This is the latest book by Gabor Mate. It's a fascinating, at times frightening look into the world of addiction, with a focus on the most serious of drug addicts whom Dr. Mate has worked with as a clinician, but also gives a broad spectrum understanding into the world of addiction from the most extreme cases to 'milder' forms of behavioural and socially accepted addictions. He goes in depth into Narcissism, childhood trauma's, brain neurology and how spirituality and consciousness ties into it. He also discusses the implications of addiction being a core societal issue because our society has completely lost touch with itself and that in essence, most, if not all human beings are generally addicts.
Out of all the psychology books I've read through being on the forum, nothing has tied together so many spiritual and psychological concepts for me as much as this one.
I see Perceval also posted a TED talk with the author The power of addiction and the addiction of power
Out of all the psychology books I've read through being on the forum, nothing has tied together so many spiritual and psychological concepts for me as much as this one.
I see Perceval also posted a TED talk with the author The power of addiction and the addiction of power
Takes One to Know One
Addictions, even as they resemble normal human yearnings, are more about desire than attainment. In the addicted mode, the emotional charge is in the pursuit and the acquisition of the desired object, not in the possession and enjoyment of it. The greatest pleasure is in the momentary satisfaction of yearning.
The fundamental addiction is to the fleeting experience of not being addicted. The addict craves the absence of the craving state. For a brief moment he’s liberated from emptiness, boredom, from lack of meaning, from yearning, from being driven or from pain. He is free. His enslavement to the external – the substance, the object of activity – consists of the impossibility, in his mind, of finding within himself the freedom from longing or irritability. “I want nothing and fear nothing,” said Zorba the Greek. “I’m free.” There are not many Zorbas amongst us.
In my addicted mode the music still thrills, but it cannot release me from the need to pursue and acquire more and more. Its fruit is not joy but disaffection. With each CD I delude myself that now my collection will be complete. If only I could have that one – just one more, one more time, I could rest satisfied. So runs the illusion. “Just one more is the binding factor in the circle of suffering,” writes the Buddhist monk and teach Sakyong Mipham.
My purest moment of freedom occurs after I park my car, hurry to Sikora’s and, slowing down just before entering, draw a deep breath as I push the door open. For this nanosecond, life is limitless possibility. “We can perceive the infinite in music only be searching for this quality in ourselves,” writes the pianist and conductor Daniel Barenboim. Very true. But that’s not the kind of infinite the addict seeks.
When you get right down to it, it’s the adrenaline I’m after, along with the precious reward chemicals that will flood my brain when I hold the new CD in hand, providing an all too temporary reprieve from the stress of my driven state. But I’ve barely left the store before the adrenaline starts pumping through my circulation again, my mind fixated on the next purchase. Anyone who’s addicted to any kind of pursuit – whether it’s sex or gambling or shopping – is after that same fix of home-grown chemicals.
… Any passion can become an addiction; but then how to distinguish between the two? The central question is: who’s in charge, the individual or the behaviour? It’s possible to rule a passion, but an obsessive passion that a person is unable to rule is an addiction. And the addiction is the repeated behaviour that a person keeps engaging in, even though he knows it harms himself or others. How it looks externally is irrelevant. The key issue is a person’s internal relationship to the passion and its related behaviours.
If in doubt, ask yourself one simple question: given the harm you’re doing to yourself and others, are you willing to stop? If not, you’re addicted. And if you’re unable to renounce the behaviour or keep your pledge when you do, you’re addicted.
There is, of course, a deeper, more ossified layer beneath any kind of addiction: the denial state in which, contrary to all reason and evidence, you refuse to acknowledge that you’re hurting yourself or anyone else. In the denial state you’re completely resistant to asking yourself any questions at all. But if you want to know, look around you. Are you closer to the people you love after your passion has been fulfilled or more isolated? Have you come more truly into who you really are or are you left feeling hollow?
Passion is divine fire: it enlivens and makes holy; it gives light and yields inspiration. Passion is generous because it’s not ego-driven; addiction is self-centred.
Passion gives and enriches; addiction is a thief. Passion is a source of truth and enlightenment; addictive behaviours lead you into darkness. You’re more alive when you are passionate, and you triumph whether or not you attain your goal. But an addiction requires a specific outcome that feeds the ego; without that outcome, the ego feels empty and deprived. A consuming passion that you are helpless to resist, no matter what the consequences, is an addiction.
You may even devote your entire life to a passion, but if it’s truly a passion and not an addiction, you’ll do so with freedom, you and a full assertion of your truest self and values. In addiction, there’s no joy, passion or assertion. The addict lurks shame-faced in the shadowy corners of her own existence. I glimpse shame in the eyes of my addicted patients in the Downtown Eastside and, in their shame, I see mirrored my own.
Addiction is a dark simulacrum and, to the naïve observer, it’s perfect mimic. It resembles passion in its urgency and in the promise of fulfillment, but its gifts are illusory. It’s a black hole. The more you offer it, the more it demands. Unlike passion, its alchemy does not create new elements from old. It only degrades what it touches and turns it into something less, something cheaper.
Am I happier after one of my self-indulgent sprees? Like a miser, in my mind I recount and catalogue recent purchases – a furtive Scrooge, hunched over and rubbing his hands together with acquisitive glee, his heart growing ever colder. In the wake of a buying binge, I am not a satisfied man.
Addiction is centrifugal. It sucks energy from you, creating a vacuum of inertia. A passion energizes you and enriches your relationships. It empowers you and gives you strength to others. Passion creates; addiction consumes – first the self and the others within orbit.
A Different State of the Brain
Scientists have looked at the chemistry of the addicted brain, at its neurological connections and its anatomical structures. They’ve analyzed the workings of molecules, the membranes of cells and the replication of genetic material. They’ve investigated how stress activates the brain circuitry of addiction. Large-scale studies have examined what hereditary predispositions might contribute to addiction and how early life experiences may shape the brain pathways of addiction.
… Are the changes in the addicted brain purely the consequence of drug use or is the brain of the habitual use somehow susceptible before drug use begins? Are there brain states that predispose a person to become addicted to drugs or to behaviours such as compulsive sexual adventuring or overeating? If so, are those predisposing brain states induced mostly by genetic inheritance or by life experience – or by some combination of both?
The drug addicted brain doesn’t work the same way as the non-addicted brain and when imaged by means of PET scans and MRIs, it doesn’t look the same. An MRI study in 2002 looked at white matter in the brains of dozens of cocaine addicts from youth to middle age, in comparison with the white matter of nonusers. The brain’s grey matter contains the cell bodies of nerve cells; their connecting fibres, covered by fatty white tissue, form the white matter. As we age, we develop more active connections and therefore more white matter. In the brains of cocaine addicts the age-related expansion of white matter is absent. Functionally, this means a loss of learning capacity – a diminished ability to make new choices, acquire new information and adapt to new circumstances.
{The C's had said that using drugs is a self-abridging of free will. Here's the proof!}
It gets worse. Other studies have shown that grey matter density, too, is reduced in the cerebral cortex of cocaine addicts – that is, they have smaller or fewer nerve cells than normal. A diminished volume of grey matter has also been shown in heroin addicts and alcoholics, and this reduction in brain size is correlated with the years of use: the longer the person has been addicted, the greater the loss of volume. In the part of the cerebral cortex responsible for regulating emotional impulses and for making rational decisions, addicted brains have reduced activity. In special scanning studies these brain centres have also exhibited diminished energy utilization in chronic substance users, indicating that the nerve cells and circuits in those locations are doing less work. When tested psychologically, these same addicts showed impaired functioning of their prefrontal cortex, the “executive” part of the human brain. Thus, the impairments of physiological function revealed through imaging were paralleled by a diminished capacity for rational thought. In animal studies, reduced nerve cell counts, altered electrical activity and abnormal nerve cell branching in the brain were found after chronic cocaine use.
… When the brain is diseased, the functions that become pathological are the person’s emotional life, thought processes and behaviour. And this creates addictions central dilemma: if recovery is to occur, the brain, the impaired organ of decision making, needs to initiate its own healing process. An altered and dysfunctional brain must decide that it wants to overcome its own dysfunction: to revert to normal – or perhaps, become normal for the very first time. The worse the addiction is, the greater the brain abnormality and the greater the biological obstacles to opting for health.
The Incentive System in Addiction
There is an area in the midbrain which, when triggered, gives rise to intense feelings of elation or desire. It’s called the ventral tegmental apparatus, or VTA. When researchers insert electrodes into the VTA of lab rats and the animals are given a lever that allows them to stimulate this brain centre, they’ll do so to the point of exhaustion. They ignore food and pain just so they can reach the lever. Human beings may also endanger themselves in order to continue self-triggering this brain area. One human subject stimulated himself fifteen hundred times in a three hour period, “to the point that he was experiencing an almost overwhelming euphoria and elation, and had to be disconnected despite his vigorous protests.”
Many studies link addiction to the orbitofrontal cortex (OFC), a cortical segment found near the eye socket, or orbit. In drug addicts, whether they are intoxicated or not, it doesn’t function normally. The OFC’s relationship with addiction arises from its special role in human behaviour and from its abundant supply of opioid and dopamine receptors. It is powerfully affected by drugs and powerfully reinforces the drug habit. It also plays an essential supporting role in nondrug addictions. Of course, it doesn’t function (or malfunction) on its own but forms part of an extensive and incredibly complex, multifaceted network – nor is it the only cortical area implicated in addiction.
Through its rich connections with the limbic (emotional) centres, the OFC is the apex of the emotional brain and serves as its mission control room. In normal circumstances in a mature human being, the OFC is among the highest arbiters of our emotional lives. It receives input from all the sensory areas, which allows it to process environmental data such as vision, touch, taste, smell and sound. Why is that important? Because it’s the OFC’s job to evaluate the nature and potential value of stimuli, based on present information – but also in light of previous experience. The neurological traces of early, formative events are embedded in the OFC, which, in turn, is connected with other memory-serving brain structures. So, for example, a smell that in early memory is associated with a pleasurable experience will likely be judged by the OFC in a positive way. Through its access to memory traces, conscious and unconscious, the OFC “decides” the emotional value of stimuli – for example, are we intensely drawn to or repelled by a person or object or activity, or are we neutral? It is constantly surveying the emotional significance of situations, their personal meaning to the individual. Through processes we are not consciously aware of, in microseconds the OFC decides our take on people or on a situation.
… We can now reconstruct yesterday’s events. When Claire sees the plastic bag with the white cocaine powder, the needle and the syringe – or when she so much as thinks about them – her brain will respond in a highly positive way. Owing to the OFC’s influence on the incentive centres described in the last chapter, dopamine will start flowing in Claire’s midbrain circuits. This causes the craving for the drug to intensify. Any thoughts of negative consequences are thrust aside: the part of the OFC that might speak up to warn her of these consequences is “gagged and bound.” Thus Claire’s OFC, impaired by years of drug use and perhaps even before then, encourages the self-harming activity, rather than inhibiting it. She injects.
Ten minutes later she takes her seat outside my office. Someone says the wrong thing – or she believes they do. Her OFC, unconsciously primed to recall the many times she has been attacked, insulted and injured, interprets this stimulus as a serious aggression. Claire is triggered. According to PET scans, the OFC distinguishes and reacts to angry, disgusted and fearful facial expression in other people but not to neutral facial expressions. Literally, all the “offending” person had to do was to look at Claire the wrong way.