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by
Gabor Maté
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February 11 - November 14, 2021
“But what are you looking for? What have you spent your whole day searching for? That same bit of freedom or satisfaction that I want; we just get it differently. What’s everybody chasing all the money for if not to get them something that will make them feel good for a while or make them feel they’re free? How are they freer than I am?
“Everybody’s searching for that feeling of well-being, that greater happiness. But I’d rather be a dog out in the street than do what many people go through to find their summation of freedom.”
At heart, I’m not that different from my patients, and sometimes I cannot stand seeing what little psychic space, what little heaven-granted grace, separates me from them
“consumer markets selling promises of instant relief from the pain of thought, loneliness, doubt, experience, envy, and old age.”
At the core of every addiction is an emptiness based in abject fear. The addict dreads and abhors the present moment; she bends feverishly only towards the next time, the moment when her brain, infused with her drug of choice, will briefly experience itself as liberated from the burden of the past and the fear of the future—the two elements that make the present intolerable.
In federal prisons, an estimated 57 per cent of inmates have been convicted of drug-related crimes, and drug offenders represented the largest source of jail population growth between 1996 and 2002—increasing by 37 per cent.
The precursor to addiction is dislocation, according to Bruce Alexander, professor of psychology at Simon Fraser University. By dislocation he means the loss of psychological, social and economic integration into family and culture; a sense of exclusion, isolation and powerlessness. “Only chronically and severely dislocated people are vulnerable to addiction,” he writes.
It is commonly thought that peer affiliation leads to drug use because kids set bad examples for each other. That’s part of the picture, but a deeper reason is that under ordinary circumstances, adolescents who rely on their peers for emotional acceptance are more prone to being hurt, to experiencing the sting of each other’s immature and therefore often insensitive ways of relating. They are far more stressed than children who are well connected to nurturing adults.
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,”
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.
From 1980 to 1996, there has been a 400 percent increase in the number of women prisoners. Many of those jailed for drug violations were mules or assistants. I venture that none was a principal organizer. Many are the mothers of small children who will be left without maternal care, and most probably without any parental care at all … The engine of punitive punishment of mothers will haunt this nation for many years to come.
The War on Drugs fails, and is doomed to perpetual failure, because it is directed not against the root causes of drug addiction and of the international black market in drugs, but only against some drug producers, traffickers and users. More fundamentally, the War is doomed because neither the methods of war nor the war metaphor itself is appropriate to a complex social problem that calls for compassion, self-searching insight and factually researched scientific understanding. The pertinent question is not why the War on Drugs is being lost, but why it continues to be waged in the face of all
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person driven largely by unconscious forces and automatic brain mechanisms is only poorly able to exercise any meaningful freedom of choice.
Almost any human being, when overwhelmed by stress or powerful emotions, will act or react not from intention but from mechanisms that are set off deep in the brain, rather than being generated in the conscious and volitional segments of the cortex. When acting from a driven or triggered state, we are not free.
“The brain forces us to become reflections of our personal histories,” write two U.S. research psychiatrists. “Simply stated, children reflect the world in which they are raised.”
less. If we cherish the human potential for transformation, the real issue becomes how to encourage and support the addict’s motivation and capacity to choose freedom despite damaging beginnings and a lifelong history of painful events
the role of the cortex, the brain’s executive part, is more to inhibit than to initiate. Impulses to act are generated in lower brain systems, but the job of the cortex is to censor some and permit others. As a prominent researcher expressed it, it’s not a matter of free will but of “free won’t.”fn2
In a well-functioning cortex the interval between awareness of the impulse and the activation of the muscles that will carry out the impulse is only one-tenth to one-fifth of a second.6 Amazingly, it’s only in this briefest of intervals that the cortex can suppress behaviour it judges to be inappropriate.
the addict comes to make his choice with a brain that overvalues the addictive substance or behaviour and undervalues the healthy alternatives. Impulses favouring the addiction process arise.
Nietzsche, he lies his way out of reality because he has been hurt by reality.
repeated drug use leads to long-lasting changes in the brain that undermine voluntary control.”
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.
In this era of sub-sub-specialization, each discipline appears to work in isolation from knowledge gathered by other researchers in closely related fields. We need far more integration of knowledge both in the professional realm and among laypeople.
“Action has meaning only in relationship,” said the spiritual teacher Jiddu Krishnamurti, “and without understanding relationship, action on any level will only breed conflict. The understanding of relationship is infinitely more important than the search for any plan of action.”
Studies on primates and other animals have also shown that low social status and being dominated enhance the risk of drug use,
after being housed with more subordinate animals, dominant monkeys had an increase of over 20 per cent of their dopamine receptors and less tendency to use cocaine.
The findings of stress research suggest that the issue is not control over others, but whether one is free to exe...
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In relegating the addict to the bottom of the social and moral scales and in our contemptuous rejection of her as a person, we have created the exact circumstances that are most likely to keep her trapped in pathological dependence on drugs.
There is no island of relief, only oceanic despair.
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.
That is not surprising, given that addiction is a response to life experience, not simply to a drug.
Thus, for all the valid reasons we have for wanting the addict to “just say no,” we first need to offer her something to which she can say “yes.” We must provide an island of relief. We have to demonstrate that esteem, acceptance, love and humane interaction are realities in this world, contrary to what she, the addict, has learned all her life.
“Proper nutrition, shelter, the controlled provision of their substances of dependence, counselling, and compassionate caring are what most addicts need if we are to help wean them from their debilitating habits,”
The UK National Treatment Outcome Survey (known as NTROS) showed that for every 1 pound invested in treatment and care, 3 pounds came back in health care and enforcement savings.
The issue in medical practice is always how best to help a patient. If a cure is possible and probable without doing greater harm, then cure is the objective.
Although we are all responsible for our lives, no human or medical principle dictates that we refuse to help others whose own decisions have brought trouble upon their heads—unless we believe that in trying to help them, we are perpetrating greater harm.
do not hold out abstinence as the Holy Grail and we do not make our valuation of addicts as worthwhile human beings dependent on their making choices that please us.
In the 1990s Switzerland, facing Europe’s highest HIV infection rate from injection drug use, initiated a trial of either heroin maintenance or of methadone treatment supplemented with heroin. The findings were: fitness for work improved considerably: permanent employment more than doubled; patients’ housing situations rapidly improved and stabilized (in particular, there was no homelessness); no fatal overdose due to prescribed substances; no notable disturbances in local neighbourhoods; significant economic benefits in terms of savings per patient-day, owing to marked reductions in legal and
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The problem’s not that the truth is harsh but that liberation from ignorance is as painful as being born. Run after truth until you’re breathless. Accept the pain involved in re-creating yourself afresh. These ideas will take a life to comprehend, a hard one interspersed with drunken moments. NAGUIB MAHFOUZ Palace of Desire
my aim is to open their eyes to the possibility of a nonjudgmental, compassionate curiosity toward themselves.
Among the necessary initial moves toward sobriety is the directing of compassionate curiosity at oneself.
The acronym COAL has been proposed for this attitude of compassionate curiosity: curiosity, openness, acceptance and love:
Justification is another form of judgment every bit as debilitating as condemnation. When we justify, we hope to win the judge’s favour or to hoodwink her. Justification connives to absolve the self of responsibility; understanding helps us assume responsibility.
I become free to acknowledge the addiction the moment the fact of having behaved along addictive patterns no longer means that I’m a failure as a person, unworthy of respect, shallow and valueless. I can own it and see the many ways it sabotages my real goals in life.
Being cut off from our own natural self-compassion is one of the greatest impairments we can suffer. Along with our ability to feel our own pain go our best hopes for healing, dignity and love. What seems nonadaptive and self-harming in the present was, at some point in our lives, an adaptation to help us endure what we then had to go through. If people are addicted to self-soothing behaviours, it’s only because in their formative years they did not receive the soothing they needed. Such understanding helps delete toxic self-judgment on the past and supports responsibility for the now.
My anxiety clothes itself in concerns about body image or financial security, doubts regarding loveability or the ability to love, self-disparagement and existential pessimism about life’s meaning and purpose—or, on the other hand, it manifests itself as grandiosity, the need to be admired, to be seen as special.
Like addiction itself, anxiety will always find a target, but exists independently of its targets.
Incompleteness is the baseline state of the addict. The addict believes—either with full awareness or unconsciously—that he is “not enough.” As he is, he is inadequate to face life’s demands or to present an acceptable face to the world. He is unable to tolerate his own emotions without artificial supports. He must escape the painful experience of the void within through any activity that fills his mind with even temporary purpose, be it work, gambling, shopping, eating or sexual seeking.
The British psychiatrist R.D. Laing wrote somewhere that there are three things human beings are afraid of: death, other people, and their own minds.
I see now that the underlying anxiety and sense of emptiness have been pervasive. Emotionally they take the shape of chronic, low-grade depression and irritability. On the thought level, they manifest as cynicism—the negative side of the healthy skepticism and independent thinking I’ve always valued. Behaviourally they mask themselves as hypomanic energy or as lethargy, as the constant hankering for activity or for oblivion.
