In this timely and profoundly original new book, bestselling writer and physician Gabor Mate looks at the epidemic of addictions in our society, tells us why we are so prone to them and what is needed to liberate ourselves from their hold on our emotions and behaviours. For over seven years Gabor Mate has been the staff physician at the Portland ...
In this timely and profoundly original new book, bestselling writer and physician Gabor Mate looks at the epidemic of addictions in our society, tells us why we are so prone to them and what is needed to liberate ourselves from their hold on our emotions and behaviours. For over seven years Gabor Mate has been the staff physician at the Portland Hotel, a residence and harm reduction facility in Vancouver's Downtown Eastside. His patients are challenged by life-threatening drug addictions, mental illness, Hepatitis C or HIV and, in many cases, all four. But if Dr. Mate's patients are at the far end of the spectrum, there are many others among us who are also struggling with addictions. Drugs, alcohol, tobacco, work, food, sex, gambling and excessive inappropriate spending: what is amiss with our lives that we seek such self-destructive ways to comfort ourselves? And why is it so difficult to stop these habits, even as they threaten our health, jeopardize our relationships and corrode our lives? Beginning with a dramatically close view of his drug addicted patients, Dr. Mate looks at his own history of compulsive behaviour. He weaves the stories of real people who have struggled with addiction with the latest research on addiction and the brain. Providing a bold synthesis of clinical experience, insight and cutting edge scientific findings, Dr. Mate sheds light on this most puzzling of human frailties. He proposes a compassionate approach to helping drug addicts and, for the many behaviour addicts among us, to addressing the void addiction is meant to fill. I believe there is one addiction process, whether it manifests in the lethal substance dependencies of my DowntownEastside patients, the frantic self-soothing of overeaters or shopaholics, the obsessions of gamblers, sexaholics and compulsive internet users, or in the socially acceptable and even admired behaviours of the workaholic. Drug addicts are often dismissed and discounted as unworthy of empathy and respect. In telling their stories my intent is to help their voices to be heard and to shed light on the origins and nature of their ill-fated struggle to overcome suffering through substance use. Both in their flaws and their virtues they share much in common with the society that ostracizes them. If they have chosen a path to nowhere, they still have much to teach the rest of us. In the dark mirror of their lives we can trace outlines of our own. --from In the Realm of Hungry Ghosts
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All humans seek to eliminate physical and emotional pain, and no one suggests that seeking pharmaceutical relief for migraine headaches or deteriorated spinal disks evidences moral laxity; no one suggests that had we been morally stronger we would have endured our pain. Yet that is what society tells the drug and alcohol addicted.
We deny addicts access to their "illegal" drugs on the rationale that they choose to take them, thereby bringing about their own dismal physical, social and legal circumstances. Mate asks why it is that society doesn't apply that same rationale (and policy) to people whose lifestyle choices bring about medical conditions such as broken legs, home and job related depression and anxiety, chronic bronchitis, coronary artery disease. He astutely observes, "No cardiologist, respiratory specialist, orthopedic surgeon, or psychiatrist would refuse treatment on the ground that the problem was self-inflicted."
Mate cites the 1998 Adverse Childhood Experiences study by Felitti et al. that two-thirds of adult addiction risk is attributable to severe childhood abuse or trauma. The greater the number of trauma exposure types (the study addressed seven), the greater the relationship to later addiction as well as other diseases/morbidities: smoking, obesity, depression, suicide, sexual behavior, STDs, ischemic heart disease and chronic obstructive pulmonary disease. With addicts he treats in the Vancouver clinic, Mate comes to know their almost unbelievable stories of abuse and betrayal in early childhood; he shares some of this horror with the reader. That young children are at the mercy (or lack thereof) of adults and circumstances beyond their control is undeniable. A 5-year-old child bears no responsibility for the sexual predation of her uncle or the substance abuse of parents, violence against her mother, or parent suicides, etc. Young children have few coping mechanism for dealing with emotional pain, except to bury it from conscious awareness and sense that they are somehow deficient - possibly unworthy of love and protection.
Society currently present drug addicts with only two choices: abstinence or prosecution. (If you think abstinence is a realistic option, be sure to watch the YouTube video, "Opiates and Tranquilizers," especially about forty minutes in when the brain's dopamine receptors are discussed.) Mate observes that we still do not have a systemic, evidence-based approach to achieving lasting abstinence (or cure, if you will). He characterizes society's approach:
So long as society ostracizes the addict and the legal system does everything it can to heighten the drug problem, the welfare and medical systems can aim only to mitigate some of its effects.
What then is the policy alternative? Harm Reduction: adopting a "public heath" rather than "criminal" approach. To reduce harm "means making the lives of afflicted human beings more bearable, more worth living." Mate cites society's harm reduction approach to rheumatoid arthritis where we aim to reduce joint inflammation, prevent bone destruction, and reduce pain. Or take the case of incurable cancers where we seek to prolong life, control symptoms (including reducing pain) and maintain quality of life as much as possible.
The reality Mate asks us to accept is that some drug users ". . . are too deeply enmeshed in substance dependence for any realistic 'cure' under present circumstances. For now there is too much pain and too few internal and external resources available. If we accept scientific findings about the physiological basis of an existing drug addiction and jettison our moralistic posturings about free choice, we can adopt a Harm Reduction model for addiction.
What are the elements of a harm reduction approach to drug addiction? Mate identifies those used in Vancouver's innovative program:
? Diagnose and treat other medical syndromes that often co-occur with addiction: Attention Deficit Hyperactivity Disorder and Bi-Polar disease.
? Establish clean needle exchanges to prevent the spread of Hepatitis C and HIV.
? Provide basic medical care of addiction-related disease: abscesses, infections, etc.
? Provide therapy for the childhood trauma underlying drug use.
? Establish drug substitution including methadone and prescribed heroin.
? Provide a medically staffed detox facility with follow-up temporary housing that temporarily separates the person from his drug environment.
? Establish counseling that seeks to reunite the former addict with his/her family.
Good intentions you might say, but too expensive! Turns out that our current punitive "war on drugs" (which has not reduced drug use or cured addiction) is costing U.S. tax payers a minimum of 100 billion dollars each and every year.
Especially now with a heroin epidemic sweeping the nation, we must confront the foundational question: the relationship society creates between itself and its drug-addicted citizens. "The fundamental question is whether or not we recognize these people as human beings who are legitimately part of the social fabric and who deserve compassion and respect." If you want to take a moral stance on addiction, take the compassionate Harm Reduction approach just as we do with rheumatoid arthritis, cancer or coronary artery disease.
Oct 13, 2011
This book helped further my knowledge about addiction, and I admire the courage and honesty of the author and his subjects.
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