ADDICTION NOT ABOUT THE DRUGS

Vancouver Author Says The Focus Should Be On The Pain

Vancouver physician and author Dr. Gabor Mate spoke at Bolen Books last
week about the root causes of addictions and the implications for treatment.

Mate, 64, was in Victoria to promote his meticulously researched book, In
The Realm of Hungry Ghosts: Close Encounters with Addiction. With his thin
frame, lined face, unruly hair, and sad but compassionate eyes, he
resembled a hungry ghost.

He is one. A decade of caring for hardcore drug addicts in Vancouver's
Downtown Eastside led him to examine his own addictions. He is a workaholic
who compulsively buys classical music, sometimes to the tune of thousands
of dollars per month.

"There is only one addiction - it's not the object or the substance, it's
the dopamine-endorphin rush you get when compulsive shopping or taking
drugs," he said.

Mate defines an addiction as any repeated behaviour that people crave and
feel compelled to carry out despite its negative impact on their lives or
the lives of others. All addictions, substance related or not, arise from
the desire to increase the level of endorphins or dopamine in the brain in
order to make emotional pain bearable.

"The question is not why the addiction, but why the pain?" said Mate.

Dopamine and endorphins are chemical messengers in the brain. With
development starting in utero, and continuing throughout childhood, they
are essential to child-parent attachment. "The conditions for developing
the endorphin and dopamine circuits in the brain are a constantly present,
non-stressed, loving caregiver," said Mate.

He said maltreatment, or the absence of loving responses by caregivers,
causes emotional pain and contributes to chronic stress. This reduces the
number of dopamine and endorphin receptors while simultaneously increasing
the need for these neurotransmitters.

"Such children are more likely to become addicts . all my addicted patients
were abused as small children," said Mate.

Not all addicts use drugs. Some turn to other substances such as food,
alcohol, or tobacco. Others try to fill the void inside through excessive
shopping, gambling, sex, gaming, overwork, or other compulsive behaviours.
But drug addiction is the one that gets bad rap.

Drugs that attach to the dopamine and endorphin receptors in the brain, and
act like the endogenous neurotransmitter, are the common drugs of
addiction. But the drug itself does not cause the addiction.

Mate said that although cocaine raises dopamine levels by 300 per cent, and
crystal meth raises them by 1,200 per cent, relatively few users become
addicted to these drugs. Similarly, palliative care patients who receive
extremely high doses of opiates to control their pain feel no further need
for these drugs once their pain is controlled by a nerve block.

Mate believes that the war on drugs is actually a war on drug addicts, and
is ineffective.

"The ones who start life with the greatest disadvantages are the ones who
are punished," he said, adding that few of the funds allocated to this
strategy go to prevention, harm reduction and treatment - most go to law
enforcement. The stress of harassment only increases an addict's need for
addiction.

What then does he see as the answer to addiction? Compassion rather than
judgment.

"An addict's core belief is that they are deficient and deeply flawed. They
feel alone and bereft," said Mate. "They feel insufficient as human beings,
and this feeling gets worse each time they do the addictive behaviour. In
addictive mode, people go into denial . only when compassion is present
will people allow themselves to see the truth."

Mate, who believes everyone has God within them, says that part of dealing
with addiction is spiritual.

"Addicts have to find the truth in themselves . the truth that their soul
knows, but their mind cannot see."

There is hope for addicts to heal, said Mate. Recent research in
neuroscience has shown that the brain is plastic - it can change its
structure in response to behaviour, an enriched environment, and conscious
mental effort. Given sufficient motivation, attention to thoughts and
emotions, and help when needed, addicts can find the truth in themselves
and change their behaviour and their brain.

After his talk, when Mate was asked if he has found the gold standard of
experience, the life we would all know if not addicted, he replied, "I've
had glimpses."