Dr Gabor Mate sees ghosts. They're not the paranormal kind; rather they are regular people afflicted by a condition that Mate says originates in the brain: addiction.
In his book In the Realm of Hungry Ghosts, Mate argues that addiction defies easy fixes and requires compassion ahead of judgment or punishment. Mate said in an interview he aimed to show his patients have turned to drugs and alcohol to set right an imbalance in their brain chemistry that often stems from a life of neglect and abuse.
The book, which has attracted mainstream media attention and is now on Canadian bestseller lists, derives its name from the Buddhist Wheel of Life, with six realms depicting different aspects of human life. The characters in the hungry ghost realm are scrawny, emaciated creatures driven by a constant search for something to calm an internal hunger that can't be sated.
"Addiction starts in womb"The case for the connection between brain function and addiction has been well-made, Mate said. "Any human activity has to have some control mechanism in the brain," he pointed out, "otherwise it can't happen."
To treat addiction, Mate said, it needs to be recognised as a condition of the brain, one that often begins in childhood or even in the womb. "When the brain is diseased the functions that become pathological are the person's emotional life, thought processes, and behaviour," he writes.
When someone takes a drug like cocaine, their brain gets a rush of dopamine, which provides a "high" that other pleasurable experiences can't quite match. An addict's brain is wired to depend on that high just for normal functioning, despite the destruction caused in its pursuit.
Addiction: not a choice
Taking drugs becomes, for an addict, less a matter of personal choice and more a matter of survival, he said. "It's not a choice they make," Mate said. "That's a false distinction." Choice implies a measure of options, he said, ones that addicts don't have.
In his book, Mate points out that many people who try drugs, even narcotics like opiates, do not become addicted to them. A survey published in the journal Clinical and Experimental Pharmacology and cited in Hungry Ghosts shows that 32 percent of those who have tried nicotine have gone on to regular long-term use, where the rate is about 23 percent for heroin and 15 percent for cocaine and alcohol. Something about those who do become addicts must be different in some way, Mate contends, or at least, the effects of the drugs themselves can't be the only cause of addiction.
"If you look at the street kids that use crystal meth, it does something for them," Mate said. It doesn't just make them high, but it also keeps them awake during nights on the street and provides them with a community of other users. Moreover, studies have shown an association between Attention Deficit Disorder and crystal meth use, he said.
Addiction a complex condition
If they could get the things they needed in another way, the crystal meth might eventually become less appealing, Mate suggested. The fact that so many factors are at play - personal history, brain chemistry, social status - explains the need for a holistic approach that doesn't over-simplify addiction treatment - and the addicts themselves, he said. "There's no single explanation, because it's a multi-faceted, multi-layered phenomenon."
Karen Minden, the CEO of Pine River Institute in Ontario, Canada, says, "Addiction is not a criminal issue. The criminal issue is the consequences of high-risk behaviour. Addiction is a mental health issue and it needs to be squarely in that realm."
Pine River Institute is a therapeutic boarding school that treats adolescents struggling with addiction. Pine River's therapeutic approach, based on research and expert opinion, recognises that the addict isn't a loser, Minden said, but is instead someone who's found a way to alleviate their pain. Because their current method is self-medication through substance abuse, staff at the institute work with the teenagers and their families to develop something better.
The teenagers who come to Pine River are mostly bright and creative, Minden said. They are also dealing with some kind of emotional trauma or pain that has led them to substance abuse, she said. By the time they end up at Pine River, they may have run into trouble at school or with the law, and many have health issues related to their addiction. Some have attempted suicide, or had suicidal thoughts, and many are already street-involved, she said. Their drug and alcohol use has increasingly isolated them from their family and friends.
"You very often can identify these kids because they've changed peer groups," Minden said. "They're no longer with the peer group they were with when they were functioning well."
Pine River's holistic approach is proving successful in students who have left the facility and gone home, Minden said. More than 80 percent of the students they've been able to follow up on are back in school, she said, and many of them are participating in new extracurricular activities in sports and the arts.
Mate described the addicts he treats at the Portland Hotel, where he has been a staff physician for a decade, as "the hardest of the hardcore." They are marked by abuse in their personal histories, many of which are related in Hungry Ghosts.
Mate said he realises that most of his patients will die young due to their addictions. His aim, he said, is to treat them and alleviate their suffering, because social and political conditions put a cure out of reach for most. "I could cure a lot of people - at least, I could do much more towards a cure, if I had the right tools, the right conditions to work with," he said. "That's not a personal issue, that's a social issue."
Terri Coles, Reuters Health
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