"All Addictions are attempts to regulate internal emotional state"            

Rob Waters January 10, 2019

Dr. Gabor Maté, a well-known addiction specialist and author, spent 12 years working in Vancouver’s Downtown Eastside, a neighborhood with a large concentration of hardcore drug users. The agency where he worked operates residential hotels for people with addictions, a detox center and a pioneering injection facility, where drug users are permitted to shoot up and can get clean needles, medical care and counseling.

Born to a Jewish family in Budapest at the time of the Nazi occupation, he and his parents migrated to Canada, where he earned his medical degree at the University of British Columbia. Maté, whose personal experience informs his work, is known for tracing substance abuse problems to trauma that often starts in childhood and spans generations.

His work has been acclaimed, but a Psychology Today columnist suggested that his theories are reductionist and unsupported by data — a contention Maté disputes.

Amid the severe opioid epidemic in the U.S., Maté recently visited Sacramento, where he conducted workshops with addiction specialists and families affected by addiction. California Healthline contributor Rob Waters caught up with him there. The following interview was condensed and edited for clarity.

Q: A big part of your book “In the Realm of Hungry Ghosts” is about how you came to see that childhood trauma and pain lie at the root of addiction. Tell me about your insights.

Downtown Eastside is North America’s most concentrated area of drug use. In 12 years, I worked with hundreds of female patients, and every one had been sexually abused as a child. Men were physically, sexually and emotionally abused, suffered neglect, were in foster care.

Thirty percent of people there are native Indians, what we call First Nations people. For generations, the government abducted their children and sent them to residential schools. Parents were barred from seeing kids. Kids were physically and sexually abused by teachers and priests. Tens of thousands died. Because of multigenerational trauma, native communities have high rates of sexual abuse, violence, addiction and suicide. It’s the most addicted population in Canada.

All addictions — alcohol or drugs, sex addiction or internet addiction, gambling or shopping — are attempts to regulate our internal emotional states because we’re not comfortable, and the discomfort originates in childhood. For me, there’s no distinction except in degree between one addiction and another: same brain circuits, same emotional dynamics, same pain and same behaviors of furtiveness, denial and lying.

Q: You were born into a Jewish family in Budapest during the Holocaust. How did that affect your life?

I was born in 1944, and two months later the Germans came in. Hungary then had the only population of Jews in Eastern Europe that hadn’t been annihilated. Now it was our turn. My mother had a stressed pregnancy. My father’s away in forced labor; she doesn’t know if he’s dead or alive. When I’m 5 months of age, my maternal grandparents are sent to Auschwitz and gassed to death. My mother is 24, terrified and depressed. In October, they start killing Jews in Budapest, taking them to the Danube and shooting them.

When I’m 11 months, she gives me to a total stranger. She said: “Please take this baby out of here because I can’t keep him alive.” I didn’t see her for six weeks. In a child’s mind, that’s abandonment. I got the template for addiction: a lot of emotional pain, which I suppressed.

Q: You write about your own addictions — being a workaholic and binge shopper of classical music, once spending $8,000 in a week on CDs.

I was not addicted to substances but I might as well have been. I couldn’t stop myself. I lied to my wife. I lied to my kids. It doesn’t matter which addiction you’re looking at; it’s the same dynamics.

Q: Last year in the U.S., an estimated 72,000 people died of drug overdoses, most from opioids. The U.S. penalizes drug use harshly and has the largest prison population in the world — 2.3 million people, almost 1 percent of the adult population. Meanwhile, 90 percent of people with substance use disorders in the U.S. are not getting treatment. What’s your take on this approach?

The more pain you cause people, the more you shame and isolate them, the worse they’ll feel about themselves. The more suffering you impose, the more you strengthen their need to escape. If you wanted to design a system to maintain drug use and enhance the profits of the illegal drug trade, I would design the system you have.

Q: Let’s talk about the science. How does trauma in the early years of life affect brain development and predisposition to addiction?

Studies show that early stress affects both the nerve cells in the brain and the immune systems of mice and humans and makes them more susceptible to cocaine as adults. If you look at brain circuits implicated in impulse regulation or stress regulation or emotional self-regulation, all are impaired in addicts.

Q: Why do you think the opioid epidemic exploded in the way it has in recent years?

On top of the childhood trauma and the profound social and economic dislocation so many people experience, most physicians are completely uninformed about trauma and don’t understand how to address chronic pain or treat addiction. Hence they have a propensity to prescribe opiates all too quickly without looking at root causes or alternatives. Most people introduced to opiates in recent years started on medical prescriptions. When these are stopped, they turn to illicit substances. All this is greatly exacerbated by pharmaceutical companies’ well-documented drive to induce doctors to prescribe.

Q: Critics like psychologist and addiction specialist Stanton Peele say you’re proposing a reductionist vision in which abuse history and biochemical changes to the brain inevitably lead to substance abuse.

Peele totally misconstrues my argument. Nobody’s saying that every traumatized person becomes addicted. I’m saying that every addicted person was traumatized. There are other outcomes of trauma including cancer, autoimmune disease, mental illness — addiction is only one of them.

Q: You write with compassion about the people you worked with. But you also write about them as broken people who rarely seem to recover. What good are you doing?

If somebody had cancer and pain and you couldn’t cure the cancer, what would you do? Would you say, “I’m not going to help you any more”? Or would you try to ameliorate their suffering? The essence of harm reduction is you reduce the harm. You don’t impose abstinence. If they choose that at some point, I provide whatever support they need.

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