Gabor Maté

“In the cloudy swirl of misleading ideas surrounding public discussion of addiction, there’s one that stands out: the misconception that drug taking by itself will lead to addiction — in other words, that the cause of addiction resides in the power of the drug over the human brain. It is one of the bedrock fables sustaining the so-called “War on Drugs.” It also obscures the existence of a basic addiction process of which drugs are only one possible object, among many. Compulsive gambling, for example, is widely considered to be a form of addiction without anyone arguing that it’s caused by a deck of cards. The notion that addiction is drug-induced is often reinforced.

Clearly, if drugs by themselves could cause addiction, we would not be safe offering narcotics to anyone. Medical evidence has repeatedly shown that opioids prescribed for cancer pain, even for long periods of time, do not lead to addiction except in a minority of susceptible people. During my years working on a palliative care ward I sometimes treated terminally ill cancer patients with extraordinarily high doses of narcotics — doses that my hardcore addict clients could only dream of. If the pain was alleviated by other means — for example, when patient was successfully given a nerve block for bone pain due to malignant deposits in the spine — the morphine could be rapidly discontinued.

Yet if anyone had reason to seek oblivion through narcotic addiction, it would have been these terminally ill human beings. An article in the Canadian Journal of Medicine in 2006 reviewed international research covering over six thousand people who had received narcotics for chronic pain that was not cancerous in origin. There was no significant risk of addiction, a finding common to all studies that examine the relationship between addiction and the use of narcotics for pain relief. “Doubts or concerns about opioid efficacy, toxicity, tolerance, and abuse or addiction should no longer be used to justify withholding opioids,” concluded a large study of patients with chronic pain due to rheumatic disease.

We can never understand addiction if we look for its sources exclusively in the actions of chemicals, no matter how powerful they are.”


Gabor Maté, In the Realm of Hungry Ghosts: Close Encounters with Addiction
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In the Realm of Hungry Ghosts: Close Encounters with Addiction In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Maté
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