Beyond Drugs: The Universal Experience of Addiction | Gabor Maté, MD


From “With the carnage imposed by the current epidemic of opioids and associated overdoses across North America—many dozens of people dying every day—public alarm around addiction is focused almost exclusively on drugs. For all the anguish around substance dependence, addiction cuts a much broader swath across our culture. Most addicted people use no drugs at all and addiction cannot be understood if we restrict our vision of it to substances, legal or illicit.

Addiction is manifested in any behavior that a person craves, finds temporary relief or pleasure in but suffers negative consequences as a result of, and yet has difficulty giving up. In brief: craving, relief, pleasure, suffering, impaired control. Note that this definition is not restricted to drugs but could encompass almost any human behavior, from sex to eating to shopping to gambling to extreme sports to TV to compulsive internet use: the list is endless.

‘I’m not going to ask you what you were addicted to,’ I often say to people, ‘nor when, nor for how long. Only, whatever your addictive focus, what did it offer you? What did you like about it? What, in the short term, did it give you that you craved or liked so much?’ And universally, the answers are: ‘It helped me escape emotional pain… helped me deal with stress… gave me peace of mind… a sense of connection with others… a sense of control.’

Such answers illuminate that the addiction is neither a choice nor a disease, but originates in a human being’s desperate attempt to solve a problem: the problem of emotional pain, of overwhelming stress, of lost connection, of loss of control, of a deep discomfort with the self. In short, it is a forlorn attempt to solve the problem of human pain. Hence my mantra: ‘The question is not why the addiction, but why the pain.’

And the source of pain is always and invariably to be found in a person’s lived experience, beginning with childhood. Childhood trauma is the template for addiction—any addiction. All addictions are attempts to escape the deep pain of the hurt child, attempts temporarily soothing but ultimately futile. This is no less true of the socially successful workaholic, such as I have been, than of the inveterate shopper, sexual rover, gambler, abject street-bound substance user or stay-at-home mom and user of opioids.

Not only is the urge to escape pain shared by all addicts, substance users or not, the same brain circuits are involved in all addictions, from shopping to eating to dependence on heroin and other opioids. The same brain circuits, the same brain systems involving pleasure and reward and incentive, the same neurochemicals—not to mention the same emotional dynamics of shame and lack of self-worth, and the same behaviors of denial and dishonesty and subterfuge.

It is time to realize, then, addiction is neither a choice nor an inherited disease, but a psychological and physiological response to painful life experiences. It can take many forms, but whatever form it takes:
• it employs the same neurological pathways and emotional patterns;
• the damage it does extends well beyond the suffering imposed by drug use specifically;
• to ostracize the drug addict as somehow different from the rest of us is arrogant and arbitrary;
• to criminalize certain substances, say heroin, while allowing the profitable distribution of more deadly products such as cigarettes is irrational and harmful—yes, though it may be a startling assertion it is medically a simple fact: heroin use, short of overdose, is far less lethal than cigarette smoke;
• to treat the addiction, which is a symptom, without treating the pain that underlies it is to deal in effects rather than in causes, and therefore dooms many to ongoing cycles of suffering.

Finally, a word about childhood trauma and its relation to addiction and the use of opioids. When people see this word, they often—perhaps naturally—assume that we are speaking of terrible events, such as abuse, sexual exploitation, the death of parents, violence in the home, and so on. And surely, as the research abundantly shows, the more such experiences a child has to endure, the exponentially greater his or her risk of addiction. But trauma is not restricted to horrific experiences. It refers to any set of events that, over time, impose more pain on the child than his or her sensitive organism can process and discharge. Therefore, trauma can occur not only when bad things happen, but also when the parents are too stressed, too distracted, too depressed, too beset by economic worry, too isolated, etc. to respond to a sensitive child’s emotional need to be seen, emotionally held, heard, validated, made to feel secure. Such is the reality behind many a story of ‘happy childhood.’ In fact, the denial of one’s pain, the splitting off of distress from conscious memory, is one of the outcomes of trauma.

As the astute trauma pioneer Peter Levine has written, ‘Trauma has become so commonplace, that most people don’t even recognize its presence.'”

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  1. More of the return of the refrigerator parents trope. The mom is usually the one depicted as frozen and unloving and traumatizing enough to cause psychosis and schizophrenia. So a generation of normal moms got heckled for causing their kids to be insane, rather than look at other reasons why the offspring were going mad with iatrogenic akathesia and other glaring side effects…no no…the jitteriness was trauma from a shit mother or absent father. Blame the parents. Here we go again.

    The problem is this…

    Child neglect and abuse are real and are on the increase and do need stopped.

    Being a happy child makes a happy adult.

    But here is a mix up.

    A good relationship with your own inner child is essential when you are an adult.

    What can get in the way of that good relationship with your own inner child is the way society sets up an over emphasis on “mind based” living and not on “heart felt” emotional living. Emotions come from the inner child. If that inner child is routinely mocked by the “logical” society, who only accept rationalist ways of being, then that inner child never gets out to play. Feelings never get out to play.

    It is not that there need be bad parents or a traumatic abuse but just that society idealizes “logic” as legitimate and “feelings” as ridiculous.

    But one way to allow “feelings” out to play…is drugs. Drugs blast the “logical” over-analytical mind away. It is a jail break out of the confines of the way “logic” monitors every move of the captive inner child. Using drugs to smash through that inner barbed wire frees the inner child. But it comes at a cost. Often there is a mopping up by blaming external people for causing the “feelings” to escape and do embarrassingly “childish” antics. The blaming comes from the restoration of the sober “logical” mind. Back behaving with rigid aherence to societal regulations. “Logical” society then looks for a rational reason why so many are drug addicted and from there it is easy to shelve any collective responsibility and instead beat up nice parents who have done nothing wrong.

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    • My late husband was a heroin addict when I first met him. A rich boy addict. Super kind. But very much an addict.

      So, Mr Matte, please think again when saying that heroin is less of a problem than cigarettes. Heroin withdrawal makes a person want to rip the doors off a truck to get a fix. Having at one time in my youth been a cigarette smoker I can say I never incurred that sort of withdrawal urgency. How irresponsible of you to be giving that snippet of knowledge to young people. You might as well have said that antipsychotics cost nothing either. Let’s sprinkle some on our coco pops. Oh wait! I am on them. Yeah! I can say I am not impressed with them and shall endure withdrawal as soon as can reasonably be doing so. Lets glorify a pure body and brain, free of all extraneous substances.

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