I apologize in advance, ya'll this is going to be a doozie of a review (in fact I had to cut it down from my word doc to fit here). I was in a training on SUD and the presenter referenced Mate's book and played a short clip from his TED talk in which he described the addiction process as a compulsive need to fill a void. This resonated well with me in much the way Johann Hari's “the opposite of addiction is not sobriety, but is connection” did and so I put it at the top of my to-read pile. I did not learn anything new from the broad strokes: sociological critique of the War on Drugs; psychological justification for treating addicts with “positive regard;” biological/neurological underpinnings of addiction particularly in response to early trauma and brain development; spiritual/mindfulness need for awareness, insight, and acceptance in order to make change. However, he goes into more depth on specific brain chemicals and responses than I had read before and most importantly, he brings his own perspective on himself and the “junkies” with whom he has worked in his Vancouver clinic. He explains the use of the hungry ghosts analogy right away: “This is the domain of addiction, where we constantly seek something outside ourselves to curb an insatiable yearning for relief of fulfillment. The aching emptiness is perpetual because the substances, objects, or pursuits we hope will soothe it are not what we really need.” Overall, the book is highly recommended. It is not too “jargon-y,” but is very approachable; it is full of entertaining (if at times sad and tragic) presentations of real people with real issues; for anyone who knows someone who struggles with addiction or struggles themselves, he does offer a pretty solid recommendation for ways to change (of course the one piece that is left out throughout is the Prohaska and DiClemente's Stages of Change; Mate's suggestions really require that a person be on the cusp of the action stage and ready to take inventory). I personally identify with Mate on several levels. I am planning to work with SUD folks. I struggle with several addictive tendencies (in Mate's words: “I tend to oscillate between excessive, multitasking busyness and a proclivity for 'vegging out' in ways that leave me nonrested and dissatisfied”), but I also feel a bit like a “poser” saying that I have a problem when my life is so clearly great. Finally, I recognize the selfishness of the way that my behaviors have impacted my kids: I was not adequately attuned to either when they were little because I was working (Mate incorporates a quote from his son Daniel that cuts to my core as likely something with which my youngest would agree: “It seemed to me that I was growing up in a house where love was never in question; it was often affirmed. So I knew I was loved, but it came in shifting, confusing, and unpredictable ways that left me on my guard about it, and always craving it in a simpler, more straightforward from. I felt I had to be crafty to catch it and get some for myself, to pin it down.”). Right now I am also embarking on a personal mindfulness quest; I feel like I need to get more balance in my life between doing and being; I need to find ways to be in the moment without relying on 'vegging out'. I have divided his material into rough sections below, mostly full of his quotes (because he does say these things well): America Is One f*cked Up System: “'It is astonishing to realize,' remarks neurologist Antonio Damasio, 'that [medical] students learn about psychopathology without every being taught normal psychology.'” “Yet, owing in large part to all the funding expended on drug prohibition, fewer than one in ten US adolescents in need of drug treatment receive it.” “most of the social harm related to drugs does not come from the effects of the substances themselves but from the legal prohibitions against their use.” “we want to eradicate or limit addiction, yet our social policies are best suited to promote it, and we condemn the addict for qualities we dare not acknowledge in ourselves. Rather than exhort the addict to be other than the way she is, we need to find the strength to admit that we have greatly exacerbated her distress and perhaps our own.”
“That is the paradox: The United States leads the world in scientific knowledge in many areas but trails in applying that knowledge to social and human realities.”
“The indispensable foundation of a rational stance toward drug addiction would be the decriminalization of all substance dependence and the provision of such substances to confirmed users under safely controlled conditions.”
Addiction is For Everyone:
“I have come to see addiction not as a discrete, solid entity—a case of 'Either you got it or you don't got it'--but as a subtle and extensive continuum.”
“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 their behavior? It's possible to rule a passion, but an obsessive passion that a person is unable to rule is an addiction....The key issue is a person's internal relationship to the passion and its related behaviors.”
“our definition of addiction: any repeated behavior, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others. The distinguishing features of any addiction are compulsion, preoccupation, persistence, relapse, and craving.”
“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.”
“Addiction is primarily about the self, about the unconscious, insecure self that at every moment considers only its own immediate desires—and believes that it must behave that way.”
Similarities and Differences with OCD
“Both the obsessive-compulsive and the addict experience overwhelming tension until they succumb to their compulsive drive. When they finally do, they gain an immense, if momentary, sense of relief.”
“In reality the addict's temporary enjoyment makes it all the more difficult for him to give up his habit, whereas the obsessive-compulsive would be only too glad to do so, if shown how.”
In his areas for change, he also links the ways that mindfulness can help with both OCD and SUD through awareness and non-judgmental observation of one's thoughts:
“Mental hygiene consists of noticing the ebb and flow of all these automatic grasping or rejecting impulses without being hooked by them.” and “awareness of where we keep ourselves hobbled and stressed, where we ignore our emotions, restrict our expression of who we are, frustrate our innate human drive for creative and meaningful activity, and deny our needs to connection and intimacy.”
Need to Acknowledging One's Own Addictions:
“I hated myself, and this self loathing manifested itself in the hard, controlling, and critical ways I'd deal with my sons and my daughter. When we're preoccupied with serving our own false needs, we can't endure seeing the genuine needs of other people—least of all those of our children.”
“No matter how hard I try, I have found that I may never fully defeat my addiction-prone tendencies. And I've also learned that this is all right. Triumph and defeat: these are still metaphors of war. If, as the research shows, addictions arise near our emotional core, to defeat them we would have to wage a war against ourselves. And a war against parts of the self—even against nonadaptive, dysfunctional parts, can lead only to inner discord and more distress.”
“I become free to acknowledge the addiction the moment the fact of having behaved along addictive patterns no longer means that I'm a failure as a person, unworthy of respect, shallow and valueless. I can own it and see the many ways it sabotages my real goals in life.”
“by definition, addiction is characterized by relapses. I have to get that there is no 'it' to work or not work. 'It' doesn't have to work. I am the one who has to work. And what is commitment? Commitment is sticking with something not because 'it works' or because I enjoy it, but because I have an intention that overrides momentary feelings or opinions.”
Hard Core Addiction is Linked to Brain Development (which can be f*cked by “not good enough” early development—otherwise known as poor attachment impacts your whole life):
“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 circ*mstances....gray matter density, too, is reduced in the cerebral cortex of cocaine addicts—that is, they have smaller or fewer nerve cells than is normal. A diminished volume of gray matter has also been show 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.”
“This recent primate study showed for the first time that the monkeys who developed a higher rate of cocaine self-administration—the ones who became more hard-core users—had a lower number of these receptors to begin with, before ever having been exposed to the chemical.”
“These attachment and aversion emotions are evoked by both physical and psychological stimuli, and when properly developed, our emotional brain in an unerring, reliable guide to life. It facilitates self-protection and also makes possible love, compassion, and healthy social interaction. When impaired or confused, as it often is in the complex and stressed circ*mstances prevailing in our 'civilized' society, the emotional brain leads us to nothing but trouble.”
“the mammalian brain develops largely under the influence of the environment, rather than according to strict genetic predetermination—and that this is especially the case with the human brain.”
“The three dominant brain systems in addiction—the opioid attachment-reward system, the dopamine-based incentive-motivation apparatus, and the self-regulation areas of the prefrontal cortex—are all exquisitely fine-tuned by the environment.”
“Parental nurturing determines the levels of other key brain chemicals too—including serotonin....We see similar effects with other neurotransmitters that are essential in regulating mood and behavior, such as norepinephrine.....Another effect of early maternal deprivation appears to be a permanent decrease in the production of oxytocin....Maternal deprivation and other types of adversity during infancy and childhood result in chronically high levels of the stress hormone cortisol....Another major stress chemical that's permanently overproduced after insufficient early maternal contact is vasopressin, which is implicated in high blood pressure.”
“Epigentic effects are more powerful during early development and have now been shown to be transmittable from one generation to the next, without any change in the genes themselves. Environmentally induced epigenetic influences powerfully modulate genetic ones.”
“Proximate separation happens when attuned contact between parent and child is interrupted due to stresses that draw the parent away from the interaction....The void is not in the parent's love or commitment, but in the child's perception of being seen, understood, empathized with, and 'gotten' on the emotional level.”
Suggestions for Change/Ways to Help:
“The moments of reprieve...come...when clients allow us to reach them, when they permit even a slight opening in the hard, prickly shells they've built to protect themselves. For that to happen, they must first sense our commitment to accepting them for who they are.”
“if recovery is to occur, the brain, the impaired organ of decision making, needs to initiate its own healing process”
“I learned that preaching at people about behaviors, even self-destructive ones, did little good when I didn't or couldn't help them with the emotional dynamics driving those behaviors.”
“It's a subtle thing, freedom. It takes effort; it takes attention and focus to not act something like an automaton. Although we do have freedom, we exercise it only when we strive for awareness, when we are conscious not just of the content of the mind, but also of the mind itself as a process.”
“It is useful to study and consider what combination of self-knowledge, strength, supportive environment, good fortune, and pure grace allows some people to escape the death grip of hard-core addiction.”
“The teaching of Buddhism is that the way to deal with the mind is not to attempt to change it, but to become an impartial, compassionate observer of it.”
“Anyone wanting to gain mastery over their addictive process must be ready, through counseling or some other means, to look honestly and clearly at the emotional stressors that trigger their addictive behaviors, whether those stressors arise at work, in their marriage, or in some other aspect of their lives.”
“The counterwill-driven resistance to any sense of coercion will sabotage even the most well-meant endeavor by one human being to change another.”
Four-step (plus one) Model for Change:
1. Relabel
“label the addictive thought or urge exactly for what it is, not mistaking it for reality.”
“The point of relabeling is not to make the addictive urge disappear—it's not going to, at least not for a long time, since it was wired into the brain long ago. 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.”
2. Reattribute
“learn to place the blame squarely on your brain. This is my brain sending me a false message.”
“Instead of blaming yourself for having addictive thoughts or desires, you calmly ask why these desires have exercised such a powerful hold over you.”
3. Refocus
“buy yourself some time.”
“Rather than engage in the addictive activity, find something else to do. The purpose of refocusing 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. Perhaps in the beginning you can't even hold out for fifteen minutes—fine. Make it five, and record it in a journal as a success.”
4. Revalue
“drive into your own thick skull just what has been the real impact of the additive urge in your life: disaster.”
acknowledge that “it promised joy and delivered bitterness. Such has been its real value to me; such has been the effect of allowing some disorder brain circuits to run my life.”
“do all this without judging yourself. You are gathering information, not conducing a criminal trial against yourself.”
5. Re-create
“choose a different life.”
“generate counterwill even against pressure that we put on ourselves.”
“two ways of abstaining from a substance or behavior: a positive and even joyful choice for something else that has a greater value for you or a forced decision to stay away from something you crave and are spontaneously attracted to”
“Move toward something positive, something that gives me lightness, that doesn't feel like a duty, and that allows for joy without artificial, external supports.”
“Sobriety is developing a mind-state focused not on staying away from something bad but on living a life led by positive values and intentions. It means living in the present moment, neither driven by ghosts of the past not lulled and tormented by fantasies and fears of the future.”
