In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

The mind and brain processes are the same in all addictions, no matter what form, as is the psycho-spiritual emptiness that resides at the core.

“We need to talk about what drives people to take drugs,” the famed trauma researcher Dr. Bessel van der Kolk has said. “People who feel good about themselves don’t do things that endanger their bodies…. Traumatized people feel agitated, restless, tight in the chest. You hate the way you feel. You take drugs in order to stabilize your body.” That is the desperation—the need to regulate one’s body and mind, to escape unbearable distress or unrest. As shown in the pages of this book, it activates all addictions, substance-related or not.

“I’m not going to ask you what you were addicted to,” I often say to people. “Nor when, nor for how long. Only, whatever your addictive focus; what did it offer you? What did you like about it? What, in the short term, did it give you that you craved or liked so much?” And universally, the answers are: “It helped me escape emotional pain; helped me deal with stress; gave me peace of mind, a sense of connection with others, a sense of control.”

addiction is neither a choice nor primarily a disease. It originates in a human being’s desperate attempt to solve a problem: the problem of emotional pain, of overwhelming stress, of lost connection, of loss of control, of a deep discomfort with the self. In short, it is a forlorn attempt to solve the problem of human pain. All drugs—and all behaviours of addiction, substance-dependent or not, whether to gambling, sex, the internet or cocaine—either soothe pain directly or distract from it. Hence my mantra: The first question is not “Why the addiction?” but “Why the pain?”

In this book I argue that there is no “war on drugs.” One cannot make war on inanimate objects, only on human beings. And the people the war is mostly waged upon are those who have been the most neglected and oppressed in childhood, for, according to all the science, all the epidemiological data, all the experience, they are the most likely to succumb to substance addiction later in life. In our civilized times we are punishing and tormenting people for having suffered trauma.

Inevitably, addictions are most prevalent and most deadly among populations who, historically, have suffered the most enduring trauma and dislocation.

“Your book humanizes the addict,” many readers have told me. That acknowledgement reflects a fundamental and common misperception. Addicts are human. What keeps many of us from seeing that? It is only the habit of our egocentric mind that divides the world into “us and them.” More precisely, it is our inability—or refusal—to see the us in “them” and the them in what we take to be “us.”

There is only one universal addiction process. Its manifestations are multiple, from the gentler to the life-threatening, but in all addictions it utilizes the same brain circuits of pain relief, reward and motivation; it imposes the same psychological dynamics of shame and denial, the same behaviours of subterfuge and dishonesty. In all cases, it exacts the price of inner peace, harm to relationships, and diminished self-worth.

Parent-blaming is emotionally unkind and scientifically incorrect. All parents do their best; only our best is limited by our own unresolved or unconscious trauma.

Addictions arise from thwarted love, from our thwarted ability to love children the way they need to be loved, from our thwarted ability to love ourselves and one another in the ways we all need. Opening our hearts is the path to healing addiction—opening our compassion for the pain within ourselves, and the pain all around us.

Those whom we dismiss as “junkies” are not creatures from a different world, only men and women mired at the extreme end of a continuum on which, here or there, all of us might well locate ourselves.

The question is never “Why the addiction?” but “Why the pain?” The research literature is unequivocal: most hard-core substance abusers come from abusive homes.

Human beings want not only to survive, but also to live. We long to experience life in all its vividness, with full, untrammelled emotion. Adults envy the open-hearted and open-minded explorations of children; seeing their joy and curiosity, we pine for our own lost capacity for wide-eyed wonder. Boredom, rooted in a fundamental discomfort with the self, is one of the least tolerable mental states.

Imagine how disabled we would be if we could not see or hear or taste or sense heat or cold or physical pain. Emotional shut-down is similar. Our emotions are an indispensable part of our sensory apparatus and an essential part of who we are. They make life worthwhile, exciting, challenging, beautiful and meaningful.

Unconditional acceptance of each other is one of the greatest challenges we humans face. Few of us have experienced it consistently; the addict has never experienced it—least of all from himself.

Drugs, in short, do not make anyone into an addict, any more than food makes a person into a compulsive eater. There has to be a pre-existing vulnerability.

we might say that three factors need to coincide for substance addiction to occur: a susceptible organism; a drug with addictive potential; and stress.

substances could affect us unless they worked on natural processes in the human brain and made use of the brain’s innate chemical apparatus. Drugs influence and alter how we act and feel because they resemble the brain’s own natural chemicals. This likeness allows them to occupy receptor sites on our cells and interact with the brain’s intrinsic messenger systems.

Addiction may not be a natural state, but the brain regions it subverts are part of our central machinery of survival.

Environmental cues associated with drug use—paraphernalia, people, places and situations—are all powerful triggers for repeated use and for relapse, because they themselves trigger dopamine release. People trying to quit smoking, for example, are advised to avoid poker if they are used to having a cigarette while playing cards.

Dopamine activity also accounts for a curious fact reported by many drug addicts: that obtaining and preparing the substance gives them a rush, quite apart from the pharmaceutical effects that follow drug injection.

Opioid circuits and dopamine pathways are important components of what has been called the limbic system, or the emotional brain. The circuits of the limbic system process emotions like love, joy, pleasure, pain, anger and fear. For all their complexities, emotions exist for a very basic purpose: to initiate and maintain activities necessary for survival. In a nutshell, they modulate two drives that are absolutely essential to animal life, including human life: attachment and aversion.

in social interactions, especially in eyes set in a smiling face, dilated pupils mean enjoyment and delight. Babies are highly sensitive to such cues—as are aphasiac adults (people who, usually due to a stroke, have lost the ability to understand spoken language). Because they pay heed to physical/emotional rather than verbal messages, young children and aphasiacs have a much better sense of when they are being lied to than most of us.

Let’s recall here our definition of addiction: 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. The distinguishing features of any addiction are: compulsion, preoccupation, impaired control, persistence, relapse and craving.

There is no such thing as a good addiction. Everything a person can do is better done if there is no addictive attachment that pollutes it. For every addiction—no matter how benign or even laudable it seems from the outside—someone pays a price.

The ego can never get enough—it doesn’t even know the concept.

People are susceptible to the addiction process if they have a constant need to fill their minds or bodies with external sources of comfort, whether physical or emotional. That need expresses a failure of self-regulation—an inability to maintain a reasonably stable internal emotional atmosphere. No one is born with the capacity for self-regulation; as I’ve mentioned, the infant is completely dependent upon the parents to regulate his physical and psychological states. Self-regulation being a developmental achievement, we reach it only if the conditions for development are right. Some people never attain it; even in advanced adulthood they must rely on some external support to quell their discomfort and soothe their anxiety. They just cannot make themselves feel okay without such supports, whether they be chemicals or food or an excessive need for attention, approval or love. Or they seek to make their lives exciting by engaging in activities that trigger elation or a sense of risk. A person with inadequate self-regulation becomes dependent on “outside things” to lift his mood and even to calm himself if he experiences too much undirected internal energy.

Also characterizing the addiction-prone personality is the absence of differentiation.3 Differentiation is defined as “the ability to be in emotional contact with others yet still autonomous in one’s emotional functioning.” It’s the capacity to hold on to ourselves while interacting with others. The poorly differentiated person is easily overwhelmed by his emotions, “absorbs anxiety from others and generates considerable anxiety within himself.”4 Lack of differentiation and impaired self-regulation reflect a lack of emotional maturity.

Psychological maturation is the development of a sense of self as separate from inner experience—a capacity entirely absent in the young child. The child has to learn that she is not identical with whatever feeling happens to be dominant in her at any particular moment. She can feel something without her actions being automatically dictated by that feeling. She can be aware of other, conflicting feelings or of thoughts, values and commitments that might run counter to the feeling of the moment. She can choose. In the addict this experience of “mixed feelings” is often lacking. Emotional processes rule the addict’s perspective: whatever she is feeling at the moment tends to define her view of the world and will control her actions. The same applies in the realm of relationships: for maturation the child must become unique and separate from other individuals. She has to know her own mind and not be overwhelmed by the thoughts, perspectives or emotional states of others. The better differentiated she becomes, the more she is able to mix with others without losing her sense of self. The individuated, well-differentiated person can respond from an open acceptance of his own emotions, which are not tailored either to match someone else’s expectations or to resist them. He neither suppresses his emotions nor acts them out impulsively.

Any gardener knows that if a plant hasn’t grown, most likely the conditions were lacking. The same goes for children. The addictive personality is a personality that hasn’t matured.

Whether we tally health expenditures, loss of human life, economic strain or any other measure, the “respectable” addictions, around which entire cultures, industries and professions have been built, leave drug addiction in the dust.

As children become increasingly less connected to adults, they rely more and more on each other—a wholesale cultural subversion of the natural order of things. The natural order in all mammalian cultures, animal or human, is that the young stay under the wings of adults until they themselves reach adulthood. Immature creatures were never meant to bring one another to maturity. They were never meant to look to one another for primary nurturing, modelling, cue giving or mentoring. They are not equipped to act as one another’s focus of orientation, to give one another a sense of direction or values. The predictable and widespread consequences of what my friend, psychologist Gordon Neufeld, has termed peer orientation are the increasing immaturity, alienation, violence and precocious sexualization of North American youth.

Kids are not cruel by nature, but they are immature. They taunt, tease and reject. Those who have lost their orientation to adults and look to the peer group instead find themselves having to shut down emotionally for sheer protection.

In short, the addiction process takes hold in people who have suffered dislocation and whose place in the normal human communal context has been disrupted: whether they’ve been abused or emotionally neglected; are inadequately attuned children or peer-oriented teens or members of subcultures historically subjected to exploitation.

War on Drugs has been dragging on for many decades. Although the term was first coined in 1971 by Richard Nixon, its policies have been pursued with escalating force since the early years of the twentieth century. Were we to apply objective measures, we would rapidly abandon both the rhetoric and the practices of this war. Were we to judge according to ethics and humane feeling, we would find the War abhorrent. “The single most conspicuous feature of wars is violence,” writes Bruce Alexander in his book Peaceful Measures: Canada’s Way Out of the “War on Drugs”: War mentality cleaves the world into noble allies and despicable enemies [and] justifies any measures necessary to prevail, including violence to innocent bystanders … In essence, war mentality suspends normal human compassion and intelligence.1

Under conditions of extreme deprivation people will continue to grow crops that promise economic relief, and they will continue to trade in those crops and their products. The ultimate beneficiaries are neither the impoverished Afghan or Colombian peasant nor the streetcorner pusher in the U.S. ghetto or on Vancouver’s Skid Row. The illegality of mind-altering substances enriches drug cartels, crime syndicates and their corrupt enablers among politicians, government officials, judges, lawyers and police officers around the world. If one set out deliberately to fashion a legal system designed to maximize and sustain the wealth of international drug criminals and their abettors, one could never dream up anything to improve upon the present one—except, perhaps, to add tobacco to the list of contraband substances. That way the traffickers and their allies could profit even more—although it’s unimaginable that their legally respectable counterparts, tax-hungry governments and the nicotine pushers in tobacco company boardrooms, would ever allow that to happen.

A CORE ASSUMPTION in the War on Drugs is that the addict is free to make the choice not to be addicted and that harsh social or legal measures will deter him from pursuing his habit. It is not that easy. Contrary to Nancy Reagan’s simplistic billboard messages, people cannot “just say no” in the face of addictive drives.

Even in cases where abstinence is not achieved, redemption would mean the reintegration of the user into the larger community and the restoration of his value as a person in his own eyes.

“Free choice only comes from thinking, it doesn’t come from emotions. It emerges from the capacity to think about your emotions. When you’re operating in the habit mode you are feeling, but those feelings are not being reflected upon. They are too powerful, they are too habitual. So, the treatment of addiction requires the island of relief where a need to soothe pain does not constantly drive a person’s motivation. It requires a complex and supportive social environment.” How to create that island of relief is the core issue in projecting a humane policy toward addiction.

Not having to spend exorbitant amounts on drugs that, in themselves, are inexpensive to prepare, addicts would not be forced into crime, violence, prostitution or poverty to pay for their habits. They would not have to decide between eating or drug use, or to scrounge for food in garbage cans or pick cigarette butts out of sidewalk puddles. They would no longer need to suffer malnutrition.

To expect an addict to give up her drug is like asking the average person to imagine living without all her social skills, support networks, emotional stability and sense of physical and psychological comfort. Those are the qualities that, in their illusory and evanescent way, drugs give the addict.

The criminality associated with addiction follows directly from the need to raise money to purchase drugs at prices that are artificially inflated owing to their illegality.

We need to absorb in our minds and guts the utter futility of what we are doing now. We need to wake to the reality that our present system actively generates misery for users and nonusers alike and places intolerable burdens on society. More of the same will only cause more of the same.

As we’ve already seen, painful early experiences program both the neurophysiology of addiction and the distressing psychological states that addiction promises to relieve. Yet human beings who are able to direct conscious attention toward their mental processes discover something 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. 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 interpretatio...

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. Ultimately, the goal of all Twelve-Step programs is not abstinence but sobriety.

Purity and impurity belong to oneself. No one else can purify another. BUDDHA The Dhammapada

If a parent and child have the same disorder, that condition may, of course, have been passed on through genes. So far so good—but since it’s obvious that children can be influenced by their parents in many other ways, the mere incidence of an ailment “running in the family” does not necessarily point to a genetic cause.

“because parents share family environment as well as heredity with their offspring, parent-offspring resemblance does not prove the existence of genetic influence.”