and addiction keeps them isolated because it sets a higher value on their motivations and behaviours around the drug than on anything else—even human contact.

It’s hard to get enough of something that almost works. VINCENT FELITTI, M.D.

I must have it and I must have it now. The desire first arises as a thought and rapidly transforms itself into a concrete object in my mind, with a weight and a pull. It generates an irresistible gravitational field. The tension is relieved only when I succumb.

Rae is suspicious. “Have you been obsessing and buying?” she’s asked me a number of times in the past few weeks. I look directly at my life partner of thirty-nine years and I lie. I tell myself I don’t want to hurt her. Nonsense. I fear losing her affection. I don’t want to look bad in her eyes. I’m afraid of her anger. That’s what I don’t want.

Addictions, even as they resemble normal human yearnings, are more about desire than attainment. In the addicted mode, the emotional charge is in the pursuit and the acquisition of the desired object, not in the possession and enjoyment of it. The greatest pleasure is in the momentary satisfaction of yearning.

The fundamental addiction is to the fleeting experience of not being addicted. The addict craves the absence of the craving state. For a brief moment he’s liberated from emptiness, from boredom, from lack of meaning, from yearning, from being driven or from pain. He is free. His enslavement to the external—the substance, the object or the activity—consists of the impossibility, in his mind, of finding within himself the freedom from longing or irritability.

This behaviour has been recurring for decades, since my children were— Wait. “The behaviour has been recurring?” What a neat way to put it outside of myself, as if it lived as an independent entity. No, I have been doing this for decades, since my children were small.

One addict knows another.

Any passion can become an addiction; but then how to distinguish between the two? The central question is: who’s in charge, the individual or their behaviour? It’s possible to rule a passion, but an obsessive passion that a person is unable to rule is an addiction. And the addiction is the repeated behaviour that a person keeps engaging in, even though he knows it harms himself or others. How it looks externally is irrelevant. The key issue is a person’s internal relationship to the passion and its related behaviours.

If in doubt, ask yourself one simple question: given the harm you’re doing to yourself and others, are you willing to stop? If not, you’re addicted. And if you’re unable to renounce the behaviour...

There is, of course, a deeper, more ossified layer beneath any kind of addiction: the denial state in which, contrary to all reason and evidence, you refuse to acknowledge that you’re hurting yourself or anyone else. In the denial state you’re completely resistant to asking yourself any questions at all. But if you want to know, look around you. Are you closer to the people you love after your passion has been ...

Passion gives and enriches; addiction is a thief. Passion is a source of truth and enlightenment; addictive behaviours lead you into darkness. You’re more alive when you are passionate, and you triumph whether or not you attain your goal. But an addiction requires a specific outcome that feeds the ego; without that outcome, the ego feels empty and deprived.

in my shame, I don’t believe I deserve any praise. A secret addiction comes equipped with praise deflectors.

I become increasingly cynical about the world—politics, people, possibility, the future. Every morning I get into a hostile argument with the newspaper, resenting it for what it says or doesn’t say. The Globe and Mail, in its news slant, editorials and choice of columnists, favours corporations, the mainstream parties and neocon foreign policy makers.

My negativity stems from my internal dissatisfaction, my harsh self-critique. The Globe doesn’t speak the truth as I see it? Neither do I. The Globe justifies selfish acquisitiveness and exonerates dishonesty? Look who’s talking.

I become increasingly and reflexively critical, irritable and self-righteous with my teenaged daughter. The more I indulge myself, the more judgmental I am toward her. I can’t be optimistic and believe in her growth and development when I know I’m sabotaging my own. How can I see the best in her when I’m blind to all but the worst in myself? Our interactions are tense. At age seventeen, she’s at no loss for words or body language to communicate her displeasure.

I hated myself, and this self-loathing manifested itself in the harsh, controlling and critical ways I’d deal with my sons and my daughter. When we’re preoccupied with serving our own false needs, we can’t endure seeing the genuine needs of other people—least of all those of our children.

Without my achievements and the opportunity to display my status, intelligence and wit, I fear I do not cut a very impressive figure.

Wryly, I observe my ego do its frantic dance. It just can’t get no satisfaction.

He speaks with the authority of someone who’s looked himself in the eye without blinking.

Two things alcoholics hate is work and time. There has to be no effort involved, and you want the results right now.”

“I don’t mean,” she says, “that my life is perfect. Sometimes it feels like things are completely falling apart, like this week. But I no longer confuse stuff that happens with my life. This moment is okay, even when things are coming apart at the seams. Right here, right now, at this moment, things are okay.”

Fuck. That God thing again. What God? Ever since I was a child, I’ve been shaking my fist at Heaven.

From the moment I had a mind of my own, I knew there was no all-knowing, all-powerful, all-loving God. In Eastern Europe under the Stalinist regimes there used to be a saying: “You can be honest or intelligent or be a member of the Communist Party. In fact, you can be any two of the three, but not all three at the same time.” In the same way, I understood that God could be all-knowing and all-powerful, but not all-loving. How else to explain the murder of my grandparents in the gas chambers of Auschwitz or my own near-death as an infant in the Budapest ghetto? Or God can be all-loving and all-knowing, but not omnipotent. A milksop. A weakling. So what is this God whose directions I’m supposed to obey?

I will come back, I decide. What I’ve witnessed here are humility, gratitude, commitment, acceptance, support and authenticity. I so desperately want those qualities for myself.

What, then, is addiction? In the words of a consensus statement by addiction experts in 2001, addiction is a “chronic neurobiological disease … characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.”1 The key features of substance addiction are the use of drugs or alcohol despite negative consequences, and relapse. I’ve heard some people shrug off their addictive tendencies by saying, for example, “I can’t be an alcoholic. I don’t drink that much …” or “I only drink at certain times.” The issue is not the quantity or even the frequency, but the impact. “An addict continues to use a drug when evidence strongly demonstrates the drug is doing significant harm…. If users show the pattern of preoccupation and compulsive use repeatedly over time with relapse, addiction can be identified.”2

Addiction is any repeated behaviour, 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. Addiction involves: compulsive engagement with the behaviour, a preoccupation with it; impaired control over the behaviour; persistence or relapse, despite evidence of harm; and dissatisfaction, irritability or intense craving when the object—be it a drug, activity or other goal—is not immediately available.

Although tolerance is a common effect of many addictions, a person does not need to have developed a tolerance to be addicted.

The addict comes to depend on the substance or behaviour in order to make himself feel momentarily calmer or more excited or less dissatisfied with his life.

We can never understand addiction if we look for its sources exclusively in the actions of chemicals, no matter how powerful they are. “Addiction is a human problem that resides in people, not in the drug or in the drug’s capacity to produce physical effects,” writes Lance Dodes, a psychiatrist at the Harvard Medical School Division on Addictions.4 It is true that some people will become hooked on substances after only a few times of using, with potentially tragic consequences, but to understand why, we have to know what about those individuals makes them vulnerable to addiction. Mere exposure to a stimulant or narcotic or to any other mood-altering chemical does not make a person susceptible. If she becomes an addict, it’s because she’s already at risk.

emotional isolation, powerlessness and stress are exactly the conditions that promote the neurobiology of addiction in human beings,

The Vietnam veterans study pointed to a similar conclusion: under certain conditions of stress many people can be made susceptible to addiction, but if circumstances change for the better, the addictive drive will abate. About half of all the American soldiers in Vietnam who began to use heroin developed addiction to the drug. Once the stress of military service in a brutal and dangerous war ended, so, in the vast majority of cases, did the addiction. The ones who persisted in heroin addiction back home were, for the most part, those with histories of unstable childhoods and previous drug use problems.

“Among the most insidious consequences to drugs of abuse is the vulnerability to craving and relapse after many weeks or years of abstinence,” says a review of addiction neurobiology in a psychiatric journal. “The enduring nature of this behavioural vulnerability implies long-lasting changes in brain function.”

Since the brain determines the way we act, these biological changes lead to altered behaviours. It is in this sense that medical language refers to addiction as a chronic disease, and it is in this sense of a drug-affected brain state that I think the disease model is useful. It may not fully define addiction, but it does help us understand some of its most important features.

addiction’s central dilemma: if recovery is to occur, the brain, the impaired organ of decision making, needs to initiate its own healing process. An altered and dysfunctional brain must decide that it wants to overcome its own dysfunction: to revert to normal—or, perhaps, become normal for the very first time. The worse the addiction is, the greater the brain abnormality and the greater the biological obstacles to opting for health.

The scientific literature is nearly unanimous in viewing drug addiction as a chronic brain condition, and this alone ought to discourage anyone from blaming or punishing the sufferer.

A child who complains bitterly of the slightest hurt and is often accused of being a “crybaby” is probably low on endorphins and is likely to be less adventurous than his peers.

A child can also feel emotional distress when their parent is physically present but emotionally unavailable. Even adults know that kind of pain when someone important to us is bodily present but psychologically absent. This is the state the seminal researcher and psychologist Allan Schore has called “proximal separation.”12 Given that the child’s dependence is as much emotional as physical, in normal circumstances a child who senses emotional separation will seek to reconnect with the parent. Once more, the parent’s loving response will flood the brain with endorphins and ease the child’s discomfort. Should the parent not respond, or not respond adequately, endorphins won’t be released, and the child will be left to his own inadequate coping mechanisms—for example, rocking or thumb-sucking as ways of self-soothing or tuning out to escape his distress. Children who have not received the attentive presence of the parent are, as we will see, at greater risk for seeking chemical satisfaction from external sources later in life.

One human subject stimulated himself fifteen hundred times in a three-hour period, “to a point that he was experiencing an almost overwhelming euphoria and elation, and had to be disconnected despite his vigorous protests.”1

Let’s take a hypothetical situation involving a hypothetical “you.” You see a chocolate bar in a Hallowe’en bag, and you’re seized by a desire to munch on it: a classic example of a positively reinforced behaviour. That is, you’ve tasted a similar chocolate bar before and liked the experience. Now, when this new bar appears in your sight, dopamine is released in the NA, inciting you to take a bite. Your four-year-old daughter, to whom the bar belonged, accuses you of thieving. “The dopamine made me do it,” you say in self-defence. Your daughter, nothing if not a reasonable preschooler, drops her resentment. “Of course, Daddy,” she says sweetly, “because a cue associated with a previously pleasurable experience triggers a surge of dopamine in the NA and incites consummatory behaviour. Seeing my candy bar was your cue, and eating it was the consummatory behaviour. You have such a silly, predictable reinforcement system.” “Wow,” you say. “That’s exactly right, honey. Will you share that last piece of chocolate with me?” “No way! Your dopamine circuits aren’t my problem.”

The role of the dopamine system in novelty-seeking helps explain why some people are driven to risky behaviours such as street racing. It’s one way to experience the excitement of dopamine release.

Just how important dopamine receptors are to substance use was illustrated by a study of mice who had previously been trained to drink alcohol. They were given an “infusion” of dopamine receptors right into the nucleus accumbens. Before the infusion these rodents had fewer than normal dopamine receptors. The receptors were incorporated into a harmless virus that entered the animals’ brain cells so that, temporarily, a normal range of receptor activity was achieved. As long as this artificial supply of dopamine receptors was available, the mice reduced their alcohol intake considerably—but they gradually became boozers again as the implanted receptors were lost to natural attrition.