BEYOND DRUGS: The Universal Experience of Addiction

With the carnage imposed by the current epidemic of opioids and associated overdoses across North America–many dozens of people dying every day– public alarm around addiction is focused almost exclusively on drugs. For all the anguish around substance dependence, addiction cuts a much broader swath across our culture. Most addicted people use no drugs at all and addiction cannot be understood if we restrict our vision of it to substances, legal or illicit.

Addiction is manifested in any behavior that a person craves, finds temporary relief or pleasure in but suffers negative consequences as a result of, and yet has difficulty giving up. In brief: craving, relief, pleasure, suffering, impaired control. Note that this definition is not restricted to drugs but could encompass almost any human behavior, from sex to eating to shopping to gambling to extreme sports to TV to compulsive internet use: the list is endless.

“I’m not going to ask you what you were addicted to,” I often say to people, “nor when, nor for how long. Only, whatever your addictive focus, what did it offer you? What did you like about it? What, in the short term, did it give you that you craved or liked so much?” And universally, the answers are: “It helped me escape emotional pain… helped me deal with stress… gave me peace of mind… a sense of connection with others… a sense of control.”

Such answers illuminate that the addiction is neither a choice nor a disease, but originates in a human being’s desperate attempt to solve a problem: the problem of emotional pain, of overwhelming stress, of lost connection, of loss of control, of a deep discomfort with the self. In short, it is a forlorn attempt to solve the problem of human pain. Hence my mantra: “The question is not why the addiction, but why the pain.”

And the source of pain is always and invariably to be found in a person’s lived experience, beginning with childhood. Childhood trauma is the template for addiction—any addiction. All addictions are attempts to escape the deep pain of the hurt child, attempts temporarily soothing but ultimately futile. This is no less true of the socially successful workaholic, such as I have been, than of the inveterate shopper, sexual rover, gambler, abject street-bound substance user or stay-at-home mom and user of opioids.

Not only is the urge to escape pain shared by all addicts, substance users or not, the same brain circuits are involved in all addictions, from shopping to eating to dependence on heroin and other opioids. The same brain circuits, the same brain systems involving pleasure and reward and incentive, the same neurochemicals—not to mention the same emotional dynamics of shame and lack of self-worth, and the same behaviors of denial and dishonesty and subterfuge.

It is time to realize, then, addiction is neither a choice nor an inherited disease, but a psychological and physiological response to painful life experiences. It can take many forms, but whatever form it takes:
• it employs the same neurological pathways and emotional patterns;
• the damage it does extends well beyond the suffering imposed by drug use specifically;
• to ostracize the drug addict as somehow different from the rest of us is arrogant and arbitrary;
• to criminalize certain substances, say heroin, while allowing the profitable distribution of more deadly products such as cigarettes is irrational and harmful—yes, though it may be a startling assertion it is medically a simple fact: heroin use, short of overdose, is far less lethal than cigarette smoke;
• to treat the addiction, which is a symptom, without treating the pain that underlies it is to deal in effects rather than in causes, and therefore dooms many to ongoing cycles of suffering.

Finally, a word about childhood trauma and its relation to addiction and the use of opioids. When people see this word, they often— perhaps naturally—assume that we are speaking of terrible events, such as abuse, sexual exploitation, the death of parents, violence in the home, and so on. And surely, as the research abundantly shows, the more such experiences a child has to endure, the exponentially greater his or her risk of addiction. But trauma is not restricted to horrific experiences. It refers to any set of events that, over time, impose more pain on the child than his or her sensitive organism can process and discharge. Therefore, trauma can occur not only when bad things happen, but also when the parents are too stressed, too distracted, too depressed, to beset by economic worry, too isolated, etc. to respond to a sensitive child’s emotional need to be seen, emotionally held, heard, validated, made to feel secure. Such is the reality behind many a story of “happy childhood.” In fact, the denial of one’s pain, the splitting off of distress from conscious memory, is one of the outcomes of trauma.

As the astute trauma pioneer Peter Levine has written, “Trauma has become so commonplace, that most people don’t even recognize its presence.”

Not all traumatized people become addicted, but all addicted people, including those addiction to opioids, were traumatized in some way. That is the reality of our culture, where addiction, like trauma, is so commonplace that most people also don’t recognize its presence. Yet it surrounds us, engulfs so many of us, that our near-exclusive focus on the troubles of drug addiction is itself but another escape from reality.

  • Aro Barral
    April 5, 2017 at 4:37 PM

    My husband is a sex addict and marijuana addict. He is also psychologically abusive. The therapy he has had has coddled him to the point of tremendous ego inflation. There is no understanding of the abuse dynamic. Therapists tend to conflate addiction and abuse, thinking that as the addiction subsides, the abuse will as well. It takes a lot of effort to keep a deceptive, compartmentalized reality a secret from your family. It takes a tremendous amount of work to dehumanize your wife in order to justify all of the escorts and pornography indulgences. The horror of worrying if my children would get diseases like hepatitis, that live on surfaces weren’t as important as him “having time before he decided to disclose his level of activity.” I appreciate that addicts need connection. All people need connection. We do need to speak about the havoc and sometimes the terror that addictive behaviour rains down on partners and children. My husband and I are separated now. I will always care for him somewhere, but I am not willing to be used and abused any more. I often wonder, if he had access to treatment that was more than an attempt at coddling and treatment that didn’t pathologize/scapegoat his wife, if he would have stepped up to the challenge. Addiction therapists should be trained on identifying abusers and have the capacity name the behaviour. Not hide in under the label of “addiction” Sex addiction is partner abuse and contributes to human trafficking. There would be lot to be gained by having treatment programs that address cause and help the people that the addict is traumatizing/objectifying…partners, sex workers and porn actors.

    • Silvia
      April 6, 2017 at 1:33 AM

      I had and have similar experience.
      With 2 children and their father, no longer husband, involved with severe form of addiction: sex, crystal meth and mostly alcohol. I went to court several times and social workers, lawyers and all therapists involved never understood the behaviour of the addict, but only made life more sad for me and children, and their father.
      Even friends are supporter of addiction, especially if involves pleasures like having drinks, that they are not open to give up and don’t understand why you ask to help.
      Alcohol being legal in almost all the world is tolerated. It took 3 years to have a wise judge to prescribe sobriety of the father at least when with the children.
      The father’s abusiviness against me, doubled, even though I saved his life, send him to rehab, and took him to therapist that reassure that everything was fine once he finished using crystal meth.
      This man has been suffering child abuses, neglection, and had uncaring parents to meet his emotional development. The same traits I saw in most of the people I saw at AA or NA.

      I live by reminding myself that my role as a parent towards children is the most beautiful and challenging job and responsibility I have. All parents should take parenting as the great job, task they have. Not the other way around. Responsabile towards our young ones and their emotional development is the key to break this chain of suffering.

      I thank you Gabor Mate for your work, your understanding and for seeing things so clearly, and advocate the cause.

  • Margie
    April 5, 2017 at 4:50 PM

    I read this from two separate yet connected perspectives.

    One from the
    place of a child that did experience trauma and is still attempting to work through that at the age of 51. And also from the place of a mother that worries about any hurts I have passed on to my 3 children all of whom are in their 20’s now.

    How can I learn to forgive both my now deceased parents and also myself for any unintentional hurt my children may have experienced? I carry regret and sadness for both my inner child and my own children.

    Seems we have so many things to still learn with regard to addiction.

    Thank you Dr Mate for the work you do. You truly speak to me.

    Margie N

    • Marg
      April 5, 2017 at 9:12 PM

      You might want to check out
      http://www.innerbonding.com for a real answer to what ‘work’ we can start on to learn. I’m 70 and YES I still have so much to learn. Just pleased that I have found innerbonding.com and Dr. Margaret Paul’s courses. The responsibility is ours and part of the lesson Margaret teaches is to accept that responsibility.

  • CM
    April 5, 2017 at 5:14 PM

    Awesome read, thank you for your insight!

  • Denise costa
    April 5, 2017 at 5:16 PM

    Sugiro que faças publicações em português ou Espanhol.
    abraços

  • Mark T
    April 5, 2017 at 5:28 PM

    Completely and utterly agree- thank you Dr Mate

  • Josh
    April 5, 2017 at 5:36 PM

    Can I not share blog posts on social media?

  • Jacqueline Ayers
    April 5, 2017 at 5:49 PM

    🙌🏼🙌🏼🙌🏼🙌🏼 THANKYOU!! I’m a nobody but been trying to make ppl understand this for almost 20 years!! ( and no , I have no wonderful big degrees to me it’s common sense , but people in the United States apparently lack common sense which is where I live it’s about time this gets understood! If I die today I’ll be a happy women because you’ve just validated a point nobody could ever understand! ✌🏼✌🏼✌🏼

  • Rossella Biagini
    April 5, 2017 at 6:01 PM

    Thanks …l share every word of this article. My son is addicted on whatever may stop his pain. He has been in a russian orphanage for 5 years. He says”at the end l don’t like drugs ,l want to harm myself “. Nobody understands that…more they are trying to treat the addiction,or even worse trying to treat “his borderline disorder” with psychiatric drugs,more he gets addicted.

  • Julie jackson
    April 5, 2017 at 6:32 PM

    I so enjoy your teachings, you have given me the strength and compassion to help my herowin addicted son stay clean for more than a year now. My son went cold turkey not so much by choice but necessity while sitting with his dying father. His dad was the director of the Port of Miami. He never had time for his kids and never accepted his son with ADD. He humiliated him endlessly, claiming he was just lazy. It was very hard on him, on us.My son felt like a truck was lifted from his chest the day his dad died.They loved each other but there was always conflict between them. Thank you for helping us both see, we/he can now confront his demons THE PAIN.

  • Sian Pugh
    April 5, 2017 at 6:33 PM

    I love reading or listening to anything you have to say on this topic! I read ‘In The Realm of Hungry Ghosts’ after my first stay in a rehab facility in 2009. I’ve been to 3 others since, but am happy to say that the last one I went to from December ’16 to February ’17 where I was able to speak to a psychotherapist every day has been the most successful. For the first time in over 6 years I’ve stayed sober for more than 4 months! Thank you so much for the great work you do!

  • Zanzara K. Fortune
    April 5, 2017 at 6:38 PM

    God forgive any of us who have judged others for something that is not their fault. May all beings be blessed.

  • Toni Hayward
    April 5, 2017 at 7:24 PM

    Dr. Mate..you do so much to bring the understanding of addiction to people. I was an addict at a very young age. I was able to get away and quit..and I thought it was as simple as will power.. After reading In The Realm of Hungry Ghosts,( crying my heart out by the second page for those poor souls that suffered so much more than I did)I realise now that it is not.Thank you for all that you do to bring this knowledge to us. I really wish,for the sake of addicts and the people that love them that the government would listen to you.. Bless you, <3

  • Annette
    April 5, 2017 at 11:39 PM

    Excellent read … also very grateful for your books. Thank you for helping me truly understand people do the best I can with what they have at that time …I that I have truly learned to forgive parent, myself, my partners, my poor choices, forever in gratitude, annette❤️

  • Agnes
    April 11, 2017 at 12:32 PM

    Dr. Mate: Thank you for your deep understanding & compassion for those who suffer…..On any level. I am not a drug addict; but a child of CEN (Childhood Emotional Neglect)…I hardly EVER felt heard – and if I did speak up, I was ‘chastised’ or humiliated in front of the rest of my immediate family! The pain/shame I grew up with has taken me the ‘better part’ of 60 yrs. to ‘grow up’ & learn that it is ok to ‘feel my feelings’ – tho they may not always be pleasant~I am a child of Hungarian immigrant family who escaped in ’56 and my parents were ‘constantly’ working like dogs; and yet, I still felt very deprived of so much. Am learning to ‘heal the little girl within who didn’t get what she really needed….pure & simple attention/love….from the very people who ‘made her’…Am learning to LOVE that little girl/protect her…

    • Emma Perry
      April 29, 2017 at 5:04 PM

      Dr Mate is so in tune with the subject of addiction that I do not understand why it is taking so long for the authorities (particularly in the UK) to change policies in the treatmentsmall available. I’ve been fortunate to be able to read both Hungry Ghosts and When the body says No and treat myself. I’ve come such a long way learning about me that I have nothing but admiration for Dr M.

  • Clara Caceres Contreras
    April 28, 2017 at 3:46 PM

    Dr Gabor Mate

    Thank you for sharing your thoughts and the courage to say what needs to be said with regards to addiction. It is much easier to say addiction is genetic or a disease. It leaves us off the hook to examine and “learn” to seek to understand and reflect with compassion. I like your compassionate way of explaining addiction and the all encompassing way of including other behaviors we normalize or rationalize to survive! You never know how many people you have touched and provided hope for healing!!! Thank you for your personal disclosure and your candid engagement with your audience.
    Respectfully, one of your many followers…

  • Magi
    April 28, 2017 at 4:42 PM

    thank you for being the Voice of Wisdom on addiction … deeply appreciate your loving presence on the planet … Blessed Be

  • Vivian A. Guglietti
    April 28, 2017 at 5:29 PM

    what a miracle worker and saint you are for us affected Dr Mate!!

  • Khumanthem Churchil
    May 14, 2017 at 2:19 AM

    I am from Manipur, a small state of northeast India. I m a very interested person in epigenetics and ‌‌neuroplasticity. I was a heroin addict year ago. I like your speech. I want your advice about how to overcome post acute withdrawal.

  • Karen King
    July 3, 2017 at 11:49 AM

    I would like your opinion about The Sinclair Method with Naltrexone for alcohol use disorder. My son, 29 has been on an addictive cycle to pot and alcohol since he was a young teenager. Traumas in his life include difficulty with school and ADHD, his father and my divorce when he was 11 and his father’s cancer death when he was 20. He has been arrested twice when drunk ( while in a day rehab program and counselling) and he says that if he tries to stop drinking for several days, he feels he can have a drink or two to deal with the cravings and he relapses. The guilt and shame then draws him into a spiral. Is there a rehab program for alcohol that you would recommend?

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