In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Maté

I have come to see addiction not as a discrete, solid entity—a case of “Either you got it or you don’t got it”—but as a subtle and extensive continuum.

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.

Just one more’ is the binding factor in the circle of suffering,” writes the Buddhist monk and teacher Sakyong Mipham.1

“We can perceive the infinite in music only by searching for this quality in ourselves,” writes the pianist and conductor Daniel Barenboim.2 Very true. But that’s not the kind of infinite the addict seeks.

it was easy for me to justify all the spending as compensation for the hard work I was doing: one addiction providing an alibi for the other.

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?

“Forget about your life situation for a while and pay attention to your life,” writes the spiritual teacher Eckhart Tolle. “Your life situation exists in time—your life is now.” I have read his book over and over, have underlined that phrase and understand it intellectually.

desiderata

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

It’s a vicious cycle: more cocaine use leads to more loss of dopamine receptors. The fewer receptors, the more the addict needs to supply his brain with an artificial chemical to make up for the lack.

When the brain is diseased, the functions that become pathological are the person’s emotional life, thought processes and behaviour. And this creates 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 impairment would be proportional to the size and importance of the malfunctioning brain centre. So it is with addiction.

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

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 satisfactio...

“But what you do deliberately is that you use cocaine.” “Because I’m addicted to it.” “That’s a choice you’re making,” I reply. Even as the words leave my lips, I know I’m mouthing a platitude. From a certain point of view, everything we do is a choice. From a scientific perspective, though, Claire is closer to the mark. Her explanation that she is addicted—and that therefore her drug use is not the result of thoughtful deliberation—fits with the research evidence. It sounds like a cop-out, but in neurological terms, it’s not.

established. Three-quarters of our brain growth takes place outside the womb, most of it in the early years. By three years of age, the brain has reached 90 per cent of adult size, whereas the body is only 18 per cent of adult size.

The dynamic process by which 90 per cent of the human brain’s circuitry is wired after birth has been called “neural Darwinism” because it involves the selection of those nerve cells (neurons), synapses and circuits that help the brain adapt to its particular environment, and the discarding of others.

Dr. Robert Post, chief of the Biological Psychiatry Branch of the [U.S.] National Institute of Mental Health: “At any point in this process you have all these potentials for either good or bad stimulation to get in there and set the microstructure of the brain.”

In many other cases it’s not a question of “bad stimulation” but of a lack of sufficient “good stimulation.”

Our genetic capacity for brain development can find its full expression only if circumstances are favourable. To illustrate this, just imagine a baby who was cared for in every way but kept in a dark room. After a year of such sensory deprivation the brain of this infant would not be comparable to those of others, no matter what his inherited potential. Despite perfectly good eyes at birth, without the stimulation of light waves, the thirty or so neurological units that together make up our visual sense would not develop. The neural components of vision already present at birth would atrophy and become useless if this child did not see light for about five years.

The child needs to be in an attachment relationship with at least one reliably available, protective, psychologically present and reasonably nonstressed adult.

For the infant and young child, attachment relationships are the major environmental factors that shape the development of the brain during its period of maximal growth … Attachment establishes an interpersonal relationship that helps the immature brain use the mature functions of the parent’s brain to organize its own processes.

At age three, the highest cortisol levels were found in those children whose mothers had been depressed during the child’s first year of life, rather than later.fn1 11 Thus we see that the brain is “experience-dependent.”

People who have difficulty forming intimate relationships are at risk for addiction; they may turn to drugs as “social lubricants.”

Adverse Childhood Experiences (ACE) Study, looked at the incidence of ten separate categories of painful circumstances—including family violence, parental divorce, drug or alcohol abuse in the family, death of a parent and physical or sexual abuse—in thousands of people. The correlation between these figures and substance abuse later in the subjects’ lives was then calculated. For each adverse childhood experience, or ACE, the risk for the early initiation of substance abuse increased two to four times. Subjects with five or more ACEs had seven to ten times greater risk for substance abuse than those with none.

The ACE researchers concluded that nearly two-thirds of injection drug use can be attributed to abusive and traumatic childhood events

Alcohol consumption has a similar pattern: those who had suffered sexual abuse were three times more likely to begin drinking in adolescence than those who had not.

For each emotionally traumatic childhood circumstance, there is a two- to-threefold increase in the likelihood of early alcohol abuse.

The brains of mistreated children have been shown to be smaller than normal by 7 or 8 per cent,

20 In a study of depressed women who had been abused in childhood, the hippocampus (the memory and emotional hub) was found to be 15 per cent smaller than normal. The key factor was abuse, not depression, since the same brain area was unaffected in depressed women who had not been abused.

Stress is a physiological response mounted by an organism when it is confronted with excessive demands on its coping mechanisms, whether biological or psychological.

Women who were pregnant at the time of the 9/11 World Trade Center attacks and who suffered post-traumatic stress disorder (PTSD) as a result of witnessing the disaster passed on their stress effects to their newborns. At one year of age these infants had abnormal levels of the stress hormone cortisol. We might wonder if this was not a post-natal effect of the mother’s PTSD. However, the greatest change was noted in infants whose mothers were in the last three months of pregnancy on September 11, 2001. So the fact that the stage of pregnancy a woman was at when the tragedy occurred was correlated with the degree of cortisol abnormality suggests that we are looking at an in utero effect.22 It turns out that during gestation, just as after birth, brain systems undergo sensitive periods of development.

my Downtown Eastside patients, pre- and post-natal environments can be recreated from one generation to the next in a way that would impair a child’s healthy development without any genetic contribution. Parenting styles are often inherited epigenetically—that is, passed on biologically, but not through DNA transmission from parent to child.

More daunting for those who hope for scientific and social progress, the genetic argument is easily used to justify all kinds of inequalities and injustices that are otherwise hard to defend. It serves a deeply conservative function: if a phenomenon like addiction is determined mostly by biological heredity, we are spared from having to look at how our social environment supports, or does not support, the parents of young children; at how social attitudes, prejudices and policies burden, stress and exclude certain segments of the population and thereby increase their propensity for addiction.

In the final analysis, it’s not the activity or object itself that defines an addiction but our relationship to whatever is the external focus of our attention or behaviour.

The distinguishing features of any addiction are: compulsion, preoccupation, impaired control, persistence, relapse and craving.

As with drug addicts, obese people have diminished dopamine receptors; in one study, the more obese the subjects were, the fewer dopamine receptors they had.

ennui

If I’ve learned anything, it’s that I have to be responsible for my own fear of emptiness. The fear is not personal—on the contrary it’s pretty much universal—but I got the void I got and it’s not going anywhere. When I can recognize that, I don’t make the mistake of confusing it with who I am, or worse, expending a lot of energy trying to make it go away by any available means. Instead, I can be vigilant, patient and good-humoured with it.

Addicted: Notes from the Belly of the Beast: Having fallen through the crust of this earth so many times, it seems that only on this small and familiar pad of concrete, where I can make seven steps in one direction, then take seven back, do my feet touch down with any certainty.1

Stephen Reid has written about the “darkness … the secret self-loathing that pools in the heart of every junkie.”

The shame arises because indulging the addiction process, even if with an ostensibly harmless object, only deepens the vacuum where connection with the world and a healthy sense of self ought to arise. The shame is that of self-betrayal.

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

The addictive personality is a personality that hasn’t matured. When we come to address healing, a key question will be how to promote maturity in ourselves or in others whose early environment sabotaged healthy emotional growth.

“Children swim in their parents’ unconscious like fish swim in the sea.”

haut monde respectability.

The addict is never satisfied. His spiritual and emotional condition is one of impoverishment, no matter how much he achieves, acquires or possesses.

By no means are a superficially positive self-image and true self-esteem necessarily identical. In many cases they are not even compatible. People with a grandiose and inflated view of themselves are missing true self-esteem at the core. To compensate for a deep sense of worthlessness, they develop a craving for power and an exaggerated self-evaluation that may itself become a focus of addiction,

I believe that to pursue the American Dream is not only futile but self-destructive because ultimately it destroys everything and everyone involved with it. By definition it must, because it nurtures everything except those things that are important: integrity, ethics, truth, our very heart and soul. Why? The reason is simple: because Life/life is about giving, not getting. HUBERT SELBY JR. Requiem for a Dream (Preface, 2000)