Why Do People Become Addicts?
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Gabor Mate M.D. has been for over ten years the staff physician at the Portland Hotel, North America’s only supervised safe-injection site in Vancouver's Downtown Eastside, home to one of the world’s densest areas of drug users. Mate advocates for and practices a holistic view of reality, its challenges and potential solutions. Mate’s books include When the Body Says No: Understanding The Stress-Disease Connection; Scattered: How Attention Deficit Disorder Originates And What You Can Do About It, and his latest, In The Realm of Hungry Ghosts: Close Encounters with Addiction.
McNally: Can you tell us a bit about your path to the work that you do today?
Mate: I’m a medical doctor. I’ve worked for 20 years in family practice in Vancouver, BC. For seven years I worked in palliative care looking after old people and for 12 years I’ve worked in the downtown eastside.
My own journey involves not just my observations and experiences as a physician, but also dealing with my own mental health issues and emotional problems and imbalances. In the process of coming to terms with my own issues, I began to understand that the medical training I’d received, although valuable and a great benefit in many ways, was also hopelessly too narrow and shallow in its approach to human beings.
The medical approach still separates the mind from the body, and still looks at individuals as discrete entities rather than seeing us as manifestations of cultural, physical and emotional alignment. I’ve come to understand that whether we’re talking about addiction or any dysfunction of human mind, body or spirit, we have to understand that we’re all connected; that people are not separate from their environment; and that we’re very much shaped by what happens to us in early childhood. Disease in the end is not the source of our problems, but a manifestation of a lifelong disconnection from ourselves.
At the same time, when disease arises it presents an opportunity for healing, which actually means wholeness; an opportunity to get back to what we actually are. I approach illness from the perspective of asking what is it telling us about the individual at that particular time in their life. This is not to say that I would therefore reject conventional medical treatment. Often that can be very helpful, but it’s not the ultimate answer.
McNally: Am I correct in saying that your work embodies these principles of holistic treatment: Deal with the whole situation – mind, body, emotions, spirit, and environment; look for root causes rather than symptoms; and treat as naturally and safely as possible?
Mate: I’m a medical doctor, but I’m also very open to alternative therapies. Western medicine has very limited responses to most chronic conditions, whether physical conditions like multiple sclerosis or mental health conditions like depression or addiction. Certainly when it comes to understanding causes, we have to look at people’s lives and the social milieu where these lives are lived.
McNally: What does it mean to say that yours is the only legal injection site in North America?
Mate: You’re referring to Insite, which is administered by the Portland Hotel Society in Vancouver. It’s a facility where people who are addicted can bring their illegal drugs like heroin or cocaine without the fear of being arrested. They’re provided with sterile swabs, clean water and clean needles, and with lights and a mirror and a sink where they can wash themselves. There they can inject their substances under the supervision of a nurse.
As a result, there’s less injection in the streets and fewer crack vials and drug needles strewn around the neighborhood. Among the benefits demonstrated by many medical studies are that people don’t transmit HIV or hepatitis-C or other infectious diseases to one another, and that saves a lot of money.
Childhood trauma is the universal template for severe addiction. These drug addicts all began life as abused children. Finally they have a place where they feel accepted and safe for the first time in their lives, so it’s a beginning of the possibility of treatment.
McNally: What is the situation in Vancouver, the city, British Columbia, the province, and Canada, the country, in terms of implementing a philosophy of harm reduction rather than criminalization with regard to drugs?
Mate: On a civic level in Vancouver and a provincial level in BC, harm reduction is well accepted in the government. But the federal government in Canada has shaped itself very much to the right of the George Bush conservatives. They claim that somehow we’re supporting or condoning addiction, a completely false and demonstrably baseless idea. And, for purely ideological reasons, they’re trying to shut the place down despite the demonstrated evidence of economic and health benefits.
I’m told the Obama administration prevented the American federal government from funding HIV programs that involve needle exchange, even though, of course, clean needle exchange is one of the best ways to prevent HIV transmission. In both cases, such actions have nothing to do with health, humanity or compassion, and everything to do with a right wing agenda.
McNally: When I look at the perpetuation of the war on drugs here in the US, I see on one side the correctional unions and what I would call the prison industrial complex, and on the other, millions of people who know better. But the issue is not high enough on their agenda to overcome the money and influence of those institutions who benefit from it.
Your latest book has a provocative title, In The Realm of Hungry Ghosts. What does it refer to?
Mate: The hungry ghost is a Buddhist image. The Buddhist wheel of life cycles through six realms of human existence: the ordinary human realm; the hell realm of unbearable emotions like rage and terror; the animal realm of passions, instincts, and drives; and so on.
The hungry ghost realm depicts creatures with large empty bellies, small scrawny necks and mouths. They’re forever hungry and insatiable, but can never fill that emptiness. So they go around attempting to satisfy this inner void without ever being able to do so. That, of course, is the realm of addiction.
And it’s not that some people are here all the time and other people are there all the time.