This interview was published previously in part in The Alibi.
Interview with Gabor Maté
A: Thank you for taking the time to talk to me today in reference to your upcoming speaking engagement in Albuquerque and to your book In the Realm of Hungry Ghosts: Close Encounters with Addiction.
Dr. Maté can discuss your background and how it led you to develop your perspectives on drug addiction in your book?
GM: I’m a medical doctor in a neighborhood in Vancouver which is known as North America’s most concentrated area of drug use. So, in a few square blocks radius you have thousands of people dependent on injectable drugs, often injecting in the back alleys and the streets and so on. And, I worked for 14 years in that area, so the book is based on my experience working with the highly addicted population challenged by cocaine, heroin dependence, crystal meth, alcoholism, mental health issues, as well as very often medical issues like HIV, hepatitis C, and multiple other medical problems. The book is based on my experience working there as well as on my personal experience, as well as on my reading of the research literature on addiction.
A: OK. Could you briefly explain the meaning of the title of your book?
GM: Yes. In Buddhist mythology, if you like, there are 6 realms that human beings will cycle through. There’s the human realm, which is our ordinary selves. There’s the animal realm which represents our passions and appetites. The god realm is our spiritual sense of peace and satisfaction. The hell realm is the realm of raging emotions, terror, fear. And the hungry ghosts realm the creatures are depicted as ones with large empty bellies, small scrawny necks, and small mouths. They’re never able to fill their bellies sufficiently to feel satisfied. So, they keep going around trying to get satisfaction and fulfillment from the outside and that’s the realm of addictions. Addictions are all about getting some outside behavior, or substance, or relationship to complete the emptiness and the pain that you have inside.
A: Much of your work seeks to improve and expand the understanding of addiction, which you’ve just defined. You’ve said that drugs are not addictive in themselves. Can you explain this further?
GM: Sure. There’s this idea that drugs are addictive, but, of course, even a superficial look will tell you that they’re not. For example, take something like food, is food addictive? Most people eat and they don’t become addicted, but some people do. Most people can play a game of cards without becoming gamblers, but some people succumb to a severe gambling addiction that wrecks their lives. Most people can be given morphine, or try heroin or cocaine without becoming addicted. I’m not recommending that they do, I’m just stating a fact. But some people who try these drugs, like alcohol or tobacco, and become hooked on them. And so the question is not just the addictive nature of the substance or the behavior, but what is the susceptibility. What creates the vulnerability in these individuals? Why are some people susceptible when most are not?
A: And what would you say that is, that creates this susceptibility?
GM: Well, the medical answer seems to be that it’s a genetic problem, but neither does science back it up nor does experience prove it. If you look at who becomes addicted, it’s people that have significant emotional losses in their childhood and particularly trauma. So that the greater the degree of trauma or stress in childhood, the exponential degree that it leads to addiction. So in the population that I worked with, all the women had been sexually abused as kids, and the men have traumatized repeatedly as well, in childhood. Large number of studies have shown for a whole number of reasons the greater the trauma, the greater the emotional loss, the greater the incidence of addiction, which is obvious, of course, addictions are all attempts to soothe emotional pain. And the more you suffer, the more emotional pain you have.
A: You’ve stated that society tends to scapegoat drug addicts. Why is this the case and what problems does this tend to distract us?
GM: So, if you look at our society which is very much based on externals, people having their needs met externally by the acquisition of products, or by the achievement of status, or by the approval of others—it’s all about getting something from the outside to make you more complete, make you more satisfied. It’s a society like that, in which there’s also a lot of insecurities, which leads to a lot of stress, people find ways of distracting themselves from their internal problems, and those ways of distracting ourselves from our internal problems tend to become addictive. So, like the internet, like gambling, like pornography, like video games, like alcohol, so do drugs, like eating, for many people its work, for some people its social activities, but there’s almost an infinite variety of ways that people use to get away from the discomfort that they experience inside and the constant need for external stimulation. The other one is that the addictive tendency is widespread throughout society, but we don’t like it, we don’t like to look at it. The drug addict represents it to the highest degree. And by making him or her the target of our disapproval or judgment we kind of believe that we’re superior and that we’re somehow different. So, basically, we’re using them as a way of not looking at our own problems. We say that they’re the ones with the problems, they’re the antisocial elements, they should be excluded from society. But we’re not looking at ourselves or the nature of the society it is.
A: You’ve also been very critical of the War on Drugs. Do you feel that harm reduction, decriminalization, and safe injection sites are the better answer?
GM: Well, what the criminalization of addiction does, and what the War on Drugs does is criminalize those people who turn to substances to soothe their pain. In other words, you begin with an abused child, society did not protect you, so then that mind your brain was affected by the trauma, that’s the part I haven’t talked about yet, that the brain is absolutely affected by the trauma, and that’s tied to addictions. So you had those experiences growing up, no one to turn to, then you turn to drugs to soothe the pain and you’re a criminal. You’re not a criminal if you sell tobacco, which kills many more people than any other drug ever does. You’re not a criminal if you sell or use alcohol, which is much more harmful to the body than say heroin is, not that I advocate either one. But you’re a criminal if you use particular substances. So, there’s no logic in it, number one. Number two, you’re basically punishing people for what happened in their childhood. And look at the addict population in the United States, or Canada for example, it’s largely made up of traumatized people. That’s not the way you deal with people who have been traumatized. You deal with them by giving them lots of compassion, lots of understanding, lots of consoling, lots of support, attention, exercise, stress training and lots of patience lots of time for those changes that preceded the addiction or came from the addiction to be reversed. And if we spent all the money that we now spend on this demonstrably useless ideological War on Drugs, we could spend it on rehabilitating people. We’d have a totally different society. Now, harm reduction like the safe injection site like we have in Vancouver, these are not the answer to addiction, they just reduce the harm. So, for example, giving somebody methadone instead of heroin, that’s harm reduction, it doesn’t treat the addiction, they’re still addicted, but at least they’re not injecting an illegal substance 4 times a day. And they don’t have to shoplift to get that heroin. Giving somebody clean needles does not stop their addiction but it reduces the harm, it means there isn’t HIV being transmitted from one person to the other. Giving somebody sterile swabs to clean their arms with does not treat addiction, but it also doesn’t promote it, it just makes it less likely that that person will be sick and suffer more and consequently cost society a lot of money in terms of health care costs. So, harm reduction is not the answer to addiction, but it’s a step toward the answer because it treats people with compassion and understanding and without judgment and accepts them for how they are at the moment. Harm reduction by itself is not sufficient to treat addiction but it’s for some people, for many, it’s a necessary first step.
A: You’ve pretty much answered my question coming up. I was going to ask what key things are necessary for an addict to recover. Is there anything you’d like to add here?
GM: Yes, the addict has to realize, number one, they may not have deliberately caused their condition but they’re the only ones who can take responsibility for it. Number two, that in order to do so they need support and help and they need to ask for that. Number three, they need to drop the shame around it, they didn’t do it deliberately, so they need to get past this idea that they’re faulty deficient human beings. And four, they need to realize there’s a genuine possibility of transformation in any human being so that nobody is ever beyond healing.
A: Is there anything else you’d like to add?
GM: No. Just that I’m looking forward to coming to Albuquerque and speaking to the Crossroads for Women which is an organization locally that supports homeless women in transitional situations who are overcoming addictions. I’m glad to offer any kind of support I can.