In the Realm of Hungry Ghosts: Close Encounters With Addiction


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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

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.


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Continued ...

Their Brains Never Had a Chance

Brain development in the uterus and during childhood is the single most important biological factor in determining whether or not a person will be predisposed to substance dependence and to addictive behaviours of any sort, whether drug related or not … “The basic cause of addiction is predominantly experience-dependent during childhood, and not substance-dependent,” Dr. Felitti has written.

Genes do dictate the basic organization, developmental schedule and anatomical structure of the human central nervous system, but it’s left to the environment to sculpt and fine tune the chemistry, connections, circuits, networks and systems that determine how well we function.

Trauma, Stress and the Biology of Addiction

The Brains of mistreated children have been shown to be smaller than normal by 7 or 8 per cent, with below-average volumes in multiple brain areas, including the impulse-regulating prefrontal cortex; in the corpus callosum (CC), the bundle of white matter that connects and integrates the functioning of the two sides of the brain; and in several structures of the limbic or emotional apparatus, whose dysfunctions greatly increase the vulnerability to addiction. In a study of depressed women who had been abused in childhood, the hippocampus (the memory and emotional hub) was found to be 15 per cent smaller than normal. The key factor was abuse, not depression, since the same brain area was unaffected in depressed women who had not been abused.

I mentioned abnormalities in the corpus callosum, which facilitates the collaboration between the brain’s two halves, or hemispheres. Not only have the CC’s of trauma survivors been shown to be smaller, but there is evidence of a disruption of functioning there as well. The result can be “split” in the processing of emotion: the two halves may not work in tandem, particularly when the individual is under stress. One characteristic of personality disorder, a condition with which substance abusers are very commonly diagnosed, is a kind of flip-flopping between idealization of another person and intense dislike, even hatred. There is no middle ground, where both the positive and the negative qualities of the other are acknowledged and respected.

Dr. Martin Teicher, Director of the Developmental Biopsychiatry Research Program at McLean Hospital in Maryland, suggests the very intriguing possibility that our “negative” views of a person are stored in one hemisphere and our “positive” responses, in the other. The lack of integration between the two halves of the brain would mean that information from the two views, negative and positive, is not melded into one complete picture. As a result, in intimate relationships and in other areas of life, the afflicted individual fluctuates between idealized and degraded perceptions of himself, other people and the world. This sensible theory, if proven, would explain a lot not only about drug-dependent persons, but also about many behavioural addicts.

Here I must admit to a shudder of recognition. I sometimes operate as if I were two different people; my view of things can be either very positive or highly cynical and pessimistic, and often dogmatically so. When I’m watching the happy channel, my negative perceptions seem like a crazy dream; when stuck in the dejected mode I can’t recall ever having felt joy.

Of course, the moods and perceptions of my drug-addicted patients swing on pendulums far wilder and more erratic than mine. To some extent these extreme oscillations must be drug induced, but they also reflect the faulty brain dynamics that resulted from my patients’ uniformly miserable childhood histories. Extreme circumstances breed extremist brains.

A brain pre-set to be easily triggered into a stress response is likely to assign a high value to substances, activities and situations that provide short-term relief. It will have less interest in long-term consequences, just as people in extremes of thirst will greedily consume water knowing that it may contain toxins. On the other hand, situations or activities that for the average person are likely to bring satisfaction are undervalued because, in the addict’s life, they have not been rewarding – for example, intimate connections with family. This shrinking from normal experience is also an outcome of early trauma and stress, as summarized in a recent psychiatric review of child development:
Neglect and abuse during early life may cause bonding systems to develop abnormally and compromise capacity for rewarding interpersonal relationships and commitment to societal and cultural values later in life. Other means of stimulating reward pathways in the brain, such as drugs, sex, aggression, and intimidating others, could become relatively more attractive and less constrained by concern about violating trusting relationships. The ability to modify behaviour based on negative experiences may be impaired.

… Stress also diminishes the activity of dopamine receptors in the emotional circuits of the forebrain, particularly in the nucleus accumbens, where the craving for drugs increases as dopamine function decreases. The research literature has identified three factors that universally lead to stress for human beings: uncertainty, lack of information and loss of control. To these we may add conflict that the organism is unable to handle and isolation from emotionally supportive relationships. Animal studies have demonstrated that isolation leads to changes in brain receptors and increased propensity for drug use in infant animals, and in adults reduces the activity of dopamine-dependent nerve cells.

Grasping the powerful impact of the early environment on brain development may leave us feeling hopelessly gloomy about recovery from addiction. It so happens there are solid reasons not to despair. Our brains are resilient organs: some important circuits continue to develop throughout our entire lives, and they may do so even in the case of a hardcore drug addict whose brain “never had a chance” in childhood. That’s the good news on the physical level … The mind may reside mostly in the brain, but it is much more than the sum total of the automatic neurological programs rooted in our pasts. And there is something else in us and about us: it is called by many names, “spirit” being the most democratic and least denominational or divisive in a religious sense. Later in this book, we will also examine its powerful transformational role.

A Void I’ll Do Anything to Avoid

In the final analysis, it’s not the activity or object itself that defines an addiction but our relationship to whatever is the external focus of our attention or behaviour … preliminary results suggest the involvement of similar brain regions in drug and non-drug related urges … For someone with a relative shortage of dopamine receptors, it’s whichever activity best releases extra quantities of this euphoric and invigorating neurotransmitter that will become the object of addictive pursuit.

...If I’ve learned anything, it’s that I have to be responsible for my own fear of emptiness. The fear is not personal – on the contrary it’s pretty much universal – but I got the void and it’s not going anywhere. When I can recognize that, I don’t make the mistake of confusing it with who I am, or worse, expending a lot of energy trying to make it go away by any available means. Instead, I can be vigilant, patient and good-humoured with it.

Too Much Time on External Things: The Addiction-Prone Personality

Stephen Reid has written about the “darkness… the secret self-loathing that pools in the heart of every junkie.” The shame arises because indulging the addiction process, even if with an ostensibly harmless object, only deepens the vacuum where connection with the world and a healthy sense of self ought to arise. The shame is that of self-betrayal. The utter insatiability of this sense of deficient emptiness hit home for me when I was invited to speak at IdeaCity, an annual conference about ideas, scientific advances and culture in Toronto. For years I looked at the list of presenters with bitterness. I was envious and longed to be invited – a longing that arose from my neediness around being wanted and recognized. Finally, I was asked to participate. My ego was satisfied – or so I thought. Once in Toronto, no sooner had I begun to enjoy the program and to relish meeting so many open-minded and fascinating people that the relentlessly possessive and ever-hungry ego voice in my mind began to agitate: “Some of these speakers have been here two or even three times. Will you be asked again? You SHOULD be asked again…” I could only laugh. The ego can never get enough – it doesn’t even know the concept.

People are susceptible to the addiction process if they have a constant need to fill their minds or bodies with external sources of comfort, whether physical or emotional. That need expresses a failure of self-regulation – an inability to maintain a reasonably stable internal emotional atmosphere.

Impulse control is one aspect of self-regulation. Impulses rise up from the lower brain centres and are meant to be permitted or inhibited by the cerebral cortex. A salient trait of the addiction-prone personality is a poor hold over sudden feelings, urges and desires. Also characterizing the addiction-prone personality is the absence of differentiation. Differentiation is defined as “the ability to be in emotional contact with others yet still autonomous in one’s emotional functioning.” It’s the capacity to hold on to ourselves while interacting with others. The poorly differentiated person is easily overwhelmed by his emotions, “absorbs anxiety from others and generates considerable anxiety within himself.”

Lack of differentiation and impaired self-regulation reflect a lack of emotional maturity.

Psychological maturation is the development of a sense of self as separate from inner experience – a capacity entirely absent in the young child. The child has to learn that she is not identical with whatever feelings happen to be dominant in her at any particular moment. She can feel something without her actions being automatically dictated by that feeling. She can be aware of other, conflicting feelings or of thoughts, values and commitments that might run counter to the feeling of the moment. She can choose. In the addict this experience of “mixed feelings” is often lacking. Emotional processes rule the addict’s perspective: whatever she is feeling at the moment tends to definer her view of the world and will control her actions.

The same applies in the realm of relationships: for maturation the child must become unique and separate from other individuals. She has to know her own mind and not be overwhelmed by the thoughts, perspectives or emotional states of others. The better differentiated she becomes, the more she is able to mix with others without losing her sense of self. The individuated, well-differentiated person can respond from an open acceptance of his emotions, which are not tailored either to match someone else’s expectations or resist them. He neither supresses his emotions nor acts them out impulsively.

The Internal Climate

The mind activity that can physically rewire malfunctioning brain circuits and alter our dysfunctional emotional and cerebral responses is conscious mental effort – what Dr. Schwartz calls mental force. If changing external circumstances can improve brain physiology, so can mental effort. “Intention and attention exert real, physical effects on the brain,” Dr. Schwartz explains.

Not surprisingly, the brain area activated in studies looking at the effect of self-directed mental effort is the prefrontal cortex, the apex of the brain’s emotional self-regulation system. It’s also an area where, we have learned, the brains of addicts are impaired. The mental activity most critical to the development of emotional self-regulation has been called “dispassionate self-observation” by the authors of an important article on the interface of brain and mind, published in the Philosophical Transactions of the Royal Society (Biological Sciences) in 2005. “The way in which a person directs their attention will,” they write, “affect both the experiential state of the person and the state of his/her brain.”

The automatic mind, the reactive product of brain circuits, constantly interprets the present in the light of past conditioning. In its psychological responses it has great difficulty telling past from present, especially whenever it is emotionally aroused. A trigger in the present will set off emotions that were programmed perhaps decades ago at a much more vulnerable time in the person’s life. What seems like a reaction to some present circumstance is, in fact, a reliving of past emotional experience.

A neglected child may be helpless, but the damage comes if he acquires the defining belief that helplessness is his real and permanent state of the world. The greatest damage done by neglect, trauma or emotional loss is not the immediate pain they inflict but the long-term distortions they induce in the way a developing child continue to interpret the world and her situation in it. All too often these ill-conditioned implicit beliefs become self-fulfilling prophecies in our lives. We create meanings from our unconscious interpretation of early events, and then we forge our present experiences from the meanings we’ve created. Unwittingly, we write the story of our future from narratives based on the past.


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Four Steps, Plus One

This chapter outlines a specific method that I view as promising for behavioural addictions – for example, shopping, gambling and eating compulsions – or for anyone wishing to disengage from maladaptive habits of thinking or acting. Its other value is that it shed further light on the nature of the addicted brain and mind … They will not work if done mechanically, but require regular practice with conscious awareness.

The method Dr. Schwartz and his colleagues have developed applies conscious attention in a systematic, four-step fashion. On brain scans they have shown that the locked circuitry of OCD undergoes a change after a relatively brief period of consistent and disciplined practice by obsessive-compulsive patients. The demonstrated ‘brain lock’ opens up, and the person is freed from the nonsensical thoughts that formerly compelled her behaviour. Can the same four steps be applied to addiction? “I haven’t worked extensively with addictions,” Dr. Schwartz told me, “but given that addiction also involves problems with intrusive urges and repetitive behaviours, there is good reason to think that the four steps could be useful in treatment.”

The four steps should be practiced daily at least once, but also whenever an addictive impulse pulls you so strongly that you are tempted to act it out.

Step 1: Re-label

In step 1 you label the addictive thought or urge exactly for what it I, not mistaking it for reality … “I don’t need to purchase anything now or eat anything now; I’m only having an obsessive thought that I have such an need … Be fully aware of the sense of urgency that attends the impulse and keep labelling it as a manifestation of addiction, rather than any reality that you must act upon … It is strengthened every time you give in to it and every time you try to suppress it forcibly. The point is to observe it with conscious attention without assigning the habitual meaning to it. It is no longer a “need”, only a dysfunctional thought. Rest assured, the urge will come back – and again you will re-label it with determination and mindful awareness.

Step 2: Re-attribute

In Re-attribute you learn to place the blame squarely on your brain. This is my brain sending me a false message.”

It represents a dopamine or endorphin “hunger” on the part of the brain systems that, early in your life, lacked the necessary conditions for their full development. It also represents emotional needs that went unsatisfied … It is not a moral failure or a character weakness; it is just the effect of circumstances over which you had no control. What you do have some control over is how you respond to the compulsion in the present. You were not responsible for the stressful circumstances that shaped your brain and worldview, but you can take responsibility now.

Re-attribution helps put the addictive drive into perspective … If you change how you respond to those old circuits, you will eventually weaken them.

Step 3: Re-focus

The key principle here, as Dr. Schwartz points out, is this: “It’s not how you feel that counts; it’s what you do.”
Rather than engage in the addictive activity, find something else to do. Your initial goal is modest: buy yourself just fifteen minutes. Choose something that you enjoy and that will keep you active: preferably something healthy and creative, but anything that will please you without causing greater harm.

The purpose of Re-focus is to teach your brain that it doesn’t have to obey the addictive call. It can exercise the “free won’t.” It can choose something else … This is not a hundred-metre dash but a solo marathon you are training for. Successes will come in increments.

Step 4: Re-value

This step should really be called de-value. Its purpose is to help drive into your own thick skull just has been the real impact of the addictive urge in your life: disaster. You know this already, and that is why you are engaged in these four steps. It’s because of the negative impact that you’ve taken yourself by the scruff of the neck and delayed acting on the impulse while you’ve re-labelled and re-attributed it and while you have re-focused on some healthier activity.

In the Re-value step you de-value the false gold. You assign to it its proper worth: less than nothing.

Be conscious as you write out this fourth step – and do write it out, several times a day if necessary. Be specific: What has been the value of the urge in your relationship with your wife, your partner, your husband, your best friend, your children, your boss, your employees, your co-workers? What happened yesterday when you allowed the urge to rule you? What happened last week? What will happen today? Pay close attention to what you feel when you recall these events and when you foresee what’s ahead if you persist in permitting the compulsion to overpower you. Be aware. That awareness will be your guardian.

Do all this without judging yourself. You are gathering information, not conducting a criminal trial against yourself. Jesus said: “If you bring forth what is within you, what you have will save you.”

Step 5: Re-create

Life, until now, has created you. You’ve been acting according to ingrained mechanisms wired into your brain before you had a choice in the matter, and it’s out of those automatic mechanisms that you’ve created the life you have now. It is time to re-create: to choose a different life.

… Write down your values and intentions and, one more time, do so with conscious awareness. Envisions yourself living with integrity, creative and present, being able to look people in the eye with compassion for them – and for yourself. The road to hell is not paved with good intentions. It is paved with lack of intention. Re-create. Are you afraid you will stumble? Of course you will: that’s called being a human being. And then you will the four steps – plus one – again.

Sobriety and the External Milieu

There are two ways of abstaining from a substance or behaviour: a positive and even joyful choice for something else that has a greater value for you or forcing yourself to stay away from something you crave and are spontaneously attracted to. This second type of abstinence, while it requires admirable fortitude and patience, can still be experienced in a negative way and contains a hidden danger. Human beings have an ingrained opposition to any sense of being forced, an automatic resistance to coercion that my friend Dr. Gordon Neufeld has called counterwill. It is triggered whenever a person feels controlled or pressured to do someone else’s bidding – and we can generate counterwill even against pressure that we put on ourselves.

{This sections talk about being more aware that if you if you take one substance or behaviour off the map, another may crop up just as easily to replace it – and how the addiction process is really a completely self-serving behaviour based off an inability to get past the narcissistic phase in infancy}

Quite contrary to feeling frustrated about any thwarted desires, I have discovered a much more satisfying freedom in not allowing the addiction process to run my life. And I’ve found another, unlooked-for benefit: just as the addiction process permeates every area of your existence, do does sobriety. As you become less attached to your addiction, you also become calmer, less attached to other things that don’t matter nearly as much as you used to believe. Your responses are less automatic, less rigid. Not having reason to be so harsh on yourself, you are not so inclined to find fault with others. Things don’t always have to go your way for you to be able to enjoy life.

… One important warning: if you want to find liberation in your commitments, your word needs to be freely given or not given at all. Don’t make promises to reform out of a sense of duty or to appease someone else. If you don’t know how to say no to other people’s expectations, howsoever well meant or valid those may be your yes has no authenticity. This is what I have learned.

There is Nothing Lost: Addiction and the Spiritual Quest

For many people, the higher power concept need not be concerned with a deity or anything expressly spiritual. It simply means rising above their self-regarding ego, committing to serve something greater than their own immediate desires. I recall what a speaker at the AA meeting I attended had said. “As you study the Big Book and you serve people and help the community, your heart softens. That’s the greatest gift, a soft heart. I wouldn’t have believed it.”

Our material culture tries to explain even unselfishness as arising from selfish motives. It is often asserted, cynically, that people who act in kindly ways, without any benefit to themselves, are doing so only to feel good. Neuroscience does not support that view: the brain area that lights up as a person performs an altruistic act is not the circuitry activated by pleasure or by the anticipation of reward. According to a recent study, a key contributor to humane behaviour is the posterior superior temporal cortex (pSTC), a region at the back of the brain whose function includes awareness of other people’s emotional states. It seems that we are wired to be in tune with one another’s needs, which if one of the roots of empathy. “Perhaps altruism did not grow out of a warm-glow feeling of doing good for others, but out of the simple recognition that that thing over there is a person that has intentions and goals. And therefore, I might want to treat like I might want to treat myself,” said one of the researchers – Scott Huettel

…There is a quality or drive innate in human beings that the Austrian Psychiatrist Victor Frankl called our “search for meaning.” Meaning is found in pursuits that go beyond the self. In our own hearts most of us know that we experience the greatest satisfaction not when we receive or acquire something but when we make an authentic contribution to the well-being of others or to the social good, or when we create something original and beautiful or just something represents a labour of love. It is no coincidence that addictions arise mostly in cultures tjat subjugate communal goals, time-honoured tradition and individual creativity to mass production and accumulation of wealth. Addiction is one of the outcomes of the “existential vaccum,” the feeling of emptiness engendered when we place a supreme value on selfish attainments.


Padawan Learner
Many, many thanks, Turgon. The excerpted material is the best I have read on addiction - and I've read a fair amount. I will share the existence of this book with the many people I know who suffer from addictions of various types - and it goes high up on my end of the month reading list. :)


Zadius Sky said:
obyvatel said:
Thanks for taking the time to share this Turgon.

I agree. Much appreciated. It's another one for my pile to read. :)

+1 I've printed the excerpts. This will help to a certain extent to understand my own addictions. Thanks Turgon.


Jedi Master
Thank you very much Turgon for sharing so much of this work. Very powerful and insightful. My husband has previously cleaned up (alcohol/pain killers) a number of times, and is currently climbing painfully back on the wagon. He came home from his counseling/meeting the other night, upset at what his behavior has done to our marriage, ashamed at the lies and deceitful behavior and fearful of not being able to stay clean. As I was reading, there were a lot of a-ha moments, shedding light on the observations as well as the frustrations my husband has shared. While there are sections within the Gabor Mate's work that makes a successful recovery seem hopeless, the 4 steps plus 1 part, along with the encouragement, gives me hope, again, that he can develop the strength and understanding needed to arm himself against relapse.
Ordering this book for him(us); there seems plenty for both of us to learn about addiction.


Thank you for the suggestion Turgon, I will definitely buy it.
It's incredible how many things I am learning about my personality and the programs I have.. I have never taken drugs or had an alcohol addiction but I have been addicted to the things that "made me feel good" whereas it was chocolate or a specific person :cry: , and this prevented me for asking questions for a long time. I hope this will help me to peel another layer of the onion.


Hello all and thanks to Turgon for sharing this, it has help me learn better about me and my addictions.
I wanted to post my though on this :

Since my preteen age i have been an introvert "absent-minded" or "in the clouds" type of person, and always had difficulties expressing myself and interacting with others. This has lead me to withdraw from social life for years.
I think its because of the social conditioning, which has make me fear peoples like paranoia. I am scarred of what people might think about me and their judgemen ts on me. I always am uneasy in social situations.
And all the generated stress fuels my addictions. I crave for the "high", for the "feel good" sensation to forget the uneasiness. It has been addiction to playing video games, watching anime, addiction to porn.

Right now it's my smoking habit of "hashish", when I wake up in the morning, I think about the work ahead I have to do, I become stressed. And then there is this hungry ghost that show up "just go smoke one it won't hurt you". And then ignoring in the little voice "No, what about your parole" I give in on my desire and it began.

There is this pleasant feeling and the nice "reveries" and funny intuitions, i become calm and relax like anesthetized then it is like descent into hell because it's like "K.O" like tired and too much relaxed, no awareness, I began to think about my life, and there is this internal dialogue that don't stop and theses negative emotions, who make me even more paranoid and anxious in social situation, incapable to understand and interact decently with people because of internal consideration and all this contribute to lower my self esteem. And then i make myself promess to stop it's funny because it's always after giving to it that I feel like shit and regret.

It is a vicious circle.

So what I make of all this is that you have to be aware of the process, always watch your machine, how "it" work in order to identifier to prevent giving in because what is fueling addiction is the craves for high, feeling good in order to avoid stress & frustration in life resulting from paranoia and narcissism and social anxiety.


Dagobah Resident
One thing that stood out for me reading this book, is that addicts are very adapted at surviving in their own niche. And only there. They are perhaps a metaphor for the ultra-specialization that is forcibly enforced in all the different careers today?
Very adapted at surviving at a very specific situation and immature.
It may be a silly realization, but this book is making me realize that emotional maturity is linked with a broader vision of the world. But this broader vision is not necessarily about having lots of experiences, but what you can make and learn of your experiences.

But to learn from our experiences, we have to be somewhat emotionally mature and stable don't we?
Is that a kind of catch 22? Did those addicts had any chance to start with?


Jedi Master
Currently reading Maté's book now.
It really is overwhelming at times with the information and accounts he gives. Stairs up my emotions with the detail of his clients and the relationship he holds with them.
Being based mainly around drug/substance addiction, he does well to include the background as to why we as people seek out addiction within our lives.
Definitely worth a read from what i have so far gathered if anyone is looking to gain some knowledge of addiction and the overall roots as to the why's and in what forms we can be addicted.

Maté also includes some of his own personal addictions and stories behind them, not with drugs, but with a simple classical music purchasing addiction that has tainted his life and made him lie to his family and be in a state of denial.
At first glance, this seems hard to compare to a substance addiction of say; a heroin addict. But the overall reasons behind these addictions and the way in which he explains them, can be very easily related.

Hopefully i will have more to say the more i get through it :).
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