Over a two-decade span of treating low-income addicts in Vancouver’s downtrodden Downtown Eastside Dr. Gabor Maté routinely posed this question to his patients: “What’s right about your addiction?” It’s his focus on the benefits that feeding an addiction provides an addict – rather than just the life-threatening risks — that has set Maté apart from other leading experts.
“Feeding the addiction can bring relief from stress, a sense of control or just a feeling of being normal, which addicts may not feel otherwise,” Dr. Maté says. For 12 years, until his recent retirement from medicine, the Hungarian-born physician ran a clinic treating Vancouver’s most serious addicts, most of whom suffered from other health issues as well, including HIV and hepatitis C. The clinic, Insite, remains the only place in North America that allows addicts a safe injection site, meaning they can come to the clinic to use clean needles and have their injections medically supervised.
Maté, author of the best-selling book, “In the Realm of Hungry Ghosts: Close Encounters with Addiction,” believes the origins of addiction stem from childhood trauma and that addicts should be treated with more compassion. He argues against the two prevailing views of addiction: that it’s a choice people make to seek out hedonistic, self-destructive pleasure due to a lack of willpower, or that it’s an inevitable result of inherited genes.
“Neither of these stand up to scientific scrutiny,” he says. Instead, Mate asserts that an addiction is driven by horrific childhood experiences like sexual or physical abuse or parental neglect. Each of these traumas, he posits, doubles the risk that a person will eventually become addicted to drugs, alcohol, overeating, gambling or some other destructive, compulsive habit. For evidence, he cites a 2004 study conducted by Kaiser Permanente researchers involving 17,000 patients which found a link between adverse childhood experiences and addictions later in life. Addiction, he believes, represents a failure of crucial brain circuits to develop early in life under the influence of a nurturing environment. “Seeing addiction itself as the problem doesn’t deal with the fundamental issue, which is a person’s attempt to solve the distress and suffering lingering from a past trauma,” he explains. “That’s why it’s not sufficient to simply try to treat the addiction.”
Maté now spends his time writing and focusing on advocacy through his website, Compassion4Addiction.org, to encourage approaches to treating addiction that emphasize compassion and understanding the root cause of the compulsive need to use within each addict. Medical schools still neglect to teach future doctors that drug and alcohol abusers should not be treated with shame, he says, but rather as patients who are dealing with a set of poor life circumstances by self-medicating in the wrong ways. “They are doing what they need to survive,” Maté says, which is why some may need to remain on their drug of choice or a safer alternative, like methadone, until they work through their trauma in a therapeutic setting.
Other treatments, he says, such as a supervised nutrition and exercise program, can help addicts develop new brain circuits that support a healthy, sober lifestyle, and work as powerful additions to the emotional support they get through therapy. “Once we acknowledge that addiction is not an inherited disease — that we’re not genetically wired to become addicts — we can provide the conditions needed to help people overcome their conditions, since the brain is neuroplastic and can change with new habits,” explains Maté.
These views are, however, aren’t widely accepted in the field of addiction treatment, nor are they validated by randomized treatment trials since Maté hasn’t conducted his treatment in a research setting. His critics claim, too, that he places too much emphasis on childhood trauma. “Maté is fundamentally proposing a reductionist vision of addiction, where abuse history and posited biochemical changes are now THE essential causes of people’s self-destructive action,” wrote psychologist and addiction specialist Stanton Peele in a widely read article on PsychologyToday.com. “It is not enough to say that this model is highly conjectural. It also isn’t true — that is, it makes little sense of the data.”
The Kaiser study, continued Peele, found that even in those people who had four or more adverse childhood experiences, only 3.5% went on to use injected drugs, which is similar to the estimated rate in the U.S. population. What’s more, Maté doesn’t account for “people’s natural tendency to overcome abuse and addictive experiences,” Peele wrote. Three-quarters of people who were dependent on alcohol at some point in their lives are able to quit drinking, often without a formalized treatment program, according to a study funded by the National Institute on Alcohol Abuse and Alcoholism. But Peele concedes that Maté “directs the focus for addiction in the right direction — away from the addictive object and towards the experience of the individual.”
For his part, Maté believes his approach has a strong foundation in genetic discoveries showing that when it comes to health, even more important than the genes we inherit are life circumstances that determine how those genes are expressed. “Even if you’re born with a genetic predisposition to addiction,” he notes, “those genes won’t necessarily be expressed if you were raised in a nurturing home.” Regardless of how much life experience factors into setting the stage for an addiction, views like Maté’s may encourage others to treat addicts with more compassion and less blame, which most experts agree, will likely help them on their road to recovery.