Gabor Maté on addiction

2017-08-14

in Language, Psychology, Science

“Nothing sways them from the habit—not illness, not the sacrifice of love and relationships, not the loss of all earthly goods, not the crushing of their dignity, not the fear of dying. The drive is that relentless… If human life was so simple that people learned from negative consequences, well then human history would be very different… The drugs solve problems in people’s lives, in the short term. Of course, they create problems in the long term… When you stress animals, they’re more likely to engage in addictive behaviours… Our whole social policy’s based on stressing the addict—and then we hope to redeem them—which flies in the face of science, not to mention human compassion… We’re punishing people for having been abused in the first place.”

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{ 6 comments… read them below or add one }

Oleh August 15, 2017 at 1:47 pm

A sad but realistic comment on the effects of negative addiction.

This is a true challenge that we are facing

If only people could develop positive addictions – being outdoors, social interaction, excercise or movement, creative pursuits

Milan August 15, 2017 at 2:35 pm

It’s well worth watching the entire talk. A big part of Maté’s argument is that many people with drug addictions are self-medicating conditions including depression, post-traumatic stress disorder, and hyperactivity. Others are using it as a mechanism to deal with pain or stress which they are otherwise unable to handle.

While perhaps a casual equivalence can be drawn between addictions as defined in the psychological literature and the potential “positive addictions” you describe, I think the idea really fails to appreciate the mechanisms at work in addiction. Repeatedly doing something pleasant or healthy really isn’t the same thing at all, though it’s true that one treatment path for addictions consists of identifying the circumstances which trigger substance use (or other addictive behaviour like excess or inadequate eating) and training people to substitute other responses to those prompts.

alena August 15, 2017 at 6:04 pm

Recently, my group read an academic study of addiction called “Capture” and it described it s a circuit that we create in order to get satisfaction or to avoid, pain, suffering etc. Addictions are addictions and the pattern is difficult to break. So difficult in fact that people rely on another addiction to break one.

. August 24, 2017 at 9:20 pm

“Nothing records the effects of a sad life so graphically as the human body.”

The service over, the mourners mingle in the parking lot for a while, before going their separate ways. It’s a bright, dazzling day – the first time this year the spring sun has shown its face in the Vancouver sky.

I say hello to Gail, a native woman who’s bravely approaching the end of her third month without cocaine.

“Eighty-seven days!” she beams at me, “I can’t believe it!”

It’s no mere exercise in willpower. Gail was hospitalized for a fulminant abdominal infection two years ago and had a colostomy to rest her inflamed intestines. The severed segments of bowel should have been surgically rejoined long before now, but the procedure was always canceled because Gail’s intravenous cocaine use jeopardized the chances of healing. The original surgeon has declined to see her again.

“I booked the OR for nothing at least three times,” he told me, “I won’t take another chance.”

I couldn’t argue with his logic.

. September 7, 2017 at 12:27 am

. November 3, 2017 at 1:30 pm

In 1980, a 23-year-old South African called Stephen Rollnick started work as a nurse’s aid in a rehabilitation centre for alcoholics. The clinicians shared a confrontational approach to the job. They believed their clients were lying to themselves, and others, about the severity of their problem. Before setting the patient on the road to recovery, the clinician needed to challenge the patient on their dishonesty and strip away their illusions – to break their resistance.

This clinic was hardly atypical. The post-war medical consensus on addiction treatment regarded patients as wayward children who needed to be taught how to behave. The counsellor’s job was to tell the addict the truth about their condition, and, if they denied it, to do so again more forcefully until they accepted it. To Rollnick, this seemed bound to poison the relationship. In the coffee room, he observed that the off-duty conversations of the counsellors were imbued with disdain for their patients.

One of the clients under Rollnick’s care was an alcoholic called Anthony, who would leave group sessions having barely said a word. One day, he walked out for the last time. Rollnick discovered the next morning that Anthony had shot his wife and then himself in front of their young children. Shattered, Rollnick resigned from the centre, left South Africa, and settled in the UK, where he embarked on a course in clinical psychology at Cardiff University.

A couple of years in, Rollnick came across a new paper written by a young American psychologist called William Miller, and was startled by how much he agreed with it. Miller argued that counsellors were having precisely the wrong kind of conversation with their clients. Addicts were caught between a desire to change and a desire to maintain their habit. As soon as they felt themselves being judged or instructed, they produced all the reasons they did not want to change. That isn’t a pathology, Miller argued, it’s human nature: the more we feel someone trying to persuade us to do something, the more we dwell on the reasons we should not. By insisting on change, the counsellor was making himself feel better, while reinforcing the addict’s determination to carry on.

Miller argued that rather than instigating confrontation, counsellors should focus on building a relationship of trust and mutual understanding, enabling the patient to talk through his experiences without feeling the need to defend himself. Eventually, and with the counsellor gently shaping the dialogue, the part of the patient that wanted to get better would overcome the part that did not, and he would make the arguments for change himself. Having done so, he would be motivated to follow through on them. Miller called this approach “motivational interviewing” (MI).

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