The Rebel Doctor
Meet Gabor Maté, a doctor who works with North America’s only supervised injection site and believes that addicts are some of the happiest people he knows.
In the field of addiction, Hungarian-born Gabor Maté is known for his controversial and revolutionary theories on the sources of addiction and how addicts should be treated. And he knows of what he speaks: in the early 2000s, Maté joined the Portland Hotel Society (PHS), a clinic for Vancouver’s homeless and drug addicted, and he followed that by working with Insite—the only supervised injection site in North America. In his so-called spare time, the Canadian doctor has written best-selling books on parenting, stress, and ADD. 2011 saw the release of In The Realm of Hungry Ghosts, his much-acclaimed treatise on the way addiction begins in childhood.
Dr. Maté spoke with The Fix about his views on how addiction arises and the best ways to treat it.
How did you get into addiction therapy?
I worked in family practice for over 20 years and in palliative care for seven, which is when I became interested in childhood mental health issues and finally I went into addiction work. It’s impossible to be in family practice and not run across some addiction. Early on in my career I had worked in downtown Vancouver [notorious for its drug use and homelessness] and I knew I would go back.
What was your role at the Portland Hotel Society?
I was on the on-staff physician there for 12 years—the first full-time physician they had ever had. It is a highly concentrated area of drug use and some of our clients were highly addicted. These are people who are at the extreme end of the addictive spectrum: they are dependent on meth, cocaine, heroin, cigarettes and alcohol and as a result, they suffer from many physical problems: HIV, Hepatitis C, joint infections, and abscesses. And of course they have mental health issues as well.
At the very heart of addiction is the deep absence of self-esteem, which is caused by stress to the traumatized child.
What was your experience at Insite?
People are allowed to bring their illicit drugs and, under supervised conditions, are given clean water and clean needles to use to inject. Nurses are on site to help so people will be resuscitated should they overdose. The immediate purpose of Insite is to eliminate the disease transmission from one addict to the next and to reduce the rate of infection. When you think about it, it’s straightforward. It’s better for people to inject with clean water rather than dirty water from a back alley. But beyond that, our intention is to treat people like human beings and, for many, this is a new experience.
What have you learned about addiction from those experiences?
First of all, I’ve come to learn that nature has very little to do with addiction. There are certain genes that may predispose to certain addictions but if the person is treated well, those genes have no impact on their behavior. Addiction runs in families because the same conditions are recreated from one generation to the next. So you need to look at people’s lives, not their hereditary. If you look at why addicts are soothing themselves through chemicals, you have to look at why they have discomfort and you will see that they have all experienced childhood adversity—the pain and distress that they needed to escape.
And from that end, what do you see as the role of stress and trauma in addiction?
Once you’re traumatized as a child, you will continue to be traumatized as an adult [until you get help] because you will not have the emotional balance necessary to heal the trauma. Women who were abused as children will seek out abusive partners. And society plays its part in that, too. Even though we live in a highly addicted society, it is only the substance addicts that are criminalized and ostracized. People who are addicted to, say, cigarettes—or even power—are considered okay. But if someone is addicted to heroin, that person will be further stressed by the criminal system and the medical system, neither of which have much understanding or compassion for addiction.
Why is the War on Drugs a failure and how can we really solve the drug epidemic?
The War on Drugs is an utter failure only if we accept that its fundamental intention is the elimination of addiction and of drug trafficking. But from another perspective, it may not be a failure at all. Is the war in Iraq a failure? Not for the companies that make billions of dollars of profit on it, not for the military who make billions of dollars, or the contractors or politicians. The War on Drugs has been a failure from the position of its stated aims. But is it a failure? Not from the point of view of the police apparatus, not from the perspective of the big drug dealers who are in cahoots with government agencies around the world, nor from those who profit from the increasingly privatized jail system, nor those who supply jails, and so on.
You seem to have a very humanistic view on addiction. Why do you think that is?
First you have to understand that the source of addiction is in the human himself. Then you think: how do you help someone who is pain? First by acknowledging their suffering and validating their attempt to escape from their pain, then by helping them not suffer so that they don’t have to rely on the drugs. It takes a whole different perspective. Resources that are used to incarcerate people would have to be used to help people to rewire their brains in healthy ways—through access to food, safe housing, good counseling, and employment skills: those things addicts that don’t have and have no way of getting under the current system. At the very heart of addiction is the deep absence of self-esteem, which is caused by stress to the traumatized child. Addicts believe that if all these negative things happen to them, there must be something wrong with them. When they are punished and attacked and criticized further, it hardens that deep sense of self-loathing.
How, then, do addicts get themselves out of that cycle? Is there room for free will in recovery from addiction?
Is there free will? When you think about it, there is no absolute free will because let’s say that you and Donald Trump both have the freedom to fly a private jet. You have the freedom but he has the ability. The same thing is true psychologically. Donald Trump might be free to have a spiritually validated life but he might not be able. He needs the accouterments, and riches and power, and that has to do with psychic factors that he has no control of. Free will implies consciousness. For addicts, their behaviors are very unconscious. The safer people feel and the more accepted they feel, the more they feel connected to others. The more defensive they are, the more reactive they are. You can give them the conditions where they can develop free will. Very few people have absolute free will because very few people have absolute consciousness—the addicts least of all, and that includes the power addict.
What do you think of 12-step programs?
The principles of the 12 steps are essential: the recognition of the powerlessness over addiction. You gain power and end your denial by acknowledging your powerlessness. The Higher Power concept is difficult for some people but it is really just saying that there’s something higher than the egoic personality. Spiritual emptiness is addressed by that acknowledgement of a Higher Power and then, of course, that’s repeated through the moral inventory of your behaviors and their effects on other people. My only issue [with 12-step programs] is that they never address the original cause of the addiction—the childhood trauma—which I think keeps people in a stuck place. That is not a rejection of the 12 steps—just a suggestion that they could be deepened. For people that had religion pushed down their throats or were abused by religion, there are programs like LifeRing, which is a [secular] 5-step program.
Do you think addicts can be as happy as non-addicts once they find recovery?
Some of the happiest people I know are in recovery: they serve others, they develop self-esteem, and they connect to something larger than themselves. They are often happier than people who have never been addicted because they are dealing with stuff that other people have never had to deal with.
Kristen McGuiness is a freelance writer and regular contributor to The Fix who wrote previously about old timers in AA and sober travel, among other topics. She is the author of 51/50: The Magical Adventures of a Single Life.