Gabor Maté shows we're wired for addiction
Downtown Eastside physician Gabor Maté has a nifty way of measuring some of the financial costs of the war on drugs. In a recent interview with the Georgia Straight in an Oak Street coffee shop, Maté cited the example of a person who finances a $100-per-day cocaine habit by shoplifting. Maté noted that a drug addict must shoplift $1,000 worth of goods to generate a $100 return because of the discounted price that people pay addicts for stolen merchandise. Therefore, to feed a $3,000-per-month cocaine habit, an addict will have to steal $30,000 worth of merchandise.
"That's the drug laws for you," Maté said. "Who is paying for that?"
Last week, the Straight published an excerpt from Maté's stunning new book, In the Realm of Hungry Ghosts: Close Encounters With Addiction (Knopf Canada, $34.95), a wide-ranging examination of the lives of addicts, the neurobiology of addiction, the war on drugs, and strategies for harm reduction and healing. He believes that most intravenous-drug addicts experienced either extreme neglect or hard-core physical or sexual abuse in their childhoods.
Maté's central thesis is that addiction is occurring on a massive scale in western society because so many people have an inner emptiness caused by societal dislocation, including the destruction of traditional relationships within families and communities, and a lack of proper attunement in infancy. By "attunement", he means a parent literally being "in tune" with the child's emotional states, and being present in a way that ensures the infant feels understood, accepted, and mirrored.
"Attunement is the real language of love, the conduit by which the pre-verbal child can realize that she is loved," he writes in the book.
He pointed out in the interview that parents might fail to provide proper attunement even when they deeply love their child. This can occur because the parents are depressed, overworked, stressed, or dealing with crises that take them away from the child. And that's when things can literally go a bit haywire in the infant's brain, contributing to addiction later in life.
In his book, Maté cites child psychiatrist Daniel Siegel to suggest that poor attunement can interfere with the development of brain circuitry. This can lead to distorted levels of the brain's endorphins, which soothe physical and emotional pain. Poor attunement can also result in fewer brain receptors of dopamine, which is a neurotransmitter that sends messages of incentives and rewards.
In the absence of a fully developed dopamine system, Maté said, a person is far more likely to crave stimulants such as nicotine, caffeine, or drugs like cocaine to provide incentives. Maté points out in his book that cocaine, which increases dopamine levels and triggers intense feelings of elation, wears off very quickly. This is why coke addicts seek an endless supply of the drug to repeat those feelings.
Maté also emphasized that infants are born with no physiological or emotional self-regulation. That's because a lot of brain development occurs after birth, including in the cortex, which provides these controls.
"If the parents are not there in an attuned, nonstressed way to regulate them, self-regulation never develops," he said. "Then there is no impulse control. If they're stressed to begin with, then they are going to go for anything to reduce the stress. One thing that addictions all do is they reduce stress momentarily."
Maté offered a surprising response when asked how parents should deal with a drug-addicted daughter. "The first step is they're going to have to be perfectly okay with their daughter using," Maté replied. "They have to be perfectly okay with this. Say, '˜This is what's happening.' Not resist it or resent it. Not wish her to be different. Not work to make her different than the way she is. Because what this girl did not get in the first place was unconditional loving acceptance—not because they didn't intend it, but because they couldn't deliver it because of their own stuff."
He added that if parents understood how deeply an addiction is ingrained in the brain, they would accept their child's condition more easily. "The only thing they can do is create an atmosphere in which she would be encouraged to become more self-reflective," Maté said. "And that can only happen when there is no judgement there, and there is no push to change."
Maté's book highlights how our attachment to "externals"—status, looks, work, achievement, alcohol, gambling, or drugs—is at the root of addiction. He believes that any full healing should be based on the concept of "sobriety", which is a positive approach that recognizes the addiction, rather than on "abstinence", which is merely avoiding the harmful substance. Maté advocates increasing one's self-perception in a tone of "compassionate curiosity" rather than through self-punishment.
He said that if policymakers properly applied what has already been learned about brain biochemistry—including teaching parents the importance of attunement—80 to 90 percent of the addictive behaviour could be eliminated in Canada within two generations. And that would save a lot more money and create far greater peace of mind over the long term than continuing the war on drugs.
Feb 23, 2008 at 11:58am
This is a timely book and an important subject. I hope Maté also addresses the fact that the reward circuitry of the brain leaves the children he is talking about especially susceptible to natural reinforcers, too. That is, they are not just susceptible drug addictions, but also to excesses of fast food and pornography.
These two natural reinforcers (highly palatable food and potent sexual stimulation) can affect the brain like drugs, according to Princeton professor Bartley Hoebel. They may be uniquely poised to over-stimulate us because our brains developed in environments where there was very little sugar and virtually no porn. Now many of us are in the position of the Native Americans who were not at all adapted to alcohol when it entered their environment - very vulnerable.
Here's another article on this subject: http://www.reuniting.info/science/natural_reinforcers_sex_food_mind_bend...
Jan 16, 2012 at 8:10pm
I totally agree with Gabor Mate,I do wish I could make the government of N.B. understand this.They have approved the Methodone Treatment and are administering it at clinics.Substituting one drug for another while the mind of the addict stays sick.I will keep trying!!
Jan 10, 2013 at 9:50pm
I've been fascinated, for sometime, by Dr. Mate's remark that people with drug problems may very well not be a hopeless medical cases or criminals, but--rather--simply be individuals with neurotransmitter insufficiency, who are seeking to correct this, with illegal drugs. I will add that--like many of us--these folks ALSO probably have psychological problems that call out for resolution.
Jan 23, 2014 at 5:23pm
i just watched a video by Dr Mate and im an addict every thing he said makes complete sense and I thank him for his wisdom and all he is doing to help addcts
Jul 21, 2014 at 10:02pm
I am extremely grateful that Dr. Gabor is such a compassionate, and insightful healer.