Unlike other treatment professionals, Canadian physician and social critic Gabor Maté disagrees with the current biomedical, genetic model of addiction. He insists that addictive patterns of behavior are rooted in the alienation and emotional suffering that are inseparable from Western capitalist cultures, which (by favoring striving and acquiring over noticing and caring for one another), end up shortchanging — and too often traumatizing — children and families.
Gabor Maté is the author of a bestseller about addictions, entitled In the Realm of Hungry Ghosts. His TED talk on The Power of Addiction and the Addiction of Power has had almost 700,000 views. Much of what Maté knows about addiction he learned doctoring to the hardcore drug addicts of Vancouver’s Downtown Eastside, which has one of highest concentrations of active drug users in North America. (He himself has struggled with a music shopping addiction and workaholism.)
Maté argues that the more stressful our early years, the likelier we are to become addicts. “Addiction is an attempt to solve a life problem. Only secondarily does it begin to act like a disease.”
In the following edited excerpt from an interview conducted by Lauren Docket and Rich Simon (Summer 2017) of the Psychotherapy Networker Magazine, Maté explores the meaning of addictions.
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Key components of addiction
Although addiction is a complex psychophysiological process, I’d say that an addiction manifests in any behavior that:
- a person finds temporary pleasure or relief in and therefore craves;
- suffers negative consequences from; and
- has trouble giving up.
The term addiction comes from a Latin word for a form of being enslaved. So if it has negative consequences, if you’ve lost control over it, if you crave it, if it serves a purpose in your life that you don’t otherwise know how to meet, you’ve got an addiction. While addiction is often to substances, it could be to anything — to religion, to sex, to gambling, to shopping, to eating, to the internet, to relationships, to work, even to extreme sports. The issue with the addiction is not the external activity, but the internal relationship to it. Thus one person’s passion is another’s addiction.
Many believe addictions are either a choice or some inherited disease. It’s neither. An addiction always serves a purpose in people’s lives: it gives comfort, a distraction from pain, a soothing of stress. Of course, it doesn’t serve this purpose effectively, but it serves a valid purpose.
A non-medical understanding of addiction
I disagree with the American Society of Addiction Medicine’s definition of addiction as a primary brain disorder. In my view, an addiction is an attempt to solve a life problem, usually one involving emotional pain or stress; it arises out of an unresolved life problem that the individual has no positive solution for. Only secondarily does it begin to act like a disease.
If you start with the idea that addiction isn’t a primary disease, but an attempt to solve a problem, then you soon come to the question: How did the problem arise? If you say your addiction soothes your emotional pain, then the question arises of where the pain comes from. If the addiction gives you a sense of comfort, how did your discomfort arise? If your addiction gives you a sense of control or power, why do you lack control, agency, and power in your life? If it’s because you lack a meaningful sense of self, well, how did that happen? What happened to you?
The largest population study concluded that nearly two-thirds of drug-injection use can be tied to abuse and traumatic childhood events. If you look at the Adverse Childhood Experiences Study, it clearly shows that the more trauma there is, the greater the risk for addiction, exponentially so. Of course, there are traumatized people who don’t become addicts. You know what happens to them? They develop depression or anxiety, or they develop autoimmune disease, or any number of other outcomes. Or if they’re fortunate enough and get enough support in life to overcome the trauma, then they might not develop anything at all.
When I give my talks across the world, it’s not unusual to have somebody stand up and say, “Well, you know, I had a perfectly happy childhood, and I became an addict.” It usually takes me three minutes of a conversation with a person like that to locate trauma in their history by simply asking a few basic questions.
Trauma can be understood in the sense of the Adverse Childhood Experiences criteria: emotional abuse, physical abuse, sexual abuse, a parent dying, a parent being jailed, a parent being mentally ill, violence in the family, neglect, a divorce. But it can be also be understood in the sense of relational trauma; that means you don’t have to be hit or physically abused. If the parents were stressed or distressed or distracted — if their own trauma got in the way of their attuning with the child — that’s enough to interfere with the development of a healthy sense of self, and with normal brain development itself.
What all addictions have in common
- A pattern of compulsive engagement in the behavior that one craves, finds temporary pleasure or relief in, but suffers negative consequences from;
- Denial, subterfuge and dishonesty about the addiction. Shame is also a common undercurrent in addiction, whatever the object of the addiction may be;
- Brain circuitry: Addictions are about the hunt, the search, the excitement of the chase. And that has to do with the brain’s incentive and motivation circuitry, the nucleus accumbens and its projections to the cortex, and the availability of dopamine (which is also what cocaine and crystal meth and nicotine and caffeine elevate). It all has to do with the brain’s pleasure-reward centers, pain-relief circuitry, incentive-motivation circuitry, and impulse-regulation circuits. You know that it’s not good for you, but you can’t stop yourself.
- Poor stress regulation: People with addictive behaviors, be it gambling, sex or shopping, go back to the behavior after having given it up for a while, when something stressful happens. Because their own stress-regulation circuitry isn’t fully developed (an artifact of childhood circumstances), they have to try to regulate it externally.
If, as I argue, addiction is rooted in trauma, then the treatment of addiction has to aim beyond just stopping the behavior. Treatment must aim at nothing less than the restoration of the individual to themselves and to their capacity to be with the present moment, whether the present moment is pleasant or not. That’s what’s too often missing from addiction treatment.