In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

For example, I have blamed my wife, Rae, for not satisfying my expectations instead of taking responsibility for the burdens I impose on our relationship through poor self-regulation and lack of differentiation

That leaves me free to use the addictions for self-soothing and to justify doing so by citing my “unmet” needs. In other words, the consequences of my own wilful refusal to be a mature, self-regulating adul...

“What an abyss of uncertainty,” wrote the novelist Marcel Proust, “whenever the mind feels overtaken by itself, when it, the seeker, is at the same time the dark region through which it must go seeking.”

The dominant emotions suffusing all addictive behaviour are fear and resentment—

“Addiction is running from reality,” a patient of mine once said, “the reality you have that something is stronger. Something that’s greater than you. Instead of admitting it and saying that something scares me—this thing scares me, or I don’t know how to do this, or I don’t know how to live—instead of just saying that, you do drugs. So you coexist with the people that are nonexistent. People are just surviving but not living.”

Friedrich Nietzsche remarked, “One cannot get rid of anything, one cannot get over anything, one cannot repel anything—everything hurts. Men and things obtrude too closely; experiences strike one too deeply; memory becomes a festering wound.”

The teaching of Buddhism is that the way to deal with the mind is not to attempt to change it, but to become an impartial, compassionate observer of it.

The automatic mind, the reactive product of brain circuits, constantly interprets the present in the light of past conditioning. In its psychological responses it has great difficulty telling past from present, especially whenever it is emotionally aroused. A trigger in the present will set off emotions that were programmed perhaps decades ago at a much more vulnerable time in the person’s life. What seems like a reaction to some present circumstance is, in fact, a reliving of past emotional experience.

According to the psychologist and memory researcher Daniel Schacter, implicit memory is active “when people are influenced by past experience without any awareness that they are remembering … If we are unaware that something is influencing our behavior, there is little we can do to understand or counteract it. The subtle, virtually undetectable nature of implicit memory is one reason it can have powerful effects on our mental lives.”

“Be at least as interested in your reactions as in the person or situation that triggers them,” Eckhart Tolle advises.

Not “he did this to me and therefore I’m suffering” but “I notice that feelings of resentment and a desire for vengeance keep flooding my mind.”

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. Eventually she will realize that there is nothing to run away from. Situations might need to be changed, but there is no internal hell that one must escape by dulling or stimulating the mind.

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.

A person can survive being beaten but cannot remain psychologically intact if he convinces himself that he was beaten because he is by nature blameworthy or because the world by its very nature is cruel. A child can overcome sexual violation, but she will be debilitated if she thinks that she somehow either deserved the abuse or brought it upon herself. She also cannot function as a self-respecting adult if she comes to believe that she is loveable or acceptable only for her sexuality. A neglected child may be helpless, but the damage comes if he acquires the defining belief that helplessness is his real and permanent state in the world.

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. All too often these ill-conditioned implicit beliefs become self-fulfilling prophecies in our lives. We create meanings from our unconscious interp...

“I have a profound relationship with meditation; I think about it every day.”

My addiction-prone, ADD brain always wants to look to the outside to get away from itself. As a result, I tend to oscillate between excessive, multitasking busyness and a proclivity for “vegging out” in ways that leave me nonrested and dissatisfied. Meditation, with its demand for stillness and self-observation, has not been an activity I’ve joyfully embraced.

The person with OCD believes that something catastrophic may happen if she doesn’t perform a particular activity a precise number of times and in a particular way.

The Four-Step program is based on the perspective that makes the best sense of disorders like OCD and addiction: that they are rooted in malfunctioning brain circuits and in implicit stories and beliefs that do not match reality.

A warning about possible pitfalls. I have a tendency, typical in ADD, of beginning projects with enthusiasm and a sense of commitment, only to abandon them after some lapse or failure. “I’ve tried that,” I’ll then say, “but it doesn’t work for me.”

Step 1: Re-label

“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.”

Be fully aware of the sense of urgency that attends the impulse and keep labelling it as a manifestation of addiction, rather than any reality that you must act upon.

The point of re-labelling is not to make the addictive urge disappear—it’s not going to, at least not for a long time, since it was wired into the brain long ago. It is strengthened every time you give in to it and every time you try to suppress it forcibly. 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. Rest assured, the urge will come back—and again you will re-label it with determination and mindful awareness.

Step 2: Re-attribute

“In Re-attribute you learn to place the blame squarely on your brain. This is my brain sending me a false message.”

In Step 1 you recognized that the compulsion to engage in the addictive behaviour does not express a real need or anything that “must” happen; it’s only a belief. In Step 2 you state very clearly where that urge originated: in neurological circuits that were programmed into your brain long ago, when you were a child. It represents a dopamine or endorphin “hunger” on the part of brain systems that, early in your life, lacked the necessary conditions for their full development. It also represents emotional needs that went unsatisfied.

Re-attribution 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.”

Step 3: Re-focus

In the Re-focus step you buy yourself time. Although the compulsion to open the bag of cookies or turn on the TV or drive to the store or the casino is powerful, its shelf life is not permanent. Being a mind-phantom, it will pass, and you have to give it time to pass. The key principle here, as Dr. Schwartz points out, is this: “It’s not how you feel that counts; it’s what you do.”

Perhaps in the beginning you can’t even hold out for fifteen minutes—fine. Make it five, and record it in a journal as a success. Next time, try for six minutes, or sixteen. This is not a hundred-metre dash but a solo marathon you are training for. Successes will come in increments.

As you perform the alternative activity, stay aware of what you are doing. You are doing something difficult. No matter how simple it may seem to others who do not have to live with your particular brain, you know that holding out for even a short period of time is an achievement. You are teaching your old brain new tricks.

Step 4: Re-value

Step 5: Re-create

It is time to re-create: to choose a different life. You have values. You have passions. You have intention, talent, capability. In your heart there is love, and you want to connect that with the love in the world, in the universe. As you re-label, re-attribute, re-focus and re-value, you are releasing patterns that have held you and that you have held on to. In place of a life blighted by your addictive need for acquisition, self-soothing, admiration, oblivion, meaningless activity, what is the life you really want? What do you choose to create?

The great art is to express our vitality through the particular channels and at the particular speed Nature foresaw for us.”

Re-create. Are you afraid you will stumble? Of course you will: that’s called being a human being. And then you will take the four steps—plus one—again.

Human beings have an ingrained opposition to any sense of being forced, an automatic resistance to coercion that my friend Dr. Gordon Neufeld has called counterwill. It is triggered whenever a person feels controlled or pressured to do someone else’s bidding—and we can generate counterwill even against pressure that we put on ourselves.

“What were my real needs that I thought alcohol satisfied?” says Anne. “Attachment, attunement, to be in a community, to be loved by people, to be able to give love, to have joy, to be able to be myself. AA, and what I have learned in AA, has more successfully, more adaptively fulfilled these basic needs.”

I am chronically and notoriously late—to work, to meetings, to family gatherings. I’ve been able to blame that propensity partly on ADD, because a deficient time sense is a well-known feature of attention deficit disorder.

My initial reaction was anger—the addicted mind’s way of resisting shame—but only for a moment. I soon allowed the feelings of shame to wash over me without either resisting them or letting them knock me down, and I felt grateful.

If I didn’t file it as yet another ADD trait, my habitual lateness represented three factors that also express the addictive process: lack of impulse control—I’d just keep on doing whatever it was that caught my attention instead of making sure I was on time; failure to consider future consequences—“forgetting to remember the future,” in the words of psychologist and ADD researcher Russell Barkley; and lack of thought for the impact of my behaviour on other people. It became crystal clear that the addiction process—and the worldview that accompanies it—had polluted my life on levels I had not ever considered.

Once programmed, the addicted mind creates a world of emptiness where one must scratch and grab for every bit of nourishment and be ever vigilant for every opportunity to get more. The addict hasn’t grown out of the stage of infancy that has been called the narcissistic phase, the period when the fledgling human being believes that everything happens because of her, to her and for her.

The prewritten cheques are not a form of self-punishment, but a way of building a structure that helps keep me sober.

Creating such structures is part of establishing an external environment that supports mental awareness and responsible behaviour. All addicts need them.

Another mental structure I’ve committed to is truth-speaking.

My advice to anyone with addictive behaviours is to begin telling the truth. If you are not ready to drop the behaviour, then choose it openly. Tell your spouse or friends what you are doing; keep it in the daylight. At the very least, do not compound your inner shame by lying. Better you should look “bad” in the eyes of others than to sink further in your own estimation of yourself.

As you become less attached to your addiction, you also become calmer, less attached to other things that don’t matter nearly as much as you used to believe. Your responses are less automatic, less rigid. Not having reason to be so harsh on yourself, you are not so inclined to find fault with others. Things don’t always have to go your way for you to be able to enjoy life.

What’s odd about the inventory is that, for me, it was an admission that I had power in the world, power to hurt others, which I’d never acknowledged. Besides denying my own responsibility, I’d also often denied that my words or actions could have any effect on anyone.

Stresses like 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.