The Addiction Philosophy of Dr. Gabor Maté

Dr. Gabor Maté is a Hungarian-born physician best known for the years he spent treating addicts in Vancouver's Downtown Eastside, much of it at a palliative care unit in British Columbia. His standing in addiction research rests largely on that work, which he wrote about in his well-known book In the Realm of Hungry Ghosts.

His own story starts far from Canada. Maté was born in Budapest during the Holocaust and lost most of his relatives in the closing days of the Second World War. At 12 he left Hungary with the remainder of his family and settled in Canada. Like a lot of young people caught up in the ferment of the 1960s, he was something of a student radical. He earned a degree from the University of British Columbia, taught high school English and literature for a stretch, and only later followed what he had wanted all along, which was to practice medicine. After medical school he ran a family practice on the east side of Vancouver and served as a medical coordinator at the palliative care institute, helping young people in the inner city who were struggling with addiction. Those encounters became the raw material for his bestselling book.

What sets Maté apart is the way he stays personally connected to the young patients in front of him. He builds that bridge by talking openly about his own troubles: his ADHD and a compulsive shopping habit. Neither carries the weight of a heroin or alcohol addiction, and he knows it, but his conviction is that the mechanism underneath is the same no matter the object.

From the clinical studies he took part in, Maté came to argue that a person's susceptibility to addiction can be traced back to a window that opens in the womb and runs through roughly the first five years of life. He tied this to a diminished capacity to produce neurochemicals like dopamine and endorphins, the compounds that let us feel pleasure and dull pain. When the body does not generate enough of them, he suggested, the result is trouble managing stress and trouble forming attachments. He located the roots of this in abuse, and in the absence of love, during childhood and the teenage years. The addict, in his reading, turns to drugs, alcohol, spending, or whatever else as a grown-up because the habit supplies a version of the neural stimulation they should have gotten from being emotionally cared for while they were growing up.

His working definition of addiction is plain: a behavior that reaches for temporary relief to quiet a deep craving. The catch is that the relief, the quick fix, nearly always drags consequences along behind it. If it did not, addiction would not be a problem in the first place. And willpower alone rarely settles it. The person stays hooked until they reach the thing driving the craving and face it directly.

In an interview with Time, Maté made the point that he is not only talking about substances. Sex, gambling, shopping, even work can light up the same circuits, the body's internal reward system that fires whenever we do something satisfying.

Speaking with CBS, he pressed his more compassionate method of treatment. Instead of asking "why the addiction?" he preferred to ask "why the pain?" That stance proved contentious enough that the institute where he worked with inner-city teenagers nearly lost its funding under Canada's conservative government of the time. The Supreme Court of Canada stepped in and ruled to keep it open, on the grounds that shutting down something clearly helping addicts would violate their civil liberties and simply pile on more suffering.

Which leaves an obvious question hanging. We are raised on the idea that love conquers all, so why does a more loving approach to treating addiction stir up so much resistance?

- E Bishop Wooten, The Liberal Conservative