In the Realm of Hungry Ghosts: Close Encounters with Addiction by Gabor Maté

In the Realm of Hungry Ghosts: Close Encounters with Addiction Reviews

• 
  BlackOxford

  Why Do We Do It ?
  
  Addiction is a purposeful activity, not a disease or even a condition to be cured. The purpose of addiction is to compensate for trauma, often experienced in childhood, that has produced an emotional deficit and real physical and psychic pain. Addiction succeeds in compensating for this deficit and in reducing the pain involved. Addiction also has undesirable physical side effects which are amplified by social stigmas and legal prohibitions.
  
  This, I think , is a fair summary of Maté’s medical philosophy. I agree with it. But it is precisely that - a philosophy, that is, a way of looking at the world which verifies itself. There is no way to ‘prove’ that Maté’s philosophy is correct. One either accepts it or does not based on what one considers as ‘rational.’ Historically there have been two forms of rationality that have dominated human thought - and the social policies resulting from it: causality and teleology.
  
  We habitually use the rationality of cause and effect when talking about inanimate objects and human beings whom we don’t hold responsible for their actions - children, victims of natural disasters, and those with diseases. Implicitly, we presume that these people are victims of their condition. They are either guilelessly ignorant, physically or mentally unable to respond to conditions, or simply too overwhelmed to do anything about their fate. Causality is simultaneously condescending and non-judgmental: ‘How sad, too bad, never mind.’
  
  On the other hand, teleological rationality, that is the ascription of intent, is the mode we tend to employ when we want to blame someone (or take credit for something ourselves - an interesting asymmetry). Teleology is the realm of responsibility rather than accident. Whatever state people find themselves in, they have actively participated in creating it - or so we presume. Our judgment kicks in: ‘They should have known better,’ indicating not just ignorance but error. ‘They had options but didn’t take them,’ suggesting a certain personal incompetence. ‘They are just self-indulgent,’ pointing toward a more profound moral defect. Teleology, when applied to others, is smug and uncompromising.
  
  Neither rationality works very well when it comes to addiction. We flip back and forth between them in public debates and in personal efforts to deal with addiction - in ourselves, our families, and our friends. The fact that the two rationales give entirely opposite implications for dealing with the problem of addiction creates as much stress as the condition itself. Should we ban the stuff that people use, thus eliminating a cause? Or should we counsel people who are addicted in order to create alternative motivations strong enough to overcome physical dependency? The choice is unpleasant; so we do both. With little positive result.
  
  Addiction, it seems, has its own rationality according to Maté. It involves unconscious psychic and obvious physical causality with equally unconscious purposeful intent. In this sense addiction may be considered a total physical commitment of body and mind. As such it is difficult to imagine any legal strictures or any therapy with a significant chance to mitigate it. The logic of commitment, as in marriage, religious vows, or even sexual identity - doesn’t allow half-measures. One is either in or out of commitment. Getting in is relatively easy, as many find in marriage; getting out is far more awkward, also as many find in marriage.
  
  As Maté is keen to point out with many examples, the logic of addiction as destructive commitment is relational. The object of that which is in relationship with an addict can be almost anything - other people, reputation, food, power, and, of course, a range of substances which affect body chemistry, mood, and feelings of ‘wholeness.’ The important point is that it is the relationship rather than the object of the relation which is the focus of the commitment and therefore the addiction (My own dominant feeling twenty years ago when I quit smoking 2 packs of Marlboroughs daily was one of loosing my best friend).
  
  Committed relationships are always networks. This is why they are so difficult to unravel. Addiction is in a sense a nexus of people, places, group behaviours, and symbolic objects, as well as whatever chemicals might be around. The programme in which Maté practiced in British Columbia didn’t even attempt to penetrate these networks. Its mission was to make addicts as safe as possible not cure them or ease them back into ‘normal’ society. This, I think, is an implicit recognition of both the causal complexity and the committed solidity of addiction. No therapy keyed on substance-abuse has a hope in hell of ‘fixing’ anyone.
  
  The clear implication of Maté’s experiences is that addiction is an issue of the society in which it occurs. Addiction is neither a choice nor a disease. It is a rational adaptation to that society by members who have been traumatised by circumstances. Such traumatisation is much more widespread than among those involved in illegal drugs. Addiction to sex, consumption, popularity, religion, politics, computer games, and power are much more common, and could easily involve most of the human population of industrialised countries. None of these are less destructive than substance abuse; although each has their own form of damage.
  
  All these addictions have the same ultimate source, and the same prognosis: None will be overcome without an almost mystical self-revelation about the commitments one has made simultaneously with the removal of causal ‘triggers.’ Maté is straightforward about the solution, which is just as mystical as the condition: “Addictions arise from thwarted love, from our thwarted ability to love children the way they need to be loved, from our thwarted ability to love ourselves and one another in the ways we all need.”
  
  I’m not sure if this leads to hope or to despair. But it is at least worth considering.
• 
  Caroline

  This is a wonderfully written and comprehensive description of addiction, written from a liberal and compassionate perspective, by someone who has experienced problems with addiction himself.
  
  Part of Vancouver is dedicated to housing and helping people with serious addiction problems. This is Downtown Eastside, where about five hotels are now used to provide accommodation for these people. Dr Gabor Maté is their doctor and has a surgery in one of the hotels. He is also a highly respected practitioner in the field of addictions.
  
  The book starts out by giving descriptions of some of Maté's patients, so we get an idea of them as people, and we get an inkling of the issues that cloud their lives. It goes on to explore a wealth of other areas relating to addiction:

  
  
  The relationship between caregivers and their clients:
  
  This is less about curing people and more about just being with them and respecting and supporting them.
  
  "I soon discovered that, in fact, I had very little to give - I could not rescue people from their pain and sadness. All I could offer was to walk beside them as a fellow human being, a kindred spirit." Liz Evans, nurse at The Portland Hotel.
  
  Why people become addicts:
  
  This is usually due to childhood trauma, or even trauma experienced by pregnant mothers and passed on to their children in the womb. Human children (as opposed to other mammals) are particularly vulnerable, as they do so much of their brain development outside the womb in the early years of their lives. A child needs to be in an "attachment relationship" with at least one reliably available, protective psychophysically present and reasonably non-stressed adult, in order to develop healthily.
  
  A hierarchy of addiction:
  
  There is a continuum of addiction, from those who inject heroin to high functioning addicts who shop too much, or who are workaholics. Maté says "I have come to see addiction not a a discrete, solid entity - a case of 'Either you've got it or you haven't' but as a subtle and extensive continuum. It's central, defining qualities are active in all addicts, from the honoured workaholic at the apex of society to the impoverished and criminalized crack fiend who haunts Skid Row. Somewhere along that continuum I locate myself.
  
  The worse the addiction and more dysfunctional the lifestyle, the higher the levels of distress that caused it.
  
  The more you take drugs, the less pleasurable life becomes without them:
  
  Just as we turn down the volume on a radio that is too loud, the brain of someone who misuses drugs adjusts by producing fewer neurotransmitters in the reward circuit, or by reducing the number of receptors that can receive signals. As a result, the person's ability to experience pleasure from naturally rewarding (i.e., reinforcing) activities is also reduced.
  
  
  Not everyone becomes an addict if exposed to drugs like heroin, barbiturates or amphetamines:
  
  20% of soldiers in Vietnam took these drugs. When they came home, 19% were able to stop using them. It is only those who had other problems who became addicted.
  
  Relapse rates amongst recovery addicts are high:
  
  Chronic drug use remodels the brain's chemical structure, its anatomy and its physiological functioning. It even alters the way the genes act in the nuclei of brain cells. Vulnerability to cravings can continue for years.
  
  Drugs and genetic theory:
  
  Maté thinks that the genetics theory for alcoholism has been disproved.
  
  Most chronic substance abusers are likely to have cross addictions:
  
  About 70% of alcoholics are also heavy smokers compared to only 10% of the general population. About half of compulsive gamblers are also alcoholics, and most are addicted to nicotine.
  
  Any passion can become an addiction:
  
  How can you tell when it goes from one to the other? It is possible to stop with a passion, but not an addiction.
  
  Effects of drug withdrawal or stopping a compulsive behaviour:
  
  A generally glum mood, restlessness, aimlessness. No doubt this has chemical components - with diminished dopamine and endorphin levels. The journey from self-indulgence to depression is rapid and inexorable.
  
  Personality Traits of addiction prone personalities:
  
  *A lack of self-regulation, instead they rely on external support to quell their discomfort and soothe their anxiety. These things take the form of chemicals & compulsive behaviours.
  
  *An excessive need for attention, approval or love.
  
  *They may seek outside activities to trigger elation or a sense of risk.
  
  *They are dependent on 'outside things' to change their mood.
  
  *They have a poor hold over sudden feelings, urges or desires. These come from the lower brain centres, and are meant to be inhibited by the cerebral cortex.
  
  *An absence of differentiation. They find it all too easy to pick up moods from other people.
  
  Addiction and romantic relationships:
  
  These have a great effect on people's moods if going well or badly, and are often reflected in level of drug use. People are often unable to engage in a process of recovery because their partner is unwilling to join them. Their relationship is seen as being more important than their health.
  
  What causes an addiction to one thing and not to another?
  
  Often it is the first thing a person encounters that is able to soothe difficult feelings, or that suggests affection in a barren world, eg as the baby of a depressed mother, you will be held while being fed, and food may therefore come to mean more to you than just physical sustenance.
  
  Higher rates of alcoholism among native peoples from various countries:
  
  This is due to loss of psychological, social and economic integration into family and culture. A sense of exclusion, isolation and powerlessness.
  
  The cost of buying drugs:
  
  A cocaine habit can cost $200 - £300 or more a day. Heroin is much cheaper, at about $30 a day. Funding often comes from stealing or prostitution. With stealing, you only get about 10% of the goods' value when you sell them on.
  
  Why some people manage to recover from hardcore addictions:
  
  Self knowledge
  Strength
  Supportive environment
  Good fortune
  Luck
  Capacity to endure pain and suffering.
  Fortuitous circumstances.
  A new relationship.
  A flash of insight.
  A sudden opening to faith.
  
  And we shouldn't judge those who can't recover:
  
  Some people manage to recover from hardcore addictions. Just because one person succeeds we cannot judge another person for failing. It is even more nonsensical to judge addicts by criteria derived from the experience of people with relatively normal lives. "It is unjust to hold a traumatized and neurologically impaired adult to the same standard as one not so afflicted." says brain researcher Martin Teicher.
  
  How much actual freedom to choose does any one human possess? There is only one answer - we cannot know. There is no way of gauging the burden of emotional suffering weighing down one person's psyche against another's.... that is why it is facile to demand that anyone should be able to "just say no" and to judge them as morally lacking if they can't.
  
  "This aberrant behaviour has traditionally been viewed as "bad choices" that are made voluntarily by the addict. However recent studies have shown that repeated drug use leads to long lasting changes in the brain that undermine voluntary control" Dr. Nora Volkow, Director of the National Institute on Drug Abuse in the U.S.
  
  Judging the addict:
  
  We cannot help people when we put ourselves in a position of judgement. Addicts, all but the few completely sociopathic ones, are deeply self-critical and harsh with themselves. They are keenly sensitive to judgemental tones in others and respond with withdrawal or defensive denial. A prayer on wall of one of the clients, called Kim
  
  "Oh, Great Spirit, whose voice I hear in the Winds and where breath gives life to all the world around me, hear our cry, for we are small and weak.... Help me make peace with my greatest enemy - myself."
  
  
  The decriminalization of drugs:
  
  Maté is in favour of this - not least because of all the stealing/prostitution that has to be done to raise the money to buy drugs. Also the jails get filled with people with addictions. He stresses that decriminalization is not the same as legalization. With decriminalization, people are allowed to carry small amounts of drugs for personal use, but the manufacturing and selling of drugs is illegal.
  
  He believes that drugs should be given to confirmed users under safely controlled conditions, via doctors prescribing drugs to people addicted to them. If they didn't have to spend exorbitant amounts on drugs that, in themselves are inexpensive to prepare, addicts would not be forced into crime, violence, prostitution or poverty to pay for their habits. Ideally there would also be publicly funded rehab facilities with after care, to help those who may be able to stop their habits.
  
  Some people can function well if supplied with drugs at a level to meet their base needs:
  
  Dr William Steward Halsted, who did incredible work at John Hopkins University in the early 20th century, was also a morphine addict for over 40 years. Most hardcore addicts couldn't function at this level, even if their substance needs were met. They have too many problems. Even so, they would be much less of a burden on society if their basic needs were met.
  
  Decriminilization and crystal meth/methamphetamine:
  
  Here Maté shows reservations. He says there is no safe way to use it. The only solution is to try and help people wean off it.
  
  Mindfulness as a path to recovery:
  
  In this section Maté talks quite a lot about his own addiction to buying classical music cds, and how mindfulness can help those whose problems are amenable to recovery. He talks about the brain being plastic, therefore open to change, about people who have had strokes or depression, Tourettes or OCD, who have managed to improve their functioning. "Arduous effort is required on the part of any addict - not least because their compulsions promise pleasure and reward." But with some people and circumstances change is possible.
  
  Mindfulness and 'Bare Attention':
  
  By consciously observing the workings of our mind, we are gradually able to let go of its habitual, programmed interpretations and automatic reactions.
  
  In a mindful state one can choose to be aware of the ebb and flow of emotions and thought patterns instead of brooding on their thought content. eg someone may notice that feelings of resentment and a desire for vengeance keep flooding their mind. Rather than just having the feelings, they will observe them.
  
  'Bare Attention' is the clear and single-minded awareness of what actually happens to us and in us at the successive moment of perception. It is called "Bare" because it attends just to the bare facts of a perception as presented either through the five physical senses or through the mind - without reacting to them.
  
  Although 'Bare Attention' was developed as a meditative practice, its use is not limited to formal meditation. It is the conscious attending to what occurs in the mind as it takes in physical or emotional stimuli from within and outside the body.
  
  Meditation for the over-active mind:
  
  Maté has always wanted to meditate, but has found it impossibly difficult " My addiction-prone ADD brain always wants to look to the outside to get away from itself. As a result I tend to oscillate between excessive, multitasking, busyness and a proclivity for 'vegging out', in ways that leave me non-rested and dissatisfied. Meditation, with its demand for stillness and self-observation has not been an activity that I have joyfully embraced."
  
  He says that at a meditation retreat, Maté had a breakthrough. He realised that one doesn't have to be good at meditation, achieve anything, or look for any particular result. As with any skill only practise leads to improvement - and improvement is not even the point. The only point is the practise. "When I do practise meditation, I find more ease in my life. I'm calmer, more emotionally present, more compassionate to others and I am far less reactive to external triggers."
  
  Recovery and honesty:
  
  He talks about exposing one's addictions to the light of day - much easier when you are treating yourself with 'compassionate curiosity'. "Even before I stopped buying compact discs, for months I would tell Rae (his wife) about it. I had nothing to hide, my compassionate curiosity discovered.... Exposed to the light of day, the addictive compulsion does not develop power and heft. I had much less of an urge to binge, and the occasional visit to the music store did not evoke a helpless desire to go back the same day, or the or the next. My advice to anyone with addictive behaviours is to begin telling the truth".
  
  Addictions and stress:
  
  If you live a life full of stress you are unlikely to be able to break your addiction. Addictions - in the short term - act as stress relievers.
  
  People often take on chronic stresses because of ingrained beliefs of how we 'ought' to behave.
  
  For friends and family of the addict:
  
  Motivation has to come from the addict. No-one outside can do that. Love and kindness though work much better than 'tough love' interventions.
  
  It's fine to set your boundaries with an addict, but not in order to control or blame them. Instead you need to communicate what you can and cannot accept.
  
  If you have to choose between staying with an addict and feeling resentment, or leaving and feeling guilt, opt for the guilt.

  
  
  I can't think of a better book to be read on the subject. Whilst I still have a few questions (most of all....surely the sudden rise in opiate addictions via medical prescriptions, cannot all be explained in the the theories put forward by Maté?), I nevertheless feel I have learnt an enormous amount from this book.
• 
  Brenda ~Creep it real, witches~traveling witch

  Dr. Mate is a physician for The Portland Hotel Society in Vancouver’s Downtown Eastside that provides housing and care to addicts who are in the last stages of addiction. He gives us a powerful and fascinating look into the science of addiction, and the addiction process. Dr. Mate also shares with us heart wrenching personal interviews of addicts he has worked with. These stories left me with feeling empathy and some understanding of individuals with addicted brains. There are no recoveries here. Even though these are important stories I did skip over some and when I am ready I might go back and read them.
  
  I was glad to see Dr. Mate address addiction and mental illness. Which I feel is important to understand addiction. The information in this book doesn't just apply to drug addiction but all addictions. Dr. Mate also tells us of his own addiction which is not a drug addiction.
  
  There is so much good information in here that I can't even begin to say in a review. I borrowed the Ebook from Overdrive but I am also going to purchase the book as I found it a very valuable source of information that I will be referencing back to.
  
  I will admit the spiritual and 12 step program wasn't something I was interested in. I would of liked more information on evidence-based therapy like CBT and Motivational enhancement training for treating addiction. I would recommend this book to anyone with a loved one who you think might or has an addiction or to anyone looking to understand addiction or just want to challenge their views on addiction.
• 
  Stephanie

  I read this for a master of social work drug and alcohol class. The professor said we would likely become enthralled and breeze through it's 400 plus pages in a weekend as she did. That was not my experience. I took a really long time reading this book, highlighting as I went.
  It was an excellent introduction to the field of addiction, blending tender humanity with hard science. I found Dr. Mate's critiques on the horribly flawed legal system to be spot on, his personal vingetes and descriptions of the addicts he knows and treats to be intimate and engaging, and most especially I loved the end of the book- where Dr. Mate breaks down the force behind the addiction and what personal healing entails. Once addiction is opened up in this way, it becomes apparent that all of us function on this continuum, which makes empathy a little easier to come by and understanding a little closer to home.
• 
  Kevin

  Addiction in Terminal City and beyond...
  
  Preamble:
  --I cannot possibly give a 5-star rating to 3 psychology books in a row… I jumped on this 480-pager after Hari’s
  Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions and
  Chasing the Scream: The First and Last Days of the War on Drugs, where the city I live in (Vancouver, Canada) is featured (“Terminal City”) for (1) grassroots activism for addiction harm reduction and (2) addiction research by author Dr.
  Gabor Maté (esp. addiction and childhood trauma) and
  Bruce K. Alexander (“Rat Park” studies).
  
  Highlights:
  
  1) Dislocation and childhood trauma:
  --I've summarized the focus on social roots of addiction (as opposed to chemical) in reviewing Hari's
  Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions. For those who find Hari's journalist writing style a bit sensationalist at times, useful supplements: "Heroin on Prescription", "Neuro-Realism", "The Least Surrogate Outcome", "The Stigma Gene", "Brain-Imaging Studies Report More Positive Findings Than Their Numbers Can Support. This Is Fishy" in physician/evidence-based medicine prof Goldacre's
  I Think You'll Find It's a Bit More Complicated Than That.
  --Maté opens the empathic door with his experiences as a doctor treating addiction in Vancouver’s infamous Downtown East-side (DTES), adding the visceral details of personal cases to the framework of addiction’s social roots: dislocation (esp. from meaning) and childhood trauma (pain). Addiction thus functions as relief (self-medication) much more than as vapid pleasure.
  --Hints of connecting an individual’s drug addiction with society's economic-growth industries gets the political-economy nod from me; lowly drug addicts are punished for serving as a mirror to society’s own addictions (endless profit-seeking growth beyond planetary boundaries/balance, which requires demand to keep up; this excess consumerism is manufactured by the colossal advertising industry, whose product is dissatisfaction and consumerist addiction). Synthesizing the roots/alternatives to addiction and applying this to our society’s addiction to economic growth in the age of ecological crises seems prescient.
  -
  Gone Tomorrow: The Hidden Life of Garbage
  -
  Captains Of Consciousness: Advertising And The Social Roots Of The Consumer Culture
  -
  A Consumers' Republic: The Politics of Mass Consumption in Postwar America
  -
  Channels Of Desire: Mass Images and the Shaping of American Consciousness
  --Maté highlights how medicine is predominantly focused on reactive disease-classifications rather than proactive public health promotion (in this case, healthy psychology esp. childhood development). Despite some technical challenges (ex. difficulty in studying positive development factors like parental attunement), medical institutions are conservative power structures lacking broader synthesis. We can add that medicine (like many social services) is increasingly marketized into profit-seeking businesses (rather than social needs); prioritizing social needs have always had many contradictions with the capitalist economy (i.e. not socialism). Note: ironically, it is Big Media’s sensationalism that obscures Big Pharma’s structural depravities with crude anti-vax/AIDS denial distractions:
  -
  Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients
  -
  Bad Science: Quacks, Hacks, and Big Pharma Flacks
  --To really get to the roots of addiction requires socially prioritizing the phase from prenatal to early childhood, providing universal economic/nursing/psychological/community support, rather than today’s fend-for-yourself individualism, economic stresses (both parents working, precarious jobs, household debt, housing costs from financial speculation) and accompanying abandonment... There are much more short-term profits in stressing the vulnerable and creating addiction!
  --For those abandoned succumbing to addiction: without social prioritization building an “island of relief”, addiction prevention erodes into addiction management (i.e. chronic disease), where harm reduction is the only viable bandage. Thus, we have Vancouver, with:
  (i) Grassroots activism winning some of the most progressive harm reduction policies to provide humane treatment for addiction as a chronic disease (i.e. safe maintenance via safe injection sites, detox, etc.), while
  (ii) Rampant capitalism (financial speculation ballooning housing prices, high inequality with precarious-yet-essential service jobs, Darwinian individualism and voracious advertising of consumerism) creating ever-more addicts and relapses. If you cannot build alternative communities, where else can you turn to?
  --I'd be interested comparing this with, say, modern China’s efforts against the legacy of colonial Opium Wars: communist China’s approach seems to be reversed, with (i) conservative anti-drug repression, while (ii) focusing on social needs and building alternatives, from pre-revolution’s 30’s life-expectancy + Century of Humiliation to mass literacy/public health/land reforms/infrastructure/anti-poverty policies (on this, see a comparison with post-colonial India:
  Capitalism: A Ghost Story)
  --I will add that bad-ass
  Michael Parenti (political economy) seemed to voice support (at the end of a lecture) for prohibition of hard drugs in the context of this actually not being enforced (because the CIA was involved in the drug trade and FBI COINTELPRO used this to derail urban black/Latino activism). I assume what Parenti meant was proper regulation, not prohibition which is, after all, US’s policy and results in criminalization, thus black market criminal violence and lethal dosing; the CIA/FBI activities are extralegal (always tricky when your government is an empire). See:
  Chasing the Scream: The First and Last Days of the War on Drugs
  
  2) Genetics vs. Environment:
  --“Psychology” was one of the earliest nonfiction topics I explored, starting with
  Steven Pinker’s
  How the Mind Works. Little did I realize I was falling into the logic-bros trap of New Atheist/Western Enlightenment theology, as I then descended down Pinker’s
  The Blank Slate: The Modern Denial of Human Nature and especially
  The Better Angels of Our Nature: Why Violence Has Declined (which I later could barely stomach to review as part of my 12-Step recovery program),
  Sam Harris’
  The Moral Landscape: How Science Can Determine Human Values (and many more, dear god, pun intended).
  --Thankfully, I am blessed to come from an immigrant family; even though I was completely ignorant of world history and geopolitics at the time, something still did not pass the smell test. Today, I have yet to fully unpack how much of their abysmal analysis of history/geopolitics lies in methodological practices/ideological assumptions that also affect their “science”; I’ve wasted enough of my life on them the first time to relapse. Thankfully, this was all pre-
  Jordan B. Peterson; what’s with all these hacks emerging from “psychology”?
  --I do remember being impressed with Pinker’s descriptions of twin studies, which I am happy to now see Maté critique. These studies buttress the medical focus on genetics over environment:
  (i) Adoption studies are supposed to isolate genetics (since for non-adoption, children and parents share both genetics and environment). However, given Maté's focus on prenatal development, many environmental factors are already introduced pre-adoption (mother’s stress, separation).
  (ii) Identical vs. fraternal twins studies are supposed to isolate genetics, but Maté highlights the environmental factors missed in comparing with fraternal twins where fraternal differences (physical, temperament) trigger different environmental responses.
  …overall, Maté’s focus on epigenetics (how environment shapes gene expression) and the “synaptic pruning” during infancy is compelling, as is the critique that conservative ideologies conveniently focus on genetics to avoid inequalities in the environment.

  In the period following birth, the human brain, unlike that of the chimpanzee, continues to grow at the same rate as in the womb. There are times in the first year of life when, every second, multiple millions of nerve connections, or synapses, are established. Three-quarters of our brain growth takes place outside the womb, most of it in the early years. By three years of age, the brain has reached 90 percent of adult size, whereas the body is only 18 percent of adult size. This explosion in growth outside the womb gives us a far higher potential for learning and adaptability than is granted to other mammals. […]
  
  Greater reward demands greater risk. Outside the relatively safe environment of the womb, our brains-in-progress are highly vulnerable to potentially adverse circumstances.

  --Now, a general critique of this book seems to be Maté’s section on his own behavioral addition, where critics seem to focus on the whimsical surface behavior (purchasing classical music) and not on the consequences (neglecting parental and doctor responsibilities).
  --I’m still processing Maté’s steps to sobriety; his bits on Buddhism reminds me how much I prefer someone like Maté mentioning this as opposed to a useful idiot like Sam Harris (
  Waking Up: A Guide to Spirituality Without Religion).
• 
  Meaghan

  Written in clear, lucid prose any reasonably intelligent adult could understand, without a lot of confusing jargon, Dr. Mate explains the forces behind addiction and why so many addicts fail time and time again to get clean, in spite of all the incentives for doing so. This book gave me a lot to think about regarding the brain, and I also found his cautionary points about adoption studies and twin studies very interesting and relevant. Mate conclusively demonstrates that addicts are not "bad," that they have very little control of the actions surrounding their addiction, and that kind and loving parents can produce an addict just as easily as indifferent or abusive parents. (On the last point Mate uses his own experiences as a child Holocaust survivor as an example: his parents loved him very much and cared for him as best they could, but the stress and deprivation of his infancy left an ineradicable mark on this brain development.) Finally, Mate sets forth a sensible "harm reduction" social policy that could potentially make life easier for everyone, not just addicts and their families, by reducing the problems drug abuse causes in the community.
  
  Everyone in Congress should read this book, as well as everyone who has to interact with addicts on a regular basis. Dr. Mate is a wise, forward-thinking man.
• 
  Sandra

  To a hammer, everything looks like a nail. And Maté is one dedicated hammer.
  
  The first part of the book (patients' personal histories) is the best and only good part. The rest is painfully repetitive and unnecessary stretched out development of the author's Grand Theory of Human Addiction. The whole thing is almost preposterous.
  
  For example, p233: "If children today are at greater risk for obesity than those of previous generations, it's not simply because they're less physically active as a result of being absorbed in TV or computers. It's primarily because under ordinary peacetime conditions there has never before been a generation so stressed and so starved of nurturing adult relationships." Seriously, this is what we are going with here? It's such an incomplete and incompetent argument, and it's hardly the first or the last one. It was the final nail in the coffin of my patience with this book.
  
  I get it, Maté is endlessly compassionate and wants the reader to come on that trip with him. Unfortunately, if you separate the compassion from the model he's advocating for, you realize that compassion and lazy thinking are the only glue keeping his ragtag theory in one piece.
  
  Also, it is hard not to get fed up with Maté's many dramatic accounts of his own so-called-addiction - compulsive purchases of classic music CDs. Really, he's completely serous about that. He even goes to AA meetings and tells his addiction story, to have other attendees as well as his patients "confirm" to him that what he experiences is totally the same addiction mechanism at play as theirs. Jesus H. Christ on a bicycle. At one point, you might catch yourself wondering if everything is okay with Mr. Maté. Ten years later, is he still spending hundreds of dollars on CDs, or has online streaming provided some relief (and savings)? You might even wonder how he would cope if his "addiction" is taken away from him. We might never know.
  
  It is obvious there might be something to some parts of his theory, but this hot mess (I didn't say dumpster fire) of a book is not it.
• 
  Tricia

  I'm not much of a fangirl until it comes to doctors or scientists that step out of the box of the limited view of their academic training and start learning and teaching from their experiences.
  
  Open-mindedness is S-E-X-Y.
  
  So I fangirl all over the place when it comes to Gabor Maté. Not only is he from my home country (Canada), he has spoken on trauma as being at the root of addiction, mental illness and a number of other behavioural "disorders"--trauma as defined as a disconnection from oneself--which in my experience with such, is bang-on TRUTH. He affirms my experiences, he opens me up to different perspectives, and I love him for it.
  
  I cannot wait to dive into this book.
• 
  Cristina

  "Dependenta este intotdeauna un substitut jalnic pentru iubire. "
  
  O lectură esențială intr-o lume mult prea modernă pentru natura umană, o lume săracă în relații si interacțiuni sincere, o lume plină de durere tainuită, de rușine, si copleșită de un sentiment de neapartenență. Gabor Maté face o treabă bună in a ne purta prin tărâmul îngrozitor al dependențelor, in a identifica si explica sursa dependențelor, si mai important, declanșează o dorință de analiză si reflecție. Persoanele dependente de substanțe injectabile sau nu sunt oglinda lumii pe care o construim. Sunt copiii de ieri a căror minte a fost copleșită de teamă. Ar trebui sprijiniți cu iubire si prietenie. Ar trebui ajutați. Se fac vinovați doar a de a fi umplut golurile și a fi îngropat durerea cu ce au avut la indemâna...in timp ce noi ii privim cu dispreț. Suntem mărunți...
• 
  Jennifer Welsh

  OK, all you Book Addicts, listen up! Because this book is about us, and that’s one reason I gave it 4 stars. I mean, here I am always whining about how a book just “wasn’t deep enough,” or “wide enough,” blaming my lack of satisfaction on the work, rather than looking within, and finally I find an author who gives me everything he’s got - deep, wide, personal, societal, serious, funny and true - and I can’t give him the 5 stars he deserves. I’d better have a good reason - this is, after all, a psychology book.
  
  Well, now I tease. Because as much fun as I’ve had last week writing more reviews than I do in months, (it was the one good thing about being laid up with a virus), I must return to work. But if you’re at all interested in the intersection between psychology and spirituality, if you’re at all curious about addictions and compulsions, you might love this book. And, if you’re wondering why you might just really like it instead, stay tuned: I will tell you soon.
  
  Here it is UPDATE 10-29-22:
  
  OK, so Gabor Mate went to the same school of spiritual teaching that I did. He went for way longer, but I put in 5 years, and some of what he talks about in this book comes right out of that teaching. I love that teaching, it still speaks to me more than no other, but he merges one of the main principles - that of psychological fixation, which we all have, although our fixations differ from person to person - with addiction. I don’t think they are the same thing. I do appreciate the compassion with which he sees addicts as suffering from the same stuff as everyone else. And one of the reasons this was recommended to me was because it also deals with fixations. I knew someone else who read this to help her understand why her boyfriends have all been abusive, even though she’s not addicted to substances. I appreciate Mate’s reach. He’s doing good in the world. Yet, addictions and fixations are not the same thing, and I wonder if the message addicts need gets diluted as a result.
• 
  Lumumba Shakur

  This is a fascinating look at the chemistry of addiction and a call to a more progressive public policy. Dr. Gabor Mate's style of writing is captivating and he is masterful at explaining specialized knowledge in laymen's language. My own mother, a recent graduate of medical school, when I summarized some of his arguments, commented on how Dr. Mate made connections for her that she could not quite make herself during her medical training (due to the emphasis on "treatment" over cause with respect to mental disorders) and she agreed with his criticisms of the way in which doctors are educated in the West. She also was amazed at how I was able to explain things to her that she herself had spent the past 8 years of her life learning based on Dr. Gabe's explanations.
  
  Stylistically, Dr. Mate draws you in by giving you the biographies of several of his patients at the harm-mitigation facility that he currently works for. Most, if not all, of the stories are of people who were severely abused as children and as a result of the pain, turned to substance abuse as a form of self-medication (and perhaps more importantly for his purposes: why this self-medication is actually an effective short-term solution) - stories of which I am all to familiar with in my own professional life as a youth counselor. Just as you feel you've been beat over the head one-too-many times with such heart wrenching stories, Dr. Mate switches themes and slowly takes you through the process of addiction and eventual self-recovery. As this is not a propaganda piece - very few of those initial stories have entirely happy endings. People are people and the story which stuck with me the most is of a man who called his sister in Ireland to tell her that he would not be flying home and that he instead would make arrangements for his body to be sent to the family plot. Other stories are perhaps more profound, but this particular one that he more-or-less ends with highlights the unfortunate reality that the lives of most hardcore addicts end in early death - something my family knows all too well.
  
  Far from being a simple tract on addiction, Dr. Mate demonstrates how drug addicts are just an extreme end of a continuum of behavior that applies to large segments of society. By weaving together the connections between early childhood development (in ureto and post-natal) and the effects of trauma on the human psyche, Dr. Mate makes the case not only for a more comprehensive and compassionate health care system, but establishes the fact that the rising levels of addiction among modern (and I would say modernizing nations) is little more than a symptom of a larger social ill that is increasingly becoming more and more malignant: the breakdown of the traditional family and community social structure. That being so, no amount of "tough love" or criminal justice involvement is going to cure the problem. Instead, our approach (the American approach that we have unfortunately successfully forced down the throats of most other nations) only further punishes and ostracizes the same victims of abuse that we all felt compassion for at an earlier point in these same peoples' lives.
  
  In keeping with the themes of his previous works (which I have not had the good fortune to read yet, but have heard numerous interviews Dr. Mate has given in American media), this is a book that should be essential reading for anyone involved in the health care industry - especially mental health and youth behavioral management - as the rate of substance abuse in those communities is incredibly high. I would also recommend this to anyone with young children, victims of abuse and young couples seeking to have little ones. Even more so, this is also a must read for anyone who suffers from any type of addiction. One particular chapter is of vital importance: "A Word to Families, Friends and Caregivers" in which he offers very realistic and practical advice to the families and loved ones' of addicts. The phrase, "Choose guilt over resentment" was profound and likewise was the self-critical analysis Dr. Mate prescribes for this group of people - most notably that we (as family, loved ones or caregivers) often make the process of recovery that much more difficult. The fact that in addition to being a youth counselor who worked with the very same sorts of people that eventually found their way into the Portland "Hotel", that I am also the son of a recovered drug addict and alcoholic made the book that much more meaningful to me.
  
  After Dr. Mate establishes the causes and the physiological factors that lead to addiction - he gives advice on how to achieve sobriety. In terms of my own religious persuasion, I could see clear parallels between Dr. Mate's recommendations and my own religious spiritual tradition. His methods of self-help reflect the techniques recommended by a savant I am affiliated to as the most tried-and-true techniques for the breaking bad habits and removing sin from one's life. This is particularly true is his "Four Steps: Plus One", his adaptation of a self-help program designed by UCLA, which is in lock-step with the tarbiyah of the Darqawi-Shadhili Order and the famed "Muraqaba Durus" one of its contemporary Hashimi branches (which was adopted and expanded as a part of the practical spirituality contained in
  Agenda to Change Our Condition).
  
  For instance, in regard to the first step, "Relabeling" Dr. Mate gives the following insight,

  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 strengthening every time you give in to it and every time you try to suppress it forcibly. (p. 377-8)

  Upon reading this, I was reminded simultaneously of the Sufic insights regarding khawatir (thoughts) and how they turn into obsessions (i.e. "behavioral addiction"), Mawlay al-Arabi's elucidations on hawa ("vain caprice" - which is precisely what Dr. Mate is talking about when he identifies addictive behaviors as things we all know are not good for us in the long run, even as they serve some short-term purpose) and of the advice that in respect to spiritual self-discipline intended to rid oneself of such problems, one should not go overboard, "lest the nafs kick-and-scream in revolt".
  
  As another example, on "Refocusing":

  Rather than engage 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. (p. 379-80)

  I.e. "Ours is not a way of rigorous spiritual struggle. Rather, ours is a way of diplomacy. We give the nafs what it wants within the convinces of the Sacred Law on the condition that it is going to work for us when we need it to." And the entire chapter "Sobriety and the External Milieu" can be summed up with the words of Abu al-Hasan al-Shadhili, "Do not stir your feet except where you expect the reward of Allah; and do not sit except where you are likely to be safe from disobeying Allah." Or as Dr. Mate put it,

  [C]reating an external environment that can support one's move towards conscious awareness is one essential feature of the recovery process. (p. 388)

  I could go on and on as I found myself able to fill in the gaps explicitly for Dr. Mate in this part of the book, as he clearly has studied Buddhism and his spirituality is rooted entirely in that world-view. Also being a Jew, he is familiar enough with the Old and New Testament - but seems to have little to no familiarity with Islam and its spiritual teachings (though I do appreciate his referencing of the Qur'an). Due to this, perhaps the only chapter of the book that I was not incredibly fond of was his attempt to relate the religious message of AA's "12 Step Program" to a wider audience - which undoubtedly involved a certain world-view and theological relativism. This is perhaps the weakest chapter of the book, though I would imagine that those who share his philosophy may disagree with me. And as it is fairly short, you do not get the impression that you are being preached to. Rather, Dr. Mate is clearly trying his best to articulate his spirituality to a general audience that may not necessarily agree with his personal theological conclusions. And in that, he succeeded, as I found myself agreeing with the overall message of this particular chapter.
  
  In sum, from cover to cover, this is a fascinating book that I highly recommend to everyone as there are few of us who to one degree or another is not addicted to something - whether it be methamphetamine, prestige, attention or power. Everyone who is honest with themselves will see something of themselves between the covers and will walk away a better person for it. And those who know, love or have loved someone addicted to life-debilitating and/or illegal substances will walk away with a more profound understanding of their struggles.
  
  Wa-Llahu `alim wa musta`am
• 
  India M. Clamp

  Hungry ghosts is an accurate description. In this particular nightmare by Gabor; though we like to think that all things are living and sentient, we forget the body may be hijacked by things that place the body in a dark cold place where mandatory attire is a blindfold and sensory deprivation. He refers to the walking dead he personally encountered when he was staff physician for the Portland Hotel Society (they provide housing and medical care to addicts). This is 450 pages with seven chapters. We begin a lurid journey with Dr. Maté commencing with part 1 titled "Hellhound Train."
  
  “The research literature is unequivocal: most hard-core substance abusers come from abusive homes. ... If they have chosen a path to nowhere, they still have much to teach the rest of us. In the dark mirror of their lives we can trace outlines of our own."
  —- Dr. Gabor Maté
  
  Place yourself now on a street in downtown Vancouver, people are living in tents. The only reason they live is for drugs. A funeral is being held now (heroin addict) for Dr. Matés' former patient. Sharon was her name (when she was alive). If you are looking for stories of recovery, seek it elsewhere---this is a blunt study of urban addiction motivated by dislocation. Maté cites alcoholism became a raging epidemic with the rise of industrial societies, destruction of the safeguards, care and love provided by family, friends and community. Root cause is indicated. Very sensitive content involving babies/children with video/audio evidence of serial rape/molestation. “Caveat Emptor.”
• 
  jenny✨

  i love gabor maté's brain, and my values align wholeheartedly with his. there was a lot i enjoyed about this book.
  
  but at the same time, this book was, surprisingly, a slog for me to get through 😭 maybe it's because i went in thinking there'd be more personal anecdotes as well as vignettes of his patients' stories, instead of being a book that is largely psychoeducational and neuroscientific - two topics i personally have saturated while at school/work.
• 
  Louise

  If you live or work in a city, every day, you see people like those described in the first 100 pages or so of this book. Dr. Gabor gives you their back stories. They are the author’s drug addicted patients. After you see how much people are willing to lose to get the next hit, you learn of the brain chemistry, social policy, how addicts can be treated and Dr. Gabor’s own socially accepted addictions.
  
  Gabor cites research that validates common sense for anyone who is observing. Addiction (and I presume a lot else) can start in the womb when 17% of the brain is formed. If the mother is stressed (living in poverty, violence, with abuse) the stress of her life will be transmitted. The result for the fetus is that the systems for producing two important soothing agents – dopamine and endorphin – will be underdeveloped. After birth, if the stress continues as the brain more fully develops its circuitry the soothing systems will remain underdeveloped leaving the child at risk for taking anything that will produce these agents.
  
  For these children and the teens and adults they become, the drug experience is a well being, previously not experienced. Gabor shows how the body develops systems to implant a habit and embeds triggers that create a “hungry ghost”. As the ghost is fed with its required drugs, the area of the brain governing impulse atrophies leaving the person disabled in the ability to stop taking drugs..
  
  Gabor uses his own experience to illustrate. As a Jew born in Hungary in 1944, he was born into stress. To save him, his mother gave him to a gentile family. Regardless of all the love his mother gave him, and that of the caregivers, his own brain, knowing only of the stress, did not develop soothing systems. Unlike his patients, he had a middle class family and guidance and became a workaholic… his work and his love of classical music feed his “hungry ghost” to the neglect of his wife and son. He shows how this “social” addiction (like gambling, shopping, sex, power, etc.) are all generated by the brain in the same way as substance addiction.
  
  While his profession is set up to give the addict hope and a means to breaking free, Gabor shows how the odds for a long term user are low to impossible. At some point the brain is wired to require the drug and disable restraint systems. The evidence can be shown scientifically in the brain and in merely observing how much the addict is willing to lose to have it.
  
  With this background, Gabor takes on the “War on Drugs” and how it plays out on the street and the havoc it wreaks on the families of the addicted without solving the problem. He poses common sense solutions and shows how difficult they are to implement with current priorities.
  
  The book is sweeping in outlining the problem and its personal and social costs. While published in 2008, this must be a classic. I was wait-listed for one of our library’s 5 copies for 4 months. If you are interested in this topic or have an addicted love one, you will want to read this book.
• 
  Reid

  This book about addictions of all types has much to recommend it. Maté has a wealth of experience with severe drug addiction, and he has obviously done his homework. But he has a tendency to go on and on (an addiction of its own!) and the book becomes tedious. He belabors many of his arguments and piles documentation upon documentation until one is bewildered by the sheer volume of the verbiage. What the author could most benefit from is a strict editor who could make this book about 2/3 its current length.
  
  Dr. Maté also seems to have several axes to grind here, and makes a case for a particular approach to the treatment of addiction that is far from proven. He also takes issue with the genetic source of addictions and spends an inordinate amount of time making this case, although there really is no question about this issue; there is a proven genetic basis to addiction, and his argument that there is not is mostly a waste of time, not merely because the science is not with him, but because it really doesn't matter much. The case he makes for environmental causes of addiction is compelling and whether there is any genetic component is, in the final analysis, mostly irrelevant.
  
  Unfortunately, such digressions and jeremiads are rife in this book. Had he merely stuck to what he knows, supplemented here and there with some support for his pet theories, both he and the reader (not to mention addicts) would have been much better served. One wishes him well in his chosen work with hardcore injection addicts in Vancouver's Downtown Eastside, and in battling his own addictions, minor in comparison, but still a real struggle, which he has the honesty and courage to reveal. Still and all, what one mainly ends up wishing for him is an authoritative editor with an outsized red pen.
  
• 
  Jansen Estrup

  Dr. Mate's book is one of the most important of our age. Throughout he documents the plague of our time, addictions ranging from drug abuse to work-a-holism. He cites study after study, experience (he is a serial addict himself) as a drug counselor and researcher. It is stress, he argues, prenatal and as infants, which causes the childhood brain to wire itself in self destructive ways. These efforts are essential to survival as children but devastating in adolescents and adults.
  As a fetus his stress was caused by the Nazi extermination of Jews and later by being passed from one frantic 'safe house' to another. Warfare severs infant bonding and such children never recover to gain a sense of trust in their environment. But it doesn't take warfare to cause this disconnect. Spousal abuse, hunger, a parent's own emotional baggage (all symptoms of Western culture) and the demand for ever more 'work' and 'things' make for a wide range of unsettled children, teens and adults. Individual assurance gets short shrift and accounts for the endless variations of magical, 'positive' and wishful thinking which attract us to charlatans of various talents.
  
  Mate's recommendations are insightful and even possible, if civic and medical leaders would examine them. They are compassionate, workable and even much less expensive than our never ending 'war on drugs' ...
  
  Tremendous piece of work!
• 
  Emma Deplores Goodreads Censorship

  This was an unusual reading experience for me, in that I initially couldn’t stand Part 1, but rather than abandoning the book, skipped ahead to sections that interested me more. The book slowly grew on me and I wound up reading it all and appreciating it quite a bit, and it works fine out of order.
  
  In the Realm of Hungry Ghosts is the work of a Canadian medical doctor who treats primarily hardcore drug addicts, seeking to explain and contextualize addiction and change the conversation around it. It evidently has been quite an influential book and has been credited with helping change minds about the War on Drugs—which has taken a positive turn since this was first published in 2008.
  
  This book’s goals go beyond policy arguments though, presenting an understanding of addiction as a continuum on which many types of dysfunction aren’t as different as we may think—from alcoholism and drugs to behavioral addictions (including those seen as respectable), as the brain processes seem to be similar. It also forwards a view of addiction that I think is much more accepted now than in 2008: not as a personal failing or genetic disease, but as a way of self-medicating trauma, dislocation and a lack of connection and meaning. Much of this wasn’t new to me, having read such excellent works as
  The Body Keeps the Score (about PTSD, in particular the long-term effects of childhood abuse and neglect) and
  Lost Connections (about societal causes of depression), but was still useful to see presented in a different context.
  
  Part 1 tells stories from the author’s medical practice, and this part threw me, because I expected it to relate the stories of his patients in a more direct and sustained way rather than centering the doctor’s perspective. It recreates the experience of having large numbers of needy people cycling through his office in a limited amount of time, rather than picking individual patients to follow in-depth. However, another reader pointed out that focusing on his frustrations and day-to-day work may make a more palatable entry point for skeptical readers, with whom this book has apparently been successful, even if it isn’t the best means of preaching to the choir. This section certainly drives home that the most “hopeless” drug addicts are people who have faced extraordinary suffering in their lives, generally from early childhood on.
  
  Subsequent sections walk readers through the science of addiction: how particular drugs affect the brain, why they’re addictive, and also how childhood abuse and neglect themselves affect the brain so as to make it vulnerable to addiction in the first place. Maté emphasizes that it isn’t the drugs themselves that create addiction (most people who try drugs don’t become addicted, or are readily able to shake it when changing environments), nor is addiction an inescapable genetic fate, but rather, a condition heavily influenced by traumatic stress, especially on the developing and even prenatal brain. He also discusses societal trends that predispose their citizens to addiction (generally, societies focused on external and ultimately meaningless endeavors such as the creation of wealth, and which lose touch with more important values), and the type of environment that can promote healing.
  
  Unsurprisingly, there’s some heavy criticism of the War on Drugs, which while failing to prevent access to drugs, has marginalized drug users, making it harder for them to heal while also rendering them unproductive in society. The discussion of the economics of all this was new to me and particularly interesting: drugs are sold in North America (Maté lives and works in Vancouver) at an enormous markup over their actual cost to produce, due to the cost and risks of smuggling and the consequent limitations on supply. Because drugs therefore become expensive, hardcore addicts wind up organizing their entire lives around making enough money to buy their drugs: generally through illegal means, including stealing items which they usually sell at an enormous discount, being stolen goods. So they might steal a $2500 bicycle, sell it for $25, steal a ton of other stuff at similar markdowns, and use the money to buy $1000 in drugs that only cost $20 in their country of origin! (Seriously: at the time of writing, apparently $150,000 of heroin in North America only cost $3,000 in Pakistan.) Maté argues for making drugs medicinally available to the addicted through supervised injection sites to solve this problem, and the data he cites about their success is promising. Essentially, drug users will get the drugs anyway, so we might better improve society by eliminating the criminality around drugs instead.
  
  Unfortunately, the U.S. has spent decades exporting its dogma about drugs to the rest of the world, not only creating an enormous black market but also discouraging other countries (including Canada) from experimenting with different solutions. I would like to think that’s changing—it is no longer true that most U.S. prisoners are being held for drugs, for instance—but so far the changes seem minuscule in comparison to the problem.
  
  So, certainly a heavy topic, though Maté does as much as he reasonably can to inject some hope. Absolutely worth a read for a better understanding of addiction, and I’m glad I pushed on despite the rough beginning.
• 
  Veronika Nyerges

  Eddig nem olvastam még a szerzőtől semmit, gondoltam, egy pohár bor mellett elmerengek itt a drogosokról, addikcióról párszáz oldalt a biztos kívülálló fennsőbbségével, spoiler alert: nem lehet elegáns távolságtartással kezelni.
  A szerző olyan helyen (is) dolgozik orvosként Kanadában, ahol a teljesen lecsúszott függőknek adnak szállást, és ha van rá igényük, akkor kapnak orvosi ellátást, szociális ellátást. Nem várnak cserébe semmit, tudomásul veszik, hogy nincs visszaút, csak segítenek, hogy a lehetőségekhez képest emberként éljenek.
  Három dolog kell a függőséghez, fogékony személyiség, addiktív szer/cselekvés, stressz, ezeket szépen végigmolyolja a könyv.
  Az első fejezetben az itt élő függők életét mutatja be, na itt borult ki a borospohár a kezemből, ezeknél az embereknél nem az jelenti a gyerekkori traumát, hogy xboxot kaptak ps helyett, annyira lemegyünk az emberi lét aljára, amit elképzelni sem akarunk, nem hogy olvasni róla. Az esetleírások ezután is előkerülnek, de kitér az addikció élettani folyamataira (nekem ez volt az egyik kedvenc részem), azokra a magzatkori-gyermekkori hatásokra, vagy éppen azok hiányára, amelyek jól megágyaznak mindenféle addikciónak. A drogosokra mindenki húzza a száját, de vannak társadalmilag elfogadottabb addikciók, pl munka, zene, kávé, mobilhasználat,olvasás, vagy ami sokkal veszélyesebb, addiktívabb mindennél, az a dohányzás, de tulajdonképpen mindegy, minden esetben ugyanaz az atipusos működés áll a háttérben. Igazából bármi lehet az addikció tárgya. A végén kapunk egy kis drogpolitikát is és mesél a drogok dekriminalizációjáról, ez volt a másik kedvenc részem. Máté Gábor maga is ADD-s és addikt, nagyon sok saját élménnyel dolgozik, és én ekkora önreflexiót még nem láttam soha, senkitől nem láttam.
  Mindenfajta függőséget nagyon egyszerűen megoldana az átlagemeber, sőt, sok szakember is: jaaaaj, kapd már össze magad, ne csináld!
  A Sóvárgás démona árnyalja a képet, a könyv elolvasása után biztosan sokkal empatikusabban, nyitottabban állunk a függőkhöz, legyen az drogos, vagy sorozatfüggő.
  Amikor éppen Eckhart Tolletól idézgetett, akkor kicsit tikkelt a szemem, de ez csak előítélet, az idézetek tartalma rendben volt.
  
• 
  Noah Graham

  Maté wants to be a Liberal/Jewish/Buddhist saint. I want to get true and interesting information about drug addiction. For much of the book our goals were in conflict.
  
  He discusses how he was no better than the junkies he treated. Because he was addicted. To.Classical. Music.
  
  He does incredible mental gymnastics to believe in free will while simultaneously claiming that 100% of addiction is due to stressful childhoods (including prenatal development). Checking over historical hard drug use rates in the UK I did find spikes occurring as children born or conceived during the second world war came of age, consistent with his claim that early life stress was a factor. I however was also able to confirm that the vast majority of people who had been through childhoods far rougher than those of many modern north american drug addicts did not in fact get addicted to drugs, hinting at genetic factors(or "free will" ;-P ).
  
  He promotes a vision of mental health as being a person who observes their own mental state with a sort of impartial compassionate curiosity. Which essentially means living life constantly wasting the vast majority of your brain power second guessing your own thoughts and feelings. Recovering schizophrenics need to do that. It's part of the reason they seem slow and emotionally dead when you talk to them.
  
  His proposal to end the war on drugs and refocus societies efforts on harm reduction seems sensible based on the data he provides. But based on the rest of the book he is a total 白左 who would rather virtue signal than think, so I have to wonder what our grandparents who'd seen a world before the war on drugs, yet voted for the war on drugs election after election, knew that he isn't telling.
• 
  Verena Wachnitz

  Very insightful book on the causes and origins on addiction as well as how best help those afflicted. A must read for anyone suffering from addictions or with affected loved ones. At times the book can become a bit too anecdotal, at times a bit repetitive, I found. But I came away with so much information and knowledge and found it so engaging that I can only give it 5*.
• 
  Sheri

  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 Fucked Up System:
  “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.”
  
  “'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.”
  
  “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 fucked 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 circumstances....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 circumstances 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.”
  
  
  
• 
  Andrew (M)

  I cannot say enough good things about "In the Realm of Hungry Ghosts". It is informative, well-written, touching, and inspirational. I have already started recommending it to friends and family as a must-read. The information is timely and important; our behaviour (collective and individual) towards addicts is at best of minimally useful and at worst counter-productive. “In the Realm of Hungry Ghosts” should be a wake up call for individuals and society to think differently about this pressing social concern.
  
  “In the Realm of Hungry Ghosts” is at its best when it is personal. Mate tells his own story and the stories of dozens of his patients in great detail. Some of these stories can be hard to read, but there is always an undercurrent of hope and love in the words that Mate writes. He sees his patients as people, and asks us to do the same. But more than that, he also acknowledges his own humanity and imperfection; he does not shy away from admitting his faults and his biases, and how they impact his work with patients. In doing so, Mate is modeling for the reader what he sees as one of the most important aspect of mental health and freedom from addictions: mindful awareness of one's self and inner experience.
  
  After the first few chapters of stories about himself and his patients, Mate discusses the neurobiology of addiction and then the problems with the way society currently fails to deal with addiction. Although these chapters are very important to the book and to a full understanding of addiction, I find it hard to comment on these sections. I already had a fairly decent understanding of the neuroscience that he discussed, and so while I found it a bit tedious and slow moving, I suspect that a reader less familiar with these topics would find them more interesting. Similarly, I already agreed with political stance that Mate takes with respect to the “War on Drugs” and so I am not sure how convincing his arguments are. What I can say is that this is not meant to be a comprehensive account of the problems with the “War on Drugs”, and Mate wisely directs the reader to more complete resources.
  
  One of the aspects I enjoyed most about “In the Realm of Hungry Ghosts” was the way Mate tied together spiritual teachings with science and medicine. While he certainly does not promote any particular dogma or religion (in fact, quotes from most major religions can be found in one place or another), Mate understands that great teachers of any tradition often have insights that can be usefully applied to modern problems. Furthermore, the truth of much of this wisdom has been borne out by recent scientific studies, so Mate feels free to use either argument (or both) to make his point. While I suspect his writing in these chapters may be a bit tough to follow for a reader who has not studied some form of mindfulness, “In the Realm of Hungry Ghosts” is probably the best book I have read for drawing links between ancient and modern wisdom.
  
  My only complaint with “In the Realm of Hungry Ghosts” was that there could have been more discussion of why some substances or behaviours are more addictive than others. In his pursuit of the conclusion that drugs aren't the cause of addiction (a void in an individual's life is the real cause), Mate tends to blend all potentially addictive substances and behaviours together. While it is true that anything can have addictive properties, there are clear differences in the ease with which addictions can arise.
  
  “In the Realm of Hungry Ghosts” is not just a book for addicts or people who work with them; it is the kind of book that everyone would benefit from reading. As Mate writes, how we treat addicts is a reflection of our entire society, and anyone wanting to make a positive difference in the world can start by taking a good look at the way we think about drug addicts.
• 
  Shervin R

  هیچ ریویو فارسی از این کتاب تو گودریدز وجود نداره پس این ریویو رو فارسی مینویسم.
  نویسنده کتاب دکتر کانادایست که در شهر ونکوور کانادا در مراکز کمک به معتادین به مواد مخدر مشغول به کار است. این مراکز با مراکز ترک اعتیاد متفاوت است و اتفاقا برعکس، به کسانی که اعتیاد دارند تحت شرایط کنترل شده ای مواد مخدر تجویز میکنند تا خطر استفاده از وسایل آلوده و اوردوز را کاهش دهند. نویسنده در این کتاب از تجربیات خودش در مواجهه با این افراد میگه و در قسمت دوم کتاب از تجریبات خودش در مواجهه با اعتیاد و همچنین سازوکار اعتیاد و روندی که بدن ما د�� این پروسه طی میکنه صحبت میکنه.
  برجسته ترین نکته ای که نویسنده بهش تاکید داره اینه که ۱) روی آوردن به مواد مخدر و اعتیاد ریشه در تراماهای زندگی و نحوه تربیت شدنمون در کودکی و نوزادی داره. ۲) فاصله کسی که با اعتیاد سروکاری نداره با کسی که شدیدا درگیر اعتیاده خیلی کمتر از چیزیه که فکرش رو میکنیم.
  
  برای من این کتاب بسیار چشم بازکن بود. هم در مورد اطلاعاتی که در مورد اعتیاد و سازوکارش گرفتم و هم در مورد دیدی که ما در مواجهه با افراد بی خانمان و معتاد به مواد مخدر داریم. در جایی از کتاب نویسنده آزادسازی خرید و فروش مواد مخدر رو به عنوان بهترین راه برای مقابله با مقوله اعتیاد معرفی میکنه و درک و موافقت من با این دیدگاه رو مدیون خود این کتاب هستم.
• 
  Debbie "DJ"

  This is the most comprehensive, thoroughly studied look at addiction I have ever read. Gabor Mate is a physician who works in one of Vancouver's roughest areas, The Portland Hotel Society, a building housing for the unhousable. Mate begins by introducing us to some of his patients, their horrific backgrounds, current addictions, and survival on the streets. Many are so heartbreaking I had to stop reading for awhile.
  
  Mate then goes into a very scientific look at the brains of addicts. He details how our minds are wired during the first three years of our life. Addicts are set up for addiction during this time, often because of the environment they are born into. The amount of stress and dysfunction the mother was under during this time can actually rewire a child's brain to a predisposition for addiction. I found the amount of research on this fascinating, completely debunking the genetic theory. Mate ties this in with how addicts are often treated as the lowest of the low, when in reality the brain was set up for it in it's wiring.
  
  America's "war on drugs" is also looked at very closely in this book. Mate's research proves it doesn't work. He looks at other countries who have decriminalized drugs with great success and explains why we seem to be so stuck on old ideas that don't work. He leaves us with many options for recovery and a chance for addicts to find sobriety.
  
  I was amazed by the many areas that Mate goes into with such depth and clarity. I learned a lot about the root cause of addiction, that addicts are just people whose very brains were rewired in an attempt to survive outward stresses. If our society could offer compassion instead of "war" the amount of suffering for all would decrease. The costs involved in offering true help far outweigh it's alternative where addicts are forced to steal for money, where dirty needles kill, medical treatment soars, and we can't build prisons fast enough. We could have a world of compassion and true help for those who want it. I can't say enough about a book so packed full of information other than it takes awhile to read, but it is well worth the effort.
• 
  Simon Parent

  A deeply personal look into addiction.
  
  This book highlighted how most of us struggle with some form of addiction, and it layed out how the sources are rooted in trauma. Through the examples illustrated by some of his patients, Gabor explains the mechanisms through which addiction take hold of our reality, replacing the comfort that should be reflected in our lives with a chemical dance that first reassures and thrill us, and then that grasp our throat and hold us as a slave.
  
  The difference between substance addicts on the street and our global addiction to social media is a matter of degrees, not of kind. Our reality is being tailored to keep us scrolling, one serotonin hit after the other (though the author did not ventured to talk about social media).
  
  Though the author has a somewhat religious outlook that tainted his final recommendations ("12 steps" programs are deeply rooted in religion and quack science), I really recommend this book. It has put into perspective my own addictions, which I never really confronted seriously.
  
  Yet, beyond this perspective, it shows how little our Capitalist society protects our most impactful years: early childhood. Given that the stress felt by parents, especially mothers, have a huge impact on the trauma and emotional needs, which translate itself in an addiction which momentarily fills this void and soothe our pain, we need a LOT more support for child-rearing. We need much longer parental leave from work, with adequate financial support. We need formations for expecting parents. Shelter. Food. Really, with a Socialist re-organisation of society, gearing production to satisfy our collective needs instead of the boundless thirst for profits our Oligarchs have.
  
  Health care plays a huge role in all this. Companies like Perdue Pharma, geared toward patching symptoms without fixing the root problems, without addressing prevention, are lining their pockets with incredible profits despite creating despair and addiction on a huge scale, leading to so much deaths from overdoses that life expectancy is going down in some countries, like America.
  
  This parasitic attitude is displayed in a lot of industries, taking a vital need hostage of Capitalism, leading inflation. Housing and Education also suffer from the same problem. Yet again another reason to move away from the prison that is Capitalism.
  
  The war on drug has been a colossal failure. Criminalizing people falling on hard times, victims of this system and of the biology of their body and their traumatic past, is inhumane. The USA has the biggest prison population in the world. Prisonners are essentially used as slave labor, enmeshed in a system setup that way since the official end of slavery, the continuation of Jim Crow policies that disproportionally target black people in America. It's the bedrock of the continual erosion of human rights, elevating the police as an untouchable section of class traitors. The war on drug becomes a tool that undermines communities, laying the ground for companies to profit from slave prison labor, and lower salaries for everyone (or move to a country where they can exploit the squallor there). This ties into international Capitalist interests and the IMF. See
  Planet of Slums,
  The Darker Nations: A People's History of the Third World and
  The Divide: A Brief Guide to Global Inequality and its Solutions.
  
  For a look into prisons and the police, read
  Are Prisons Obsolete?, and
  The End of Policing.
  
  These structures of organized violence (and crime, look up Police Gangs), contribute immensely to the destruction of our social structure, and to the trauma spawning addictions and millions of deaths of despair. See
  https://youtu.be/VoF8RmohTB4 .
  
  For all of these reasons, I see how much good could be achieved if we let go of our Capitalist Realism (
  Capitalist Realism: Is There No Alternative?), and rise up to win a future where those institutions and the mechanism behind them (Capitalism), is toppled once and for all.
  
  Finally, about the book. The author describes how little "genetic predispositions" count, by exposing the glaring flaws in twin studies, namely, the ignorance of the role of trauma and epigenetic consequences that arise from this trauma. Really, this means that the "Nature VS Nurture" debate surrounding this issue points far more toward environmental factors. This is incredibly hopeful. It means that we are not flawed sinners born this way. We can change our environment, our socio-economic system and some of it's manifestations as described earlier, and change ourselves for the better in the process.
  
  This review was also amazing.
  
  https://www.goodreads.com/review/show...
  
  
• 
  Kate

  Though mostly written in the early 2000s, I think the concepts Maté speaks to in his book are still relevant, both scientifically and socially. It feels like this book was really ahead of its time.
  
  The first section where Maté tells the stories of many of his patients from the downtown Eastside of Vancouver is extremely moving. I would urge our policy makers to read this book as it really delves deep into the social, psychological, and environmental aspects of addiction.
• 
  Erin

  E. suggested I read “In the Realm of Hungry Ghosts” as part of my introduction to Vancouver, and gosh but was he right in recommending it.
  
  The book’s author, Gregor Mate, is a doctor who works in Vancouver’s notorious downtown eastside - a neighbourhood known for being a drug zone. Mate uses interviews and character sketches of his patients as the individual grounding for his discussion of the causes and outcomes of addiction, as well as the detrimental drug policies that currently govern drug addicts’ behaviour. The chapters vary among first person reflections on his own addicted behaviour, reflections on the life experiences of his patients, accessible descriptions of brain science and development and exhortations for evidence based addictions/drug policies.
  
  The book is, simply put, brilliant. Mate methodically lays out his argument all the while drawing in personal narratives that make the science not only accessible but entirely compelling. The reader cares about addictions science and drug laws because we are made to know the addicts - ourselves! - as people. The demand that we reserve judgement because we too, find ourselves in addicted patterns, or because we begin to understand the lack-of-choice inherent in addicts’ actions, persuasively asks us to reconsider our long held judgements about those addicted to X or Z.
  
  I’m anxious for someone I know to read the book, too, so that I might discuss the ending - a suggestion that the ‘cure’ for addicted behaviour might be meditation and mindfulness - and the overarching premise of the book that addiction isn’t so much a choice as a set of circumstances thrust upon that must be chosen against, refused, rather than actively sought. My local library is hosting a book club night on the book, and I’m eager to go and hear what others in my community thought of the book, but I’d really (really) like for you to read it, too, and let me know your thoughts.
  
  Given how much I’m struggling to sort out how to reconcile the gross inequality I’ve been encountering in Vancouver, and given my own (relative) addictions, the book has been incredible in provoking thought, challenging assumptions, and arguing for a kind of generosity to the self and to others that is otherwise unspoken.
• 
  Kony

  An engaging and eye-opening education about addiction’s psychosocial, neurological, biochemical roots — and its destructive consequences — and the folly of our country’s military/criminal approach to what's really a social, emotional, cultural problem.
  
  What’s impelled me to stay engaged with this fat paperback, reading for 3+ hours at a time? Not the bare desire to learn the facts, nor the shock value of these facts — but rather the author’s voice, his personality, the world of memories and regrets and tragedies he’s constructed through vivid characters, interactions, street scenes.
  
  It’s with an anecdote that he opens the book, and it’s with a personal confession that he hammers home a central point: that no one is above falling prey to addiction. (Not even a bestselling author-doctor whose fame derives from treating addicts.) This notion — that there’s a potential addict in all of us — might be harder for readers to swallow if not encapsulated in such a daring act of self-exposure.
  
  Vulnerable truth-telling invites enlightened listening — and perhaps further acts of vulnerable truth-telling — which might then snowball…
  
  Maybe *this* interpersonal process is the real key to social change.
• 
  Missy J

  Finally finished this book. For some reason, I thought that my sister highly recommended this book to me (she doesn't recall this) and I saw that one of my GR friends named it the best book she read in 2012. I liked Gabor Mate's work, but it's not mind-blowing nor the best thing that I read this year. Gabor Mate, a doctor in Vancouver has worked extensively with drug addicts and in this book gives us his thoughts and findings about addiction in general.
  
  "Addiction is often a misguided attempt to relieve stress, but misguided only in the long term. In the short term addictive substances and behaviours do act as stress relievers."
  "...definition of addiction: any repeated behaviour, 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, impaired control, persistence, relapse and craving."
  
  I found his dealings with his drug addict patients very interesting and Mate is more of the opinion that environment has a greater influence on humans than simple genetics. Almost all addicts that Mate came across, suffered some kind of sexual abuse as children. Mate also points out that mothers who are stressed during their pregnancy have a negative impact on the baby's brain development. He also explains that the loss of traditional culture has made indigenous people more susceptible to addiction in order to soothe their pain. Mate himself was born in Budapest during WWII and was separated from his Jewish mother at a very young age so other people could take care of him outside of the ghetto.
  
  Overall, I think I did get a few new ideas and information regarding drug addiction. But some of it was written in a somewhat messy way that I feel I didn't get all of it. Sometimes his way of reasoning was very strange and just a subtle way of saying something different. I didn't like that. And it's a long book so I lost track of the names of the drug addicts. Some quotes below:
  
  "If I've learned anything, it's that I have to be responsible for my own fear of emptiness." - Daniel, son of Gabor Mate.
  
  "Being able to lighten up is the key to feeling at home with your body, mind and emotions, to feeling worthy of living on this planet...In addition to a sense of humor, a basic support for a joyful mind is curiosity, paying attention...Happiness is not required, but being curious without a heavy judgmental attitude helps. If you are judgmental, you can even be curious about that." - Pema Chodron.