Book Review

“Realm of Hungry Ghosts: Close Encounters with Addiction,” written by Dr. Gabor Maté

In the “Realm of Hungry Ghosts: Close Encounters with Addiction,” written by Dr. Gabor Maté, won the 2009 Hubert Evans prize for non-fiction.

Dr. Maté, who practiced medicine in Vancouver’s Downtown Eastside for 12 years, describes addiction as a failure of our brain circuits to effectively govern such functions as physical and emotional pain relief, stress, and the capacity to feel and receive love, largely due to a neglected or oppressed childhood.

Dr. Maté argues that prevention needs to begin with the first prenatal visit followed by support in schools such as personnel trained to recognize the signs of early trauma and to provide remedial interventions that will meet a young person’s “requirement for connection, adult guidance and meaningful activity”.

The author stresses the importance of nurturing adult relationships in the lives of youth rather than peers as they are not typically malicious but are generally immature.

“Peer affiliation,” according to an article in the Journal of Drug and Alcohol Dependence, “is possibly the strongest social factor in predicting the onset and early escalation of adolescent substance use.”

Most hard-core substance abusers come from abusive homes with nearly two-thirds of injection drug use attributed to abusive and traumatic childhood events.

With the addicted brain impaired from childhood and further damaged by drugs, we must see rehabilitation as a long term process with in which young families at risk are identified and supported, explains the author.

Addiction originates in pain, felt openly or hidden in the unconscious. Drugs are emotional anesthetics that addicts use to self-medicate, offering protection from their pain and enabling them to engage with others with “excitement and meaning.”

In the U.S., even after hospital treatment the opiate re-addiction rates are over 70%, signaling that drugs do not make an addict. There must be a preexisting underlying vulnerability that also must be treated and usually over a much longer time period.

Dr. Maté’s Downtown Eastside patients found it virtually impossible to stop drug use unless they moved to a different part of town or to a recovery home. They needed an environment where drugs were not readily available, people’s behaviors didn’t remind them of their drug habit, and the chronic stressors that in great part led them to continuous drug use are addressed.

In 2009, long before our current overdose crisis, Dr. Maté’s prescription for a comprehensive substance addiction treatment system included harm-reduction, substitution opiate treatment, detox, and graded facilities where people can move from detox to trauma healing.

He goes on to say that while not perfect, “Twelve-Step programs provide the best available healing environment for many people.”

Despite their flaws “they have saved more lives—emotionally and probably even physically—than the medical treatments of addiction”.

Dr. Maté clearly outlines that practising harm reduction doesn’t mean we need give up on abstinence — “on the contrary, we may hope to encourage that possibility by helping people feel better, bringing them into therapeutic relationships with caregivers, offering them a sense of trust, removing judgment from our interactions with them and giving them a sense of acceptance.”

However he does warn that building endless harm-reduction facilities will not “stem the tide of addiction so long as our system fails to recognize the source of the problem in trauma and social dislocation, and so long as treatment facilities focus mostly on trying to change the behaviours of addicted human beings instead of healing the pain that drives those behaviours.”

There is hope as our brains, including those of a drug addict, continue to develop throughout our lives. Addictions — whether to drugs or other compensators like gambling, compulsive sex pursuits, food, or in Dr. Gabé’s case classical CD’s — can be tamed to the benefit of the addicted and the society within which they live.

“The false separation between mental health issues, on the one hand, and addictions, on the other—practiced in many institutions and treatment facilities—must be ended.”

With much more to learn than can be described in this short article, I would encourage all to set aside some time this summer and enjoy a little brain exercise by reading this influential book.

Norm Letnick is MLA for Kelowna-Lake Country and the health critic.