In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

Addiction is often a misguided attempt to relieve stress, but misguided only in the long term. In the short term addictive substances and behaviours do act as stress relievers.

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

The counterwill-driven resistance to any sense of coercion will sabotage even the most well-meant endeavour by one human being to change another. There are many other factors, too, including the powerful underlying emotional currents and brain physiology from which addiction springs in the first place. The person attached to his addiction will respond to an attempt to separate him from his habit as a lover would to someone who disparages his beloved: with hostility. Any attempts to shame him will also trigger rage.

Unconditional acceptance of another person doesn’t mean staying with them under all circumstances, at no matter what cost to oneself; that duty belongs only to the parents of a young child.

Acceptance in the context of adult-to-adult relationships may mean simply acknowledging that the other is the way he or she is, not judging them and not corroding one’s own soul with resentment that they are not different. Acceptance does not mean saintly self-sacrifice or tolerating an eternity of broken promises and hurtful eruptions of frustration and rage.

If refusal to take on responsibility for another person’s behaviours burdens you with guilt, while consenting to it leaves you eaten by resentment, opt for the guilt. Resentment is soul suicide.

Although we may believe we are acting out of love, when we are critical of others or work very hard to change them, it’s always about ourselves. “The alcoholic’s wife is adding to the level of shame her husband experiences,” says Anne, a veteran of AA. “In effect, she is saying to the addict, he is bad and she is good. Perhaps she is in denial about her addiction to certain attitudes, like self-righteousness, martyrdom or perfectionism. What if, on the other hand, the wife said to her husband: ‘I’m feeling good today, honey. I only obsessed about your drinking once today. I’m really making progress on my addiction to self-righteousness. How are you feeling?’ Wouldn’t that be a loving way to approach each other rather than one person trying to control another’s addiction? After all, if the developmental roots of the addiction process lie in insufficient attachment, recovery includes forming attachments. As with good parenting, real attachment relationships are based on truth. The truth is, a wife who thinks she does not have plenty of her own spiritual or psychological work to do, that is, one for whom another’s behavior becomes the central determinant of her own emotional/spiritual condition, is not in touch with the truth.”

If you want to point the addict toward more fulfilling possibilities in his life, drop the self-righteousness. The conversation needs to be opened not as a demand, but as an invitation that may be refused. It is helpful to acknowledge that the person had reasons for “choosing” the addiction, that it held some value for him. “It was your way of surmounting some pain, or helping you through some difficulty. I can understand why you went in that direction.”

These questions will help to keep us from projecting our unconscious anxieties and concerns onto the other—a burden the addict will instinctively reject. Nobody wants to perceive himself as someone’s salvage project.

A tremendous step forward, albeit a very difficult one, is for people who are in relationship with the addict not to take his behaviours 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. A loving partner or friend may openly acknowledge his or her own pain around the behaviour, but the belief that somehow the addict’s actions deliberately betray or wound them only compounds the suffering.

He’ll keep riding the alternately sad and elated merry-go-round of his relationship with Joyce as long as he remains unable to integrate and accept the hurt that his parents could not love him unselfishly, the way he needed to be loved, and that, as a result, he has never learned to accept himself.

They are prone to experience themselves as demeaned and abandoned by authority figures and caregivers, for reasons we have explored. When a busy physician or overworked nurse is short tempered and impatient with them, they interpret it as personal rejection. They react instinctively to the least tension or condescension on the part of caregivers.

For any young person, if the deity she hears about is not manifested in the actions of the people who make up her world, the God-word turns into hypocrisy. If she does retain an image of God, it’s likely to be the vindictive moralizer who judges her mercilessly or the impotent sky phantom I rejected as a child.

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.

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.”2

Our material culture tries to explain even unselfishness as arising from selfish motives. It is often asserted, cynically, that people who act in kindly ways, without any benefit to themselves, are doing so only to feel good.

According to a recent study, a key contributor to humane behaviour is the posterior superior temporal cortex (pSTC), a region at the back of the brain whose function includes awareness of other people’s emotional states.3 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,”

Armed with compassion, we recognize that addiction was the answer—the best answer we could find at one time in our lives—to the problem of isolation from our true selves and from the rest of creation.

Given the long-term effects of prenatal stress and the dominant influence of the environment on brain development following birth, is it surprising that infants of alcoholic biological fathers would also have a greater propensity to drink? We know from the Adverse Childhood Experiences (ACE) Study that alcoholism is associated with many other traumatic circumstances—for example, either parent being alcoholic increases the chance of the mother being battered by a factor of thirteen.5 When we consider what it’s like for a woman to live with an alcoholic male partner—the insecurity she experiences through the pregnancy and beyond, and the abuse she may be subjected to—we can see that the stresses on such a woman, both before and after birth, would have been greater than the stresses on most other pregnant women. Furthermore, if a child spent the first months of his or her life—and possibly the first three years—under such circumstances, it would mean that by the time he was adopted, his attachment-reward, incentive-motivation and self-regulation systems would have been significantly impaired, along with his stress-response mechanisms. Such a study can tell us nothing about genetic effects. Similar objections, and a wide range of others, could be made—and have been made—to the other adoption studies.6

Will the parent use the same tone of voice or play in the same way with, say, a smaller female child than with her larger and more robust male sibling, or vice versa?

On a deeper level, will the parents project the same fears, hopes and expectations on the children? Clearly not: each child represents something different to each parent and that means these two children do not grow up under identical conditions. They don’t share the same formative environment—not in the home and not on the playground or in school where nonidentical twins are much more likely to have very different peers and experiences than identical twins.

No wonder that adopted children are generally more vulnerable to various developmental disorders—for example, ADHD—that increase the risk for addiction. No wonder that many adults who were adopted as infants harbour a powerful and lifelong sense of rejection or that among adoptees the adolescent suicide risk is double that of nonadopted children.

The link between ADHD and a predisposition to addiction is obvious and, in fact, inevitable. The connection has little to do with genetics. ADHD is no more inherited genetically than addiction is, despite the widespread assumption among ADHD experts that it’s “the most heritable of all mental disorders.”

My point is not that abuse is the cause of ADHD, although it certainly increases the risk for it, but that early childhood stress is the major factor—abuse being only an extreme form of childhood stress. It is the impact of early stress on the brain—maternal depression, for example—that creates vulnerability to ADHD and to addictions. Stresses or interruptions in the infant–mother relationship lead to permanent alterations in the dopamine systems of the mid-brain and prefontal cortex, disturbances that are implicated in both ADHD and in substance abuse and other addictions.

ADHD and addiction have much in common, both in their characteristics and in their neurobiology. They are both disorders of self-regulation. They both involve abnormal dopamine activity—in fact, the medications used to treat ADHD are stimulants like methylphenidate (Ritalin, Concerta) or amphetamines (Dexedrine, Adderall), whose method of action is to increase dopamine activity in important brain circuits.8 The personality traits of people with ADHD and addiction are often identical: poor self-regulation, deficient impulse control, poor differentiation and a constant need to find distractions from distressing internal states.