Addicts defy easy fixes

By Terri Coles

TORONTO (Reuters) -- Dr. Gabor Mate sees ghosts. They're not the paranormal kind but regular people afflicted by a condition that Mate says originates in the brain: addiction.

In his book "In the Realm of Hungry Ghosts", Mate argues that addiction defies easy fixes and requires compassion ahead of judgment or punishment. Mate, who works in Vancouver's notorious Downtown Eastside, said in an interview he aimed to show his patients have turned to drugs and alcohol to set right an imbalance in their brain chemistry that often stems from a life of neglect and abuse.

The book, which has attracted mainstream media attention and is now on Canadian bestseller lists, derives its name from the Buddhist Wheel of Life, with six realms depicting different aspects of human life. The characters in the hungry ghost realm are scrawny, emaciated creatures driven by a constant search for something to calm an internal hunger that can't be sated.

To treat addiction, Mate said, it needs to be recognized as a condition of the brain, one that often begins in childhood or even in the womb. "When the brain is diseased the functions that become pathological are the person's emotional life, thought processes, and behavior," he writes.

The case for the connection between brain function and addiction has been well-made, Mate said. "Any human activity has to have some control mechanism in the brain," he pointed out, "otherwise it can't happen." When someone takes a drug like cocaine, their brain gets a rush of dopamine, which provides a high that other pleasurable experiences can't quite match. An addict's brain is wired to depend on that high just for normal functioning, despite the destruction caused in its pursuit. Taking drugs becomes, for an addict, less a matter of personal choice and more a matter of survival, he said.

"It's not a choice they make," Mate said. "That's a false distinction." Choice implies a measure of options, he said, ones that addicts didn't have.

In his book, Mate points out that many people who try drugs, even narcotics like opiates, do not become addicted to them. A survey published in the journal Clinical and Experimental Pharmacology and cited in "Hungry Ghosts", shows that 32 percent of those who have tried nicotine have gone on to regular long-term use, where the rate is about 23 percent for heroin and 15 percent for cocaine and alcohol. Something about those who do become addicts must be different in some way, he writes, or at least, the effects of the drugs themselves can't be the only cause of addiction.

"If you look at the street kids that use crystal meth, it does something for them," Mate said. It doesn't just make them high, but it also keeps them awake during nights on the street and provides them with a community of other users, and studies have shown an association between Attention Deficit Disorder and crystal meth use, he said. If they could get the things they needed in another way, the crystal meth might eventually become less appealing, he suggested. The fact that so many factors are at play -- personal history, brain chemistry, social status -- explains the need for a holistic approach that doesn't over-simplify addiction treatment -- and the addicts themselves, he said. "There's no single explanation, because it's a multi-faceted, multi-layered phenomenon."

Karen Minden, the CEO of Pine River Institute in Ontario, Canada, says, "Addiction is not a criminal issue. The criminal issue is the consequences of high-risk behavior. Addiction is a mental health issue and it needs to be squarely in that realm."

Pine River Institute is a therapeutic boarding school that treats adolescents struggling with addiction. Pine River's therapeutic approach, based on research and expert opinion, recognizes that the addict isn't a loser, Minden said, but is instead someone who's found a way to alleviate their pain. Because their current method is self-medication through substance abuse, staff at the institute work with the teenagers and their families to develop something better.

The teenagers who come to Pine River are mostly bright and creative, Minden said. They are also dealing with some kind of emotional trauma or pain that has led them to substance abuse, she said. By the time they end up at Pine River, they may have run into trouble at school or with the law, and many with have health issues related to their addiction. Some have attempted suicide, or had suicidal thoughts, and many are already street-involved, she said. Their drug and alcohol use has increasingly isolated them from their family and friends.

"You very often can identify these kids because they've changed peer groups," Minden said. "They're no longer with the peer group they were with when they were functioning well."

Pine River's holistic approach is proving successful in students who have left the facility and gone home, Minden said. More than 80 percent of the students they've been able to follow up on are back in school, she said, and many of them are participating in new extracurricular activities in sports and the arts.

Mate described the addicts he treats at the Portland Hotel, where he has been a staff physician for a decade, as "the hardest of the hardcore." They are marked by abuse in their personal histories, many of which are related in "Hungry Ghosts". In the book, Mate goes beyond his discussion of drug and alcohol addiction to examine compulsive behaviors exhibited by people who might otherwise look like they don't have a problem, including Mate's own struggle with compulsive shopping.

Mate has a family, a home, a career and good health, things his patients do not enjoy. "The differences, anybody can see," he said. "I'm much more interested in the similarities."  If people are resistant to his comparisons of drug addiction to behavioral addiction, it's because they are afraid they may see something of themselves in the patients he sees at the Portland Hotel, he said.

"By pointing out the similarities, I'm not saying that they're the same or identical," Mate explained. "I'm saying that the same dynamics operate to lesser degrees throughout our culture, and if we were able to recognize that we'd be a lot less judgmental."

Mate said he realizes that most of his patients will die young due to their addictions. His aim, he said, is to treat them and alleviate their suffering, because social and political conditions put a cure out of reach for most. "I could cure a lot of people -- at least, I could do much more towards a cure, if I had the right tools, the right conditions to work with," he said. "That's not a personal issue, that's a social issue."