ANNALS OF ADDICTION

We're All Strung Out Somehow

A Vancouver Doctor Who Treats The Most Desperate Calls For Compassion
And Common Sense In Our Approaches To Addiction

In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Mate

Knopf Canada,

465 pages, $34.95

He would dispute it, pointing instead to a deep clinical
understanding of the nefarious workings of addiction, but Dr. Gabor
Maté is something of a compassion machine, hugely wary of casting the
first stone.

How else to regard the one-man M.A.S.H. unit (a physician working
Vancouver's squalid Downtown Eastside) whose pitiful patient roster
includes hardcore drug addicts who can't stop using despite
pregnancy, potential limb and digit amputation and even possible quadriplegia?

Maté's subjects are the living, breathing embodiment of the nation's
grimmest statistics for HIV/AIDS, hepatitis, homelessness, crime,
abuse, neglect, overdose and death. More than merely poor and
disenfranchised, they are truly the lowest of the low, reviled by
society and demonized by law enforcement.

Despite that, Maté sees them as people first, addicts second, and
particularly deserving of love, acceptance and latitude, given the
hell most of them have invariably suffered to arrive at this point.

What's more, Maté sees these front-line addicts as essential links in
a cabal toward a complete rethink/revamp of the current approach to
understanding and treating addictive behaviours of all stripes,
including gambling, sex, shopping and eating disorders.

Sound heavy, progressive, nuts? There's more. With his powerful new
book, In the Realm of Hungry Ghosts: Close Encounters with Addiction,
Maté hopes not only to make the case for decriminalizing drugs but
for changing the way society at large perceives addicts.

As Maté observes at the book's beginning, "Those whom we dismiss as
`junkies' are not creatures from a different world, only men and
women mired at the extreme end of a continuum on which, here or
there, all of us might well locate ourselves."

And that means you too, mister socially accepted workaholic.
Evidently, the so-called biology of addiction places you closer on
the spectrum to the dope fiend than you may care to admit.

Basically divided into three parts, In the Realm of Hungry Ghosts
first introduces us to many of Maté's most dire patients, those who
steal, cheat, prostitute and otherwise harm themselves for their next
hit despite debilitating illness, spiritual agony and the sure
knowledge that other lives (children especially) are being destroyed.

Next, Maté wades through the vast learning behind the root causes of
addiction, applying a clinical and psychological view to the physical
manifestation and unearthing some surprising (to the layman anyway)
answers for why people do such frightening and destructive things to
themselves.

"In the words of one researcher, `maternal contact alters the
neurobiology of the infant.' Children who suffer disruptions in their
attachment relationships will not have the same biochemical milieu in
their brains as their well-attached and well-nurtured peers.

"As a result their experiences and interpretations of their
environment, and their responses to it, will be less flexible, less
adaptive and less conducive to health and maturity. Their
vulnerability will increase, both to the mood-enhancing effect of
drugs and to becoming drug dependent.

"We know from animal studies, for example, that early weaning can
have an influence on later substance intake: rat pups weaned from
their mothers at two weeks of age had, as adults, a greater
propensity to drink alcohol than pups weaned just one week later."

Finally, Maté takes aim at the hugely ineffectual, largely U.S.-led
war on drugs, challenging the current wisdom of fighting the illicit
trade rather than aiding the addict (or potential addict). He shows
how controversial measures such as safe injection sites (including
the one in downtown Vancouver), are measurably more successful at
reducing drug-related crime and the spread of disease than anything
the White House (or Parliament Hill) has going.

"As summed up in the Canadian Medical Association Journal,
`Vancouver's safer injecting facility (known colloquially as Insite)
has been associated with an array of community and public health
benefits without evidence of adverse impacts.' The city's current
mayor and his three more recent predecessors, including the present
premier of British Columbia – no liberal when it comes to social
policy – support the continuation of Insite. Despite initial
scepticism, so do local merchants and the Vancouver Police Department."

In the Realm of Hungry Ghosts (the title refers to a point on the
Buddhist Wheel of Life) is enormously compelling and Maté, as noted,
is admirably, sometimes inexplicably, empathetic to all who cross his path.

But easy reading it's not. Addicted pregnant women who have already
had children taken away and who continue using heroin and cocaine are
repugnant no matter how pathetic their upbringing.

So too are guys shooting drugs into their necks and risking brain
abscesses because they can't otherwise locate a useable vein without
a doctor's help (you read that right). Furthermore – and Maté would
probably admit this – when it comes to addiction, one size doesn't
fit all. Not all addicts come from horrendous backgrounds. And not
all people from horrendous backgrounds become addicts.

Moreover, Maté indulges some distracting tangents, chief among them a
parallel exploration of his own "addiction" to the compulsive
purchase of classical music CDs, which surfaces throughout the book.
While Maté's attempt to refract the impulses of his drug-addled
patients through the prism of his own rash behaviour is conceptually
admirable, it also just seems kind of dumb by comparison. Ditto his
musings on the reckless deeds committed by Conrad Black.

Still, there is no disputing Maté's core point that the current
system for dealing with addicts – heavy on the policing and
prosecuting, light on the treatment and R&D – simply isn't working.

This book won't itself spur the sweeping change and legislative
reform needed to fix a woefully broken system. But it should get us
thinking about how our tax dollars are being spent on ineffective and
frequently unenforceable laws.

And it might engender some of Maté's truly noble compassion among
those of us who would rather look away than consider the
circumstances propelling a zoned-out streetwalker. When it comes to
solving the illegal drug problem, every little bit helps.