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Close Encounters with Addiction

Dr. Gabor Maté: Thank you kindly, one and all. And especially to Leonard for organizing this event. We can take the perspective that addiction is a terrible problem to be excised and that it’s a plague to somehow be fought and defeated, or we can take another perspective. Let me read you something that a spiritual teacher whom I cherish, who actually lives and works here in California wrote. His words go, “Your conflicts and all the difficult things, your problematic situations in your life are not chance or haphazard. They are actually yours. They are specifically designed for you by a part of you that loves you more than anything else. That part of you that loves you more than anything else has created roadblocks to lead you to yourself.”

And I’d like you to consider, even before we speak about addictions, the meaning of recovery. We talk about recovery, and in addiction, recovery is, of course, the goal. Well, what does it mean to recover? To recover something is to find it. That’s what the word means. Which is to say that recovery means finding something that must have been there all along, because if it wasn’t, you couldn’t find it. And that something that recovery aims at finding is nothing less than oneself. So in recovery, we find ourselves. The word healing comes from the word whole, so healing is to become whole. In Hebrew, the word for wholeness is shalem. The word for peace is shalom. It’s when we find ourselves and become whole that we find peace. Addiction is all about lack of peace. It’s all about internal unrest. It’s all about disconnection from the self. And so there is a part of us that created a conflict precisely to lead us to ourselves. It will go to extreme measures to wake you up. It will make you suffer greatly if you don’t listen to it. What else can it do? That is its purpose.

The spiritual teacher I mentioned goes on to say that the most difficult things that happen to you on the deepest level are the most compassionate. In other words, we can look at addiction, and I would say any problem whatsoever in our life, whether it be conflict in our marriage, difficulty in our daily lives, disease, and so forth. We can look upon them all as problems to get rid of or we can see them as learning opportunities. We can see them as episodes in our lives that were meant to bring us to ourselves. I don’t recommend it, but I’ve had many people tell me that their cancer, for example, is the best thing that ever happened to them. I don’t recommend getting cancer as a way of finding yourself. I don’t recommend getting addicted as a way of finding yourself. But I’m saying that once this phenomenon arrives, given that it’s already there, we can take the attitude of a problem that we have to get rid of, or we can say “what is the opportunity that life is giving us here to learn about ourselves and what is the path that’s been shown for us to get back to ourselves.”

That’s the perspective I’d like to use in addressing addiction tonight. Obviously, there are many, many ways of looking at addictions, this being one of them. But for me, it’s also the most useful, practical, and the most liberating. And, of course, I’m talking not just spiritually or in the abstract, nor am I just talking about the highly addicted population of human beings with whom I’ve worked with the last twelve years: people who die of HIV, people who die of Hepatitis C, people who die of infections of all kinds, people who die of overdoses, people who commit suicide, people who have accidents because they are too drugged to look after themselves. No, I’m not just talking about them. I’m also talking about myself in that when I look at addictive patterns in my own life, and I do have them, when I get past the shame that I feel, when I get past the guilt, or the defensiveness, or the denial that automatically accompanies any addictive behavior, there is always profound teaching there.

Let me actually begin with a very personal example—a very recent one. Because of my books and because of my name, I get a lot of people writing to me and wanting to meet me. I don’t have a whole lot of time to meet a whole lot of people, but I do have a dog called Rosie, and I walk her every day, and I say to people who contact me, “Okay, meet me and come and walk the dog with me.” So two weeks ago, I walked on four different mornings with four different people, and one of them was a woman in her forties, twenty years younger than me, the mother of two kids, and we had coffee, went for a walk, and by the time I got home I was all excited. My wife, Rae, who knows me all too well, says “Are you in love?” And I said, “Well, I find her attractive, but I find you attractive too.” Quick recovery.

You know the story of the guy who goes into the bar, you’ve seen this is the movies, you know, he’s all alone in the bar at midnight and he’s crying in his beer and says to the bartender, “You know, my problem is that my wife doesn’t understand me.” Well, my problem is that my wife understands me. But what happened subsequently is because I wasn’t honest. I was really excited about having met this woman and there was this charge, a sexual energy there, this attraction and playfulness. And I hid that from my wife.

So we got into this playful, flirtatious email exchange. Now if we had to do it by mail or carrier pigeon, this wouldn’t happen. But the speed of email allows the exchange of several messages a day and of course you wait for the next message and you’re interpreting, “What does she mean by that phrase?” It stopped within two or three days, but was enough so that my wife was hurt. And not because anything had happened or was going to in the physical sense, but simply because I was clearly draining energy from our relationship and putting it somewhere else.

And where that was coming from is that I had spiritually and emotionally allowed myself to get defeated by taking on too much work. My workaholism got the better of me. And when I allow that to happen, I get defeated, and then I don’t do my spiritual work and I lose myself. I lose my connection to myself. I create that void, that emptiness, and whenever that void or emptiness is created, I want to fill that up from the outside. That filling up could be more work, more public recognition, or it could be just the exciting idea that a younger woman finds me attractive. And it had nothing to do with the other person—she had her own role, whatever her own need was, but I’m talking about myself here. It came out of a position of emptiness.

What I’m also saying is that emptiness is precisely the foundation for addiction. Whenever we feel empty, whenever we allow ourselves to become defeated, or whenever we are impaired from knowing who we are, whenever we are disconnected from ourselves, addiction can flood in. It could just be flirtation. It could be in some cases repeated sexual acting out. It could be shopping, it could be gambling, it could be work, it could even be meditation, it could be exercise. In the case of the most affected individuals, it will be drugs—in such a way as to make their lives completely unmanageable; in fact, threaten their lives. Not only threaten their lives, but take their lives, as with many of the clients who I’ve worked with. But the basis of it all is the disconnect from themselves, a desperate emptiness. And that, of course, is the Buddhist image of the Hungry Ghost—these creatures with large, empty bellies, small scrawny necks, and tiny mouths and they are always trying to get satisfaction from the outside.

So the question is “What is that all about?” By the way, my little escapade of two weeks ago reminded me of the ending of the wonderful book The Plague, by Albert Camus. It takes place in Algeria and there’s a bubonic plague epidemic and it is Dr. Rieux, who is one of the people in the city who fights the plague and the rats that carry the plague. And the book ends by Camus writing that you have to be vigilant all the time because even though the plague had been defeated this time, you never know when the rats will come back carrying their deadly organisms again into the heart of the city, and that’s how it is with all of us.

Recovery is not just about stopping the addictive behavior; it’s actually about having something positive inside. If we only stop the behavior but we’re not vigilant about making sure that we keep ourselves filled with ourselves, and if we don’t stay connected to ourselves, then surely and invariably something from the outside will come along to seduce us or lead us away from ourselves. So you have to possess that vigilance that Camus talked about at the end of The Plague.

The question then is what is that emptiness all about? And incidentally, of course, our problem is that we live in a society that in a million ways wants to seduce us every day. It tells us with dogged determination that we are not enough the way we are. That who we are is not good enough and that in order to be worthwhile you have to do this, achieve that, attain that, possess this, conquer that, seduce that. So the message from the world, rather than supporting our essential self, completely undermines it and invalidates it. And as the Buddhist teacher wrote in The Tibetan Book of Living and Dying, the greatest achievement in modern civilization is the brilliant selling of suffering.

What is the essence of this void? What is the cause of the emptiness inside so many of us that we are so filled with external concerns and external activities and external goals and suffering? Well, in North America the answer is straightforward. The popular answer, the legal answer, the social answer, the acceptable answer is just a “choice.” Hence, you have the “Just Say No” campaign by Nancy Reagan. This is the same ideology that in a more sinister way underlies the whole concept of the war on drugs, because it is only if addiction is a choice that it makes any sense to punish those who struggle with it. Only if it’s a choice that people make does it make any sense to attempt to deter them by the imposition of the punitive measures that we visit upon people who engage in substance abuse.

In the United States, I may not need to tell you, the land of the free makes up 5 percent of the world’s population, but 25 percent of the world’s jail population—mostly because of the drug laws. And the drug laws are mostly based on the simplistic idea that it’s not even worth debating too much because its all a matter of choice. Because if it’s not a matter of choice, if it’s anything else other than choice, what sense does it make to punish people? Clearly, if it’s a choice and if you make the punishment dire enough, you can deter people, but if it’s not a choice, it makes no sense whatsoever. And yet that is the socially dominant response to the dilemma of addiction.

The other perspective on addiction, which is more accepted in the treatment community, in twelve-step groups, and in the medical community is that addiction is a disease of the brain. Now, of course, there is proof to that. You can do brain scans on addicts and you will see certain surfaces won’t function very well. Furthermore, you can also show on serial brain scans that the longer a person uses drugs, the more fragmentation in brain anatomy will be noticed, the more loss of brain anatomy will be noticed, and the more loss of functioning in terms of psychological and sexual behavior will be noticed. So the disease hypothesis certainly has a lot of scientific grounds for it.

However, when you ask the question, what causes the disease, the answer that society gives, insofar as it considers addiction to be a disease at all, is that it is a problem of genetics, a problem of heredity. And by the way, the medical profession loves that perspective on everything. You notice I don’t stand still very much. Why not? Because I have Attention Deficit Hyperactivity Disorder, more commonly known as ADHD. And the perspective on that, along with everything else, is that it is largely determined by genes. You just had the bad luck to inherit the wrong set of genes. Now I won’t hold to that perspective at all despite the fact that two of my kids have been diagnosed with it. I just don’t think it is genetic at all. Or rather, very little about it is genetic.

Incidentally, when I was at KPFK this morning, it was mentioned that a recent study at UCLA showed kids with ADHD have an increased risk of addiction. Once more they’ve reinvented the wheel as this information has been known for at least a decade. That’s fine, another study proves it. If you look at the very issue of conditions like ADHD and autism, childhood developmental disorders, and conduct disorders, and you see the burgeoning numbers, the increasing numbers of kids who are being diagnosed with one condition or another, right away that should tell you that it can’t be genetic, because genes don’t change in a population over a short period of time. They can’t. Not even over 100 years, let alone a decade. So either we are over-diagnosing, or we are better at diagnosing, or indeed there are many more kids who are troubled now.

If you actually look at the question of why are these childhood conditions, each of which predispose them to addiction, are increasing in our society, then you open up a different perspective, because it can’t be genetic. Something is happening in society that is affecting a large number of people in a similar way; affecting large numbers of children in a similar way. Now for that perspective there is lots of evidence, and not just, by the way, for mental health conditions or the developmental problems of addiction. It’s true of disease across the board.