Dr. Gabor Maté on the Trauma Underlying the Stigma of Addiction: An Interview

By John Lavitt 12/12/17

There are legitimate uses of opioids in the treatment of physical pain. There is no legitimate use in the treatment of emotional pain.

Gabor Maté

Part 1 of a 2 part interview.

The Fix: In your book, In the Realm of Hungry Ghosts, you write, “We create meanings from our unconscious interpretation of early events, and then we forge our present experiences from the meaning we’ve created. Unwittingly, we write the story of our future from narratives based on the past.”

You explain how childhood trauma leads to the creation of a harmful personal mythology where the resulting meaning of that mythology becomes a weapon of the addicted person’s own self-destruction. How can a person escape such a self-defeating prophecy? Once ingrained, how hard is it to fully overcome such a storyline?

Dr. Gabor Maté: The impact of childhood adversity is to give a person a distorted and negative view of the world and of themselves. By nature, we are born into the world expecting to be nurtured and loved and supported, understood and seen and heard because that’s how human beings evolved. In fact, that’s how any mammal evolved. When that doesn’t happen, when we’re hurt for whatever reason, when we’re simply not seen or understood or nurtured emotionally in the way that we need, then we immediately come to believe, and this belief becomes ingrained in our psyches, that’s there’s something wrong with us. We believe we should be ashamed of who we actually are, and that’s because children take everything personally.

Children are narcissists, not in a negative sense, but in the developmental sense that they think it’s all about them. When things don’t go well, they develop a deficient sense of themselves. They also develop a view of the world that is rather fearful in which they have to hide or defend themselves or run or escape how they feel. All of that is the basis of addiction.

However, it’s not human nature to develop in that manner. Human nature is to be connected and loving, open and social, and compassionate. Not being able to be true to our nature is one of the reasons why we suffer. That true nature is still working for us and is still inside us. The very suffering itself helps to wake us up. That very suffering helps to guide us in the right direction if we are open to receiving the guidance.

In the addiction movement, people talk about recovery. What does it mean to recover something — it means to find it. When you recover something, you get it back. In other words, what we get back is ourselves. That self is never actually lost. If we can identify how we lost the way and how we “lost” ourselves, we can find a way back to ourselves, which is the essence of all healing.

When commenting on the neurobiology of addiction, you write how, “addiction is related psychologically, in terms of both emotional pain relief and neurobiological development, to early adversity.”

If the neurobiological development of a child is affected by trauma, how can such physical changes set in place long ago be reversed? Is it possible for an adult to “renew” their brain, and if so, how long would such a process of renewal take? What tools would be required?

When we do brain scans on adult addicts, you see several neural systems that just don’t work very well, including the opiate pain relief, pleasure, reward, attachment, and love circuitry. Other problematic systems include the stress regulation circuitry, the impulse regulation circuitry, and especially the dopamine-driven incentive motivation circuitry. As a result, doctors often conclude that because these brain circuits aren’t working well, there has to be a brain disease and that addiction is that disease.

The actual truth is that these circuitries are shaped by early experience. From countless studies and from the overall consensus in brain developmental science today, we know these essential brain circuits develop through the interaction of genetics and experiences. Experiences turn genes on and off. What we are seeing in the adult is not the result of some inborn genetic disorder, but the result of childhood experience. That’s the first point.

The second point is that addictive behaviors, particularly substance use disorder, further distorts the structure of the brain. Certain neural changes can be seen in the majority of substance addicts. The longer they use, the more significant those changes are. However, the brain also has a remarkable capacity to change, which is called neuroplasticity. Neuroplasticity is the brain’s innate ability to develop new circuits, even later on in life, in response to new experiences.

With any developmental question, it’s a matter of what conditions do you provide. If you are growing plants, you have to set the right condition for the plants to blossom. This is the same for any organic creature. Whether in childhood or adulthood, the healthy development or the healthy redevelopment requires the right conditions. From the outside, those conditions include a compassionate environment where you are seen and understood and not unduly criticized, attacked, stigmatized, or criminalized. It also includes, of course, nutrition. It includes contact with nature. It includes getting real help to process the childhood difficulties, adversities, and traumas that influenced your development in negative ways. It also involves mindful awareness practices that help to develop new circuits in the brain.

In other words, in response to this comprehensive question, it takes time to heal. The longer you have been addicted, the longer you used, the longer it may take, but it’s entirely possible. Indeed, the brain can change in positive ways at almost any age.

You have written that “The difference between passion and addiction is that between a divine spark and a flame that incinerates… Passion creates, addiction consumes.”

Can you explain this distinction in the context of being a workaholic? How about when drug abuse is connected to the desire to work harder, be more productive, and keep pace in the rat race? Isn’t it possible for passion without healthy boundaries, even a passion for something perceived as being healthy or positive, to also destructively consume?

The difference between a passion and an addiction is very simple. A passion is something that you love, that excites you and makes you feel alive, but it doesn’t control you. In most cases, it doesn’t cause negative consequences. If it causes negative consequences and you still continue, then you are a slave to it and that means you are an addict. Healthy passion is an expression of vitality and energy and beauty. In contrast, an addiction always carries negative consequences. From the outside, you cannot necessarily tell whether someone’s being passionate or someone’s being addicted because they could be pursuing the same behavior. One could be doing it because there is a hole in their soul that they’re trying to fill while the other might be doing it out of sheer love and commitment. It’s the internal impact that tells you whether it’s constructive or destructive, whether it’s passion or addiction.

Regarding work, many people do use drugs, particularly stimulants, as a way of working harder and getting ahead in the rat race. It may help them achieve success in the external sense of the word, but ultimately it will play havoc with their spiritual life, with their physical and mental health, and with their relationships. What you have is one addiction supporting another, and that’s a dangerous combination. You have the substance dependence supporting the work addiction.

My definition of addiction is any behavior that a person finds pleasure or relief in and craves, but suffers negative consequences and can’t give up. You can do work to support yourself and create something and make a legitimate contribution to the world, but such intentions and actions can be polluted by a deficient sense of self. If you have to do the work in order to feel okay about yourself and validate yourself, then it becomes an addiction. If you are doing the work to chase other people’s approval to bolster your self-esteem, if any and all success is about filling that hole inside, ultimately, it’s going to become an addiction, sabotaging even the good aspects of what you’re doing.

At the same time, you might become very successful by taking this path, and we see many people in the world that fall into this category. However, they tend to do a lot of damage to other people because of the addictive root that lies behind their actions. The distinction that needs to be made is not whether you are working hard, but who’s working hard; which part of you is working hard and for what internal reason? Ultimately, how much genuine authority do you have over what you do or are you driven to do it?

When writing In the Realm of Hungry Ghosts, you wondered why, “We readily feel for the suffering child, but cannot see the child in the adult who, his soul fragmented and isolated, hustles for survival a few blocks away from where we shop or work.”

From a macrocosmic or bigger perspective of overcoming the societal stigma in regards to the disease of addiction, this makes sense because the negative perception of the person with addiction allows for ostracism and prevents treatment. By humanizing people with substance use disorders, we build compassion and allow help to be provided and funded. However, isn’t seeing the suffering child in the person with addiction potentially harmful in the smaller perspective, or microcosm of the context of families and loved ones? Given the dangers that go hand-in-hand with addiction like theft and emotional abuse, shouldn’t the family be wary of such behavior? In reality, shouldn’t they actively resist the codependent desire to enable the adult addict who manipulates by playing the game of the suffering child?

Yes, John, and those are important distinctions that you are raising in that question. First of all, it’s not a question of humanizing the addict. People often tell me that they are so grateful because my work humanizes the addict. My response is, “No, I don’t humanize the addict because the addict is a human being.”

The very activity of addiction itself is a very human activity. No matter what the addiction, when you ask people what they are getting from it, they tend to repeat the same things over and over again: “I get distraction from stress. I get comfort. I get a sense of power. I get companionship. I get a warm feeling inside. I get peace of mind.”

Temporarily, of course. It’s the nature of addiction that it gives these things temporarily and then causes negative consequences. Whether it’s the sex addict looking for love or the food addict looking to ease emotional discomfort or the opioid addict looking for emotional pain relief, these are all human qualities that we all want. This wanting of love or emotional relief or connection or stress relief are what we all ultimately want. They are all human qualities that are universally desired, and this is why addiction is a very human activity.

The real question is what happened to deprive us of these qualities in the first place. The answer, of course, lies with the suffering child. The childhood suffering that people undergo is what separates us from these human qualities. As a result, it is important to see this suffering child in every adult that is caught up in an addictive pattern. I don’t care what the behavior is – gambling, sex, shopping, eating, drugs – it doesn’t matter. The suffering child is behind the addictive behaviors, so the suffering child needs to be seen.

However, just because we see and recognize the suffering child, this act does not absolve the adult addict from the damage they have caused. It doesn’t mean that we absolve them and behave permissively. Having compassion and an awareness of trauma is not the same as being permissive. If a family is suffering because an addicted loved one lies to them and steals from them, then I advise them that they have a decision to make. They can tell the addict in the family:

“Look, we love you very much, and we understand that this addiction that you are pursuing is an expression of your pain and is a desperate attempt to help yourself feel better temporarily, but we cannot support you stealing from us and lying to us all the time. We can’t live that way. We want to stay connected with you, but we cannot permit such abuses. If you are unable to stop taking these harmful actions against us, then we have to sever contact with you.”

That’s a legitimate thing to say. It’s not just a question of drawing a boundary, but rather it’s a deeper understanding of how do we draw that boundary with compassion while ensuring the safety of the family as a whole. We do not draw that boundary in a punitive or vindictive way. Even such a boundary needs to be drawn compassionately. Also, how do we maintain the lines of communication? How do we convey that we are still there for this person emotionally?

The best thing for family to do is to look deeper and see that the addiction in one person reflects trauma and distress and suffering in the multigenerational family. The addict is manifesting in a very clear way what is also manifested in every other member of the family as well. One member’s addiction often becomes an opportunity for the whole family to heal. Rather than put all the pressure on the addict that they have to heal and get better, you emphasize the healing of the whole family. Recovery always is more effective when the whole family can heal in conjunction with the addicted member of the family. We all have to look at ourselves. We all have to compassionately consider how our family has carried forward suffering for generations.

In "BEYOND DRUGS: The Universal Experience of Addiction," you quote trauma pioneer Peter Levine, “Trauma has become so commonplace, that most people don’t even recognize its presence.”

Do you believe that the widespread experience of trauma is behind this current opioid epidemic? Given the warm bubble of pleasure that opioid use brings about where a user barely can be touched by anything outside the addictive cycle, did prescription painkillers and heroin become the easy choice for a wounded generation? Lacking awareness of their trauma and access to treatment options, did opioids become the most straightforward available option to medicate the experience of latent pain?

“Yes,” is the only answer to the first point about opioids. They are pain relievers, and they happen to be the most powerful pain relievers that we have. They not only relieve physical pain; they also relieve emotional pain in the brain. Opiate use always has to do with both physical pain and emotional pain. When you give opioids to people who only need them for physical pain, they don’t become addicted.

The myth that the opioids create the addiction is wrong; it’s the pain that creates the addiction combined with access to the opioids. There are legitimate uses of opioids in the treatment of physical pain. There is no legitimate use in the treatment of emotional pain. The opioid epidemic represents an epidemic of emotional pain that is rooted in the childhood experience of trauma. Such emotional pain is coupled with a troubled society where disconnection, isolation, and increasing amounts of stress have become commonplace. For example, we know that for every percentage point in the increase of the unemployment rate, there is a corresponding increase in opioid use. It’s a question of a very stressed society where people are seeking escape.

Another key factor in the opioid epidemic is the under-education and inadequacy of the medical profession when it comes to learning how to deal with pain. We don’t teach or learn about the complexity of pain. We don’t explain how physical pain is often a result of a combination of both physical and emotional factors. We don’t learn how to speak to people with pain and how to listen to them. We don’t learn about the roots of chronic physical pain and chronic emotional pain that often lies in childhood experience. We don’t learn about non-pharmacological ways of treating pain. Therefore, it’s much easier and much quicker, and it’s an awful lot cheaper just to write an opioid prescription and move on to your next patient. All of these other modalities would take more time. Combined with a troubled society and an epidemic of emotional pain caused by unresolved trauma, such medical inadequacy was nothing less than a recipe for such an epidemic. When you consider all of these factors, the opioid epidemic is not that surprising, but the loss of human life remains tragic and so unnecessary. There are ways to break these cycles.

Click here for the second part of this interview, in which Dr. Gabor Maté takes on some of the bigger macrocosmic issues facing the United States as a whole, including the trauma-plagued presidency of Donald Trump as well as the damaging influence of traumaphobia in American institutions.

Please read our comment policy. - The Fix

Growing up in Manhattan as a stutterer, John Lavitt discovered that writing was the best way to express himself when the words would not come. After graduating with honors from Brown University, he lived on the Greek island of Patmos, studying with his mentor, the late American poet Robert Lax. As a writer, John’s published work includes three articles in Chicken Soup For The Soul volumes and poems in multiple poetry journals and compilations. Active in recovery, John has been the Treatment Professional News Editor for The Fix. Since 2015, he has published over 500 articles on the addiction and recovery news website. Today, he lives in Los Angeles, trying his best to be happy and creative. Find John on Facebook, Twitter, and LinkedIn.