ADDICTS ARE NOT ENEMIES

In The Realm Of Hungry Ghosts - Close Encounters With Addiction

by Gabor Mate (Alfred A. Knopf, 465 pages, $34.95 hardcover)

It seems odd to use the word "beautiful" to describe a book that
focuses, frequently in graphic, unrelenting detail, on the lives of
some of the most hopeless outcasts of our society: the hard-core
street addicts with whom Dr. Gabor Mate works. Yet that's the word
that came repeatedly to mind as I read In the Realm of Hungry Ghosts.

It's not only the grace of Mate's writing, though that's certainly a
great part of it. It's the sense of compassion that infuses the entire
book, the author's continued faith in and affection for the men and
women with whom he works, even when he is the victim of their
drug-fuelled abuse, racial epithets and thefts.

He has few illusions about these people, but he is apparently not
disillusioned by them, either.

"Beautiful," however, does not necessarily mean "comfortable." Dr.
Mate makes it very clear that addiction is not confined to society's
outcasts -- or, for that matter, to substance abusers. He mentions
addictions to, among many other things, cosmetic surgery, exercise,
food, nicotine, talk radio -- the list of potential addictions is
endless and applies to many, many people who would laugh or grow
hostile at any suggestion that they were addicts. Note to reader: This
means you.

Mate is staff physician at a residence and resource centre in
Vancouver's gritty Downtown eastside, many of whose residents suffer
from addiction, mental illness, HIV or all three. He is also an addict
himself -- not to drugs but to classical music CDs, for which, at
times, he has had a $1,000-a-month jones.

What Ever The Craving

In Chapter Nine, after more than 100 pages devoted to the drug addicts
of Vancouver, Mate suddenly shifts the focus to himself, a dramatic
way of signalling that when he speaks of addiction, he has in mind not
just substance abusers but all addicts, whatever their craving.

He does not equate an expensive but affordable addiction to shopping
or music with the pain felt by crack addicts, but he shows that the
causes of addiction, among the most important of which are brain
physiology and childhood experience, know no social or economic
boundaries. Ditto for the symptoms. Addiction and addicts differ only
in degree -- and in society's view of them.

Society's view is the true target of this book. Mate makes it clear,
through the stories of his patients, medical and sociological studies,
research on the brain and more, that addicts are not enemies, drugs do
not cause addiction, and addiction is very far from being confined to
the inner cities and the unemployed. All these facts directly
contradict the underlying premises of the disastrous U.S.-led War on
Drugs, which has a great deal of influence far beyond America's
borders, and about which Mate writes scathingly. Indeed, one major
thrust of the book is a plea to abandon the hugely destructive and
ineffective policies of the War on Drugs in favour of a more humane
(and certainly more effective) approach to addiction.

Compassion Urged

At the root of the author's suggestions is compassion on every level:
on the part of society by implementing policies that view the addict
as a sufferer rather than an enemy (policies that, incidentally, have
been shown to reduce crime, poverty and health-care costs); on the
part of doctors and others who work with addicts; and on the part of
addicts themselves, who, through what Mate calls "compassionate
curiosity," can stop blaming and pitying themselves for their
addiction and its consequences, instead turning each success and
failure in their battle with addiction into an opportunity for
nonjudgmental self-analysis. Mate neatly sums up this attitude: "Hmmm.
I wonder what drove me to do this again."

"Nonjudgmental": perhaps that's the key element of Mate's viewpoint
and proposals. Whether for governments, police forces, doctors,
addicts' friends and families, or addicts themselves, removing the
blame and the guilt is what will allow a shift in how addiction is
viewed. For addicts, it will allow the all-important step of seeing
addiction as something that can be controlled -- a view that may at
first appear ludicrous to someone caught in addiction's grasp.

Mate offers no easy fixes (pun intended), but does offer hope and
understanding.

"Envision yourself living with integrity, creative and present, being
able to look people in the eye with compassion for them -- and for
yourself," he writes. "The road to hell is not paved with good
intentions. It is paved with lack of intention . . . Are you afraid
you will stumble? Of course you will: that's called being a human being."

Hal Goodman is an editor, writer and musician living in Waterloo. He
has written extensively for The New York Times' Book Review and Travel
sections, and for many other publications.

In the preface to his book, Dr. Gabor Mate explains that "Realm of
Hungry Ghosts" refers to one of six realms in the Buddhist Wheel of
Life, each representing aspects of human existence. Those in the
Hungry Ghost Realm, are "depicted as creatures with scrawny necks,
small mouths, emaciated limbs and large, bloated, empty bellies. This
is the domain of addiction where we constantly seek something outside
ourselves to curb an insatiable yearning for relief or fulfilment."