In the Realm of Hungry Ghosts: Close Encounters with Addiction

"It’s a great book. Gabor Maté was a baby when his mother was stranded in the Budapest Ghetto at the height of the Holocaust. She didn’t know it, but her parents had just been murdered in Auschwitz and she was convinced that the Nazis were going to come and kill her and her baby. One day she saw a Christian stranger in the ghetto and she handed her baby to him and said, ‘Please take my baby because I’m going to die here and I want my baby to survive,’ and the stranger did take her baby. Gabor ended up, many years later, in Downtown Eastside in Vancouver as a doctor. This is a place notorious for having the worst concentration of drug addicts in North America, and Gabor was working with homeless, hardcore street addicts. He wanted to pioneer an approach where you talk to addicts and listen to them, which no one had ever tried to do, at least with this group. What Gabor noticed, when he talked about their lives, is that they had all had horrific childhoods. Either sexual abuse or extreme physical abuse or neglect. He began to wonder about this. At the same time, he noticed he was having this addictive impulse that he couldn’t control. He would abandon women in the middle of delivering babies, or his children in public places, and just go out and obsessively buy CDs that he wouldn’t even listen to. He would just obsessively spend, he didn’t understand it, and Gabor started to look into the role that childhood trauma can play in adult addiction. He found something called the “Adverse Childhood Experiences Study” which had been conducted by the Center for Disease Control, the US public health body. In it, he discovered something extraordinary. It looked at ten categories of traumatic experience that can happen to a child, and how they correlate with adult addiction. It turns out that for every traumatic category of experience that happens to a child, they are two to four times more likely to grow up to be an injecting drug user. If you had had six of those traumatic categories of experience, you were 4,600% more likely to become an adult addict. It’s mind-blowing, and, of course, Gabor began to think about this in relation to himself. He’d obviously had this traumatic childhood, and that was partly why he had these problems. It also helped to explain the people around him. There’s a psychoanalyst here in London called Sue Gerhardt who wrote a very good book called Why Love Matters , and she gives a partial explanation for this. When we’re babies, we internalise the way that our caregivers treat us. When you were upset, your caregiver reassured you and calmed you down. Over time, you learned to calm yourself and reassure yourself. If, when you were upset, your caregiver was angry or hostile, you will respond to your own upset by being angry or hostile, and, as you get older, you will be more likely to need external soothers, which may be drugs, or may be other things. Gabor, who I interviewed a lot, is friends with Bruce Alexander. At first I thought these were contradictory theories, that childhood trauma and isolation is different. But actually I think they’re connected, and Gabor says this as well. If you have a very traumatic childhood, it’s harder to trust the world, it’s harder to believe the world will treat you well. You are more likely to grow up to be isolated and disconnected, and therefore you’re more likely to be like the rats in the first rat cage, and less like the rats in Rat Park. I think Bruce and Gabor’s books together really help us to understand how this issue needs to be reframed and thought about very differently. For the 90% of drug users who are not harmed by their drug use, even according to the UN, they should have liberty. I personally don’t use any drugs, I haven’t for years, I don’t ever want to use them again. I occasionally drink a glass of wine, that’s it, and even that, very rarely, although I do drink industrial quantities of caffeine. But it’s not for me to tell you what’s good for you. If you’re not harming anyone else, and you’re not harming yourself, that’s fine by me, crucially as an adult, of course. If you are harming yourself and you are in a terrible state, as addicts are, clearly that’s a different matter. Most addicts feel an internal conflict. There’s a big part of them that wants help and wants to stop. For those people I would certainly advocate — I’d be wary of using the word ‘therapeutic,’ solely for one reason which is that the direction we have tended to go in when we talk about therapy of addicts is a very narrow model of residential rehab. I’m not against residential rehab, but we have to be honest. The results have been appalling. They have extremely poor success rates, because not all, but many, residential rehabs are based on the wrong theory of addiction. What they do is the equivalent of taking the rat out of the first cage, putting it into Rat Park for a while, and then putting it back into that first cage. Unsurprisingly, it fails. I think the rehab industry needs to be challenged and changed in all sorts of ways, although there are many people in it doing good and valuable work. Rather than rehab, I would focus on reconnection. I would talk much more about what they do in Portugal, which is about connecting people with sources of meaning, and turning their lives around, rather than a model that’s just about physically separating people from the drug for a while, and then putting them back into a disastrous, addictogenic environment. The evidence is clear: A system based on stigma and punishment and hatred doesn’t work. A system based on compassion and care and love does work. It turns people’s lives around. So now we have a choice. Do we want to have another century of charging off in the wrong direction? Or do we want to listen to the countries where they are trying the new approach, and it is having amazing results?"