How To Understand Addiction

By Dr.Gabor Maté

book with page opened to addiction

We all know what is wrong with addiction; we need to inquire what is “right” about it. In other words, what does the user seek, what temporary benefit does he or she derive from the experience, whether the addiction be to alcohol, heroin, cocaine, sex, food, gambling, video games? The answers, in my experience, are straightforward: “I find temporary relief from emotional pain.

A decrease of stress. I feel more alive. I feel less alone. Less anxious. More at peace with myself.”

My definition of addiction is any behavior—substance related or not–that involves craving, temporary pleasure or relief, negative long term consequences and an inability to stop despite these negative impacts. As we can see from the answers above, addicts just want to feel normal: they want to feel what a normal human being would naturally feel: pain-free, non-stressed, at peace, connected, alive.

That this quest is doomed, that they are likely to sacrifice their health, their position in society and their dignity shows only how powerful is the desperation that drives them. What is the source of that despair? Why are they willing to risk illness and death for the sake of their habit? “I’m not afraid of death,” a patient told me. “I’m more afraid of life.”

Addictions always originate in unhappiness, even if hidden. They are emotional anesthetics; they numb pain. The first question — always — is not “Why the addiction?” but “Why the pain?”

The essence of the drug high was best expressed by a patient of mine, a 27-year-old sex-trade worker. “The first time I did heroin,” she said, “it felt like a warm, soft hug.” In a phrase, she summed up the psychological and chemical cravings that make some people
vulnerable to substance dependence. It’s a doomed search for love, or what love would give us: a sense of belonging, security, inner peace, joy.

No drug is, in itself, addictive. Only about 8 per cent to 15 per cent of people, who try, say alcohol or marijuana, go on to addictive use. What makes them vulnerable? Neither genetic predispositions nor individual moral failures explain drug addictions. Chemical and emotional vulnerability are the products of life experience, according to current brain research and developmental psychology. Most human-brain growth occurs following birth;
physical and emotional interactions determine much of our brain development. Each brain’s circuitry and chemistry reflects individual life experiences as much as inherited tendencies.

For any drug to work in the brain, the nerve cells have to have receptors — sites where the drug can bind. We have opiate receptors because our brain has natural opiate-like substances, called endorphins, chemicals that participate in many functions, including the regulation of pain and mood. Endorphins are released in the infant’s brain when there are warm, non-stressed, calm interactions with the parenting figures. Endorphins, in turn, promote the growth of receptors and nerve cells, and the discharge of other important brain chemicals. The fewer endorphin-enhancing experiences in infancy and early childhood, the greater the need for external sources. Hence, the greater vulnerability to addictions.

Distinguishing skid row addicts is the extreme degree of stress they had to endure early in life. Almost all women now inhabiting Canada’s addiction capital suffered sexual assaults in childhood, as did many of the males. Childhood memories of serial abandonment or severe physical and psychological abuse are common. The histories of my Portland patients tell of pain upon pain.

But what of families where there was not abuse, but love, where parents did their best to provide their children with a secure, nurturing home? One also sees addictions arising in such families.

The unseen factor here is the stress the parents themselves lived under, even if they did not recognize it. That stress could come from relationship problems, or from outside circumstances such as economic pressure or political disruption. The most frequent source of hidden stress is the parents’ own childhood histories that saddled them with emotional baggage they had never become conscious of. What we are not aware of in ourselves, we pass on to our children.

Stressed, anxious, or depressed parents have great difficulty initiating enough of those emotionally rewarding, endorphin liberating interactions with their children. Later in life such children may experience a hit of heroin as the “warm, soft hug” my patient described: What they didn’t get enough of before, they can now inject.

The U.S.-based Adverse Childhood Experiences studies have demonstrated beyond doubt that childhood stresses, including factors such as abuse, addiction in the family, a rancorous divorce, and so on, provide the template for addictions later in life. It doesn’t
follow, of course, that all addicts were abused or that all abused children become addicts, but the correlations are inescapable.

Another major factor feeding addiction in our society is the loss of the traditional attachment network: of clan, tribe, village, extended family, and their replacement by a powerful but immature and seductive peer culture. Studies are clear that the peer group—enhanced these days by the technology of social networking—is the most common context for young people’s introduction to drug use.

Feeling alone, feeling there has never been anyone with whom to share their deepest emotions, is universal among drug addicts. No matter how much love a parent has, the child does not experience being wanted unless he or she is made absolutely safe to express exactly how unhappy, or angry, or hate-filled he or she may at times feel. The sense of unconditional love, of being fully accepted even when most ornery, is what no addict ever experienced in childhood — often not because the parents did not have it to give, simply because they did not know how to transmit it to the child.

Given these facts, addicts need to be treated with compassion, not with punishment; with understanding, not with judgment; with care, not with neglect. They need to be helped to face the pain in their lives and very few of us can do that alone. Yes, they need to confront their reality, without denial. But how to support that? As the spiritual master A.H. Almaas teaches, “Only when compassion is present can people allow themselves to see the truth.”

Gabor Maté is a Vancouver physician and the author of the bestseller, In the Realm of Hungry Ghosts: Close Encounters with Addiction.