Author: Gabor Maté

ASIN: B07CJNMY2H

Some really interesting research and thoughts on (treating) addiction!

EXCERPTS

What, in the short term, did it give you that you craved or liked so much?” And universally, the answers are: “It helped me escape emotional pain; helped me deal with stress; gave me peace of mind, a sense of connection with others, a sense of control.” Such responses illuminate that addiction is neither a choice nor primarily a disease. It originates in a human being’s desperate attempt to solve a problem: the problem of emotional pain, of overwhelming stress, of lost connection, of loss of control, of a deep discomfort with the self. In short, it is a forlorn attempt to solve the problem of human pain. All drugs—and all behaviours of addiction, substance-dependent or not, whether to gambling, sex, the internet or cocaine—either soothe pain directly or distract from it. Hence my mantra: The first question is not “Why the addiction?” but “Why the pain?”

But not all the harm-reduction facilities in the world will suffice to stem the tide of addiction so long as our system fails to recognize the source of the problem in trauma and social dislocation, and so long as treatment facilities focus mostly on trying to change the behaviours of addicted human beings instead of healing the pain that drives those behaviours.

While at first sight some might find it strange to liken “mild” addictions to lethal drug habits, it has become more widely recognized through the last decade that addiction can take on many guises, from substances to seemingly “respectable” compulsions that all take a toll on human health and happiness. There are no good addictions; none are mere “foibles.” All addictions cause harm.

In its proper ceremonial setting … ayahuasca may achieve in a few sittings what many years of psychotherapy can only aspire to do.

Parent-blaming is emotionally unkind and scientifically incorrect. All parents do their best; only our best is limited by our own unresolved or unconscious trauma.

This is the domain of addiction, where we constantly seek something outside ourselves to curb an insatiable yearning for relief or fulfillment. The aching emptiness is perpetual because the substances, objects or pursuits we hope will soothe it are not what we really need. We don’t know what we need, and so long as we stay in the hungry ghost mode, we’ll never know. We haunt our lives without being fully present.

Over half [of addicts] have been diagnosed with mental illness.

IT IS IMPOSSIBLE to understand addiction without asking what relief the addict finds, or hopes to find, in the drug or the addictive behaviour.

Far more than a quest for pleasure, chronic substance use is the addict’s attempt to escape distress. From a medical point of view, addicts are self-medicating conditions like depression, anxiety, post-traumatic stress or even ADHD (attention deficit hyperactivity disorder). Addictions always originate in pain, whether felt openly or hidden in the unconscious. They are emotional anaesthetics.

Not all addictions are rooted in abuse or trauma, but I do believe they can all be traced to painful experience. A hurt is at the centre of all addictive behaviours. It is present in the gambler, the Internet addict, the compulsive shopper and the workaholic.

A sense of deficient emptiness pervades our entire culture. The drug addict is more painfully conscious of this void than most people and has limited means of escaping it. The rest of us find other ways of suppressing our fear of emptiness or of distracting ourselves from it. When we have nothing to occupy our minds, bad memories, troubling anxieties, unease or the nagging mental stupor we call boredom can arise. At all costs, drug addicts want to escape spending “alone time” with their minds. To a lesser degree, behavioural addictions are also responses to this terror of the void.

From the Latin word vulnerare, “to wound,” vulnerability is our susceptibility to be wounded. This fragility is part of our nature and cannot be escaped. The best the brain can do is to shut down conscious awareness of it when pain becomes so vast or unbearable that it threatens to overwhelm our capacity to function. The automatic repression of painful emotion is a helpless child’s prime defence mechanism and can enable the child to endure trauma that would otherwise be catastrophic. The unfortunate consequence is a wholesale dulling of emotional awareness. “Everybody knows there is no fineness or accuracy of suppression,” wrote the American novelist Saul Bellow in The Adventures of Augie March; “if you hold down one thing you hold down the adjoining.”

Our emotions are an indispensable part of our sensory apparatus and an essential part of who we are. They make life worthwhile, exciting, challenging, beautiful and meaningful. When we flee our vulnerability, we lose our full capacity for feeling emotion. We may even become emotional amnesiacs, not remembering ever having felt truly elated or truly sad. A nagging void opens, and we experience it as alienation, as profound ennui, as the sense of deficient emptiness described above.

Unconditional acceptance of each other is one of the greatest challenges we humans face. Few of us have experienced it consistently; the addict has never experienced it—least of all from himself.

It’s hard to get enough of something that almost works. VINCENT FELITTI, M.D.

Addictions, even as they resemble normal human yearnings, are more about desire than attainment. In the addicted mode, the emotional charge is in the pursuit and the acquisition of the desired object, not in the possession and enjoyment of it. The greatest pleasure is in the momentary satisfaction of yearning.

The addict craves the absence of the craving state. For a brief moment he’s liberated from emptiness, from boredom, from lack of meaning, from yearning, from being driven or from pain. He is free.

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 behaviour? It’s possible to rule a passion, but an obsessive passion that a person is unable to rule is an addiction. And the addiction is the repeated behaviour that a person keeps engaging in, even though he knows it harms himself or others. How it looks externally is irrelevant. The key issue is a person’s internal relationship to the passion and its related behaviours. If in doubt, ask yourself one simple question: given the harm you’re doing to yourself and others, are you willing to stop? If not, you’re addicted. And if you’re unable to renounce the behaviour or to keep your pledge when you do, you’re addicted.

Passion is generous because it’s not ego-driven; addiction is self-centred. Passion gives and enriches; addiction is a thief. Passion is a source of truth and enlightenment; addictive behaviours lead you into darkness. You’re more alive when you are passionate, and you triumph whether or not you attain your goal. But an addiction requires a specific outcome that feeds the ego; without that outcome, the ego feels empty and deprived. A consuming passion that you are helpless to resist, no matter what the consequences, is an addiction. Addiction is centrifugal. It sucks energy from you, creating a vacuum of inertia. A passion energizes you and enriches your relationships. It empowers you and gives strength to others. Passion creates; addiction consumes—first the self and then the others within its orbit.

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.

Addiction is 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. Addiction involves: compulsive engagement with the behaviour, a preoccupation with it; impaired control over the behaviour; persistence or relapse, despite evidence of harm; and dissatisfaction, irritability or intense craving when the object—be it a drug, activity or other goal—is not immediately available.

The addict comes to depend on the substance or behaviour in order to make himself feel momentarily calmer or more excited or less dissatisfied with his life.

IN THE CLOUDY swirl of misleading ideas surrounding public discussion of addiction, there’s one that stands out: the misconception that drug taking by itself will lead to addiction—in other words, that the cause of addiction resides in the power of the drug over the human brain. Clearly, if drugs by themselves could cause addiction, we would not be safe offering narcotics to anyone. Medical evidence has repeatedly shown that opioids prescribed for cancer pain, even for long periods of time, do not lead to addiction except in a minority of susceptible people.

“Addiction is a human problem that resides in people, not in the drug or in the drug’s capacity to produce physical effects,”

It is true that some people will become hooked on substances after only a few times of using, with potentially tragic consequences, but to understand why, we have to know what about those individuals makes them vulnerable to addiction. Mere exposure to a stimulant or narcotic or to any other mood-altering chemical does not make a person susceptible. If she becomes an addict, it’s because she’s already at risk.

These results suggested that the addiction did not arise from the heroin itself but from the needs of the men who used the drug. Otherwise, most of them would have remained addicts. [The Vietnam War example.]

Some people, a relatively small minority, are at grave risk for addiction if exposed to certain substances. For this minority, exposure to drugs really will trigger addiction, and the trajectory of drug dependence, once begun, is extremely difficult to stop.

As we will see, emotional isolation, powerlessness and stress are exactly the conditions that promote the neurobiology of addiction in human beings, as well.

Drugs, in short, do not make anyone into an addict, any more than food makes a person into a compulsive eater. There has to be a pre-existing vulnerability. There also has to be significant stress, as on these Vietnam soldiers—but, like drugs, external stressors by themselves, no matter how severe, are not enough. Although many Americans became addicted to heroin while in Vietnam, most did not. Thus, we might say that three factors need to coincide for substance addiction to occur: a susceptible organism; a drug with addictive potential; and stress. Given the availability of drugs, individual susceptibility will determine who becomes an addict and who will not

There are controversies, as we shall see, but everyone agrees that on the basic physiological level, addiction represents “a different state of the brain,” in the words of physician and researcher Charles O’Brien. The debate is over just exactly how that abnormal brain state arises. Are the changes in the addicted brain purely the consequence of drug use or is the brain of the habitual user somehow susceptible before drug use begins? Are there brain states that pre-dispose a person to become addicted to drugs or to behaviours such as compulsive sexual adventuring or overeating? If so, are those predisposing brain states induced mostly by genetic inheritance or by life experience—or by some combination of both?

It can take months or longer for the receptor numbers in the brain to rise back to pre–drug use figures.

And this creates addiction’s central dilemma: if recovery is to occur, the brain, the impaired organ of decision making, needs to initiate its own healing process. An altered and dysfunctional brain must decide that it wants to overcome its own dysfunction: to revert to normal—or, perhaps, become normal for the very first time. The worse the addiction is, the greater the brain abnormality and the greater the biological obstacles to opting for health.

Environmental cues associated with drug use—paraphernalia, people, places and situations—are all powerful triggers for repeated use and for relapse, because they themselves trigger dopamine release. People trying to quit smoking, for example, are advised to avoid poker if they are used to having a cigarette while playing cards. Unless they move to a different area of town or to a recovery home, my Downtown Eastside patients find it virtually impossible to stop drug use, even when they form a strong intention to do so. Not only are drugs readily available, but everything and everyone in the environment reminds them of their habit.

More importantly, research now strongly suggests that the existence of relatively few dopamine receptors to begin with may be one of the biological bases of addictive behaviours. When our natural incentive-motivation system is impaired, addiction is one of the likely consequences.

If our society were truly to appreciate the significance of children’s emotional ties throughout the first years of life, it would no longer tolerate children growing up, or parents having to struggle, in situations that cannot possibly nourish healthy growth. STANLEY GREENSPAN, M.D.

Brain development in the uterus and during childhood is the single most important biological factor in determining whether or not a person will be predisposed to substance dependence and to addictive behaviours of any sort, whether drug-related or not.

The three environmental conditions absolutely essential to optimal human brain development are nutrition, physical security and consistent emotional nurturing.

The child needs to be in an attachment relationship with at least one reliably available, protective, psychologically present and reasonably nonstressed adult. Attachment, as we’ve already learned, is the drive to pursue and preserve closeness and contact with others; an attachment relationship exists when that state has been achieved. It’s an instinctual drive programmed into the mammalian brain, owing to the absolute helplessness and dependency of infant mammals—particularly infant humans.

researchers defined stress “as a state of disharmony or threatened homeostasis.” According to such a definition, a stressor “is a threat, real or perceived, that tends to disturb homeostasis.” What do all stressors have in common? Ultimately they all represent the absence of something that the organism perceives as necessary for survival—or its threatened loss. The threat itself can be real or perceived. The threatened loss of food supply is a major stressor. So is the threatened loss of love—for human beings.

Neglect and abuse during early life may cause bonding systems to develop abnormally and compromise capacity for rewarding interpersonal relationships and commitment to societal and cultural values later in life. Other means of stimulating reward pathways in the brain, such as drugs, sex, aggression, and intimidating others, could become relatively more attractive and less constrained by concern about violating trusting relationships. The ability to modify behavior based on negative experiences may be impaired.

Addiction is a deeply ingrained response to stress, an attempt to cope with it through self-soothing.

“Stressful experiences,” another research group points out, “increase the vulnerability of the individual to either develop drug self-administration or relapse.”

The research literature has identified three factors that universally lead to stress for human beings: uncertainty, lack of information and loss of control. To these we may add conflict that the organism is unable to handle and isolation from emotionally supportive relationships.

It may be argued that, at least so far as work is concerned, what I call my addictions have benefited other people. Even if that were true, it still wouldn’t explain or justify addiction. The contributions I have made in a number of areas that I am passionate about could have been achieved without the addictive zeal that often drove me. There is no such thing as a good addiction. Everything a person can do is better done if there is no addictive attachment that pollutes it. For every addiction—no matter how benign or even laudable it seems from the outside—someone pays a price.

A credo of discouragement and defeat that many of us share: a child may be completely in the present moment, but an adult can get there only with artificial assistance.

No one is born with the capacity for self-regulation; as I’ve mentioned, the infant is completely dependent upon the parents to regulate his physical and psychological states. Self-regulation being a developmental achievement, we reach it only if the conditions for development are right. Some people never attain it; even in advanced adulthood they must rely on some external support to quell their discomfort and soothe their anxiety. They just cannot make themselves feel okay without such supports, whether they be chemicals or food or an excessive need for attention, approval or love. Or they seek to make their lives exciting by engaging in activities that trigger elation or a sense of risk. A person with inadequate self-regulation becomes dependent on “outside things” to lift his mood and even to calm himself if he experiences too much undirected internal energy.

Zhey see the relationship as being more important than their own healthy self. Poor differentiation also keeps people in destructive relationships, which themselves take on an addictive quality.

When, owing to internal demons arising from their own childhoods or to external stressors in their lives, parents are unable to regulate—that is, keep within a tolerable range—the emotional milieu of the infant, the child’s brain has to adapt: by tuning out, by emotional shutting down and by learning to find ways to self-soothe through rocking, thumb-sucking, eating, sleeping or constantly looking to external sources of comfort. This is the ever-agitated, ever-yawning emptiness that lies at the heart of addiction.

I’ve had a lifelong resistance to receiving love—not to being loved or even to knowing intellectually that I am loved, but to accepting love vulnerably and openly on a visceral, emotional level. People who cannot find or receive love need to find substitutes—and that’s where addictions come in.

Music gives me a sense of self-sufficiency and nourishment. I don’t need anyone or anything. I bathe in it as in amniotic fluid; it surrounds and protects me. It’s also stable, ever-available and something I can control—that is, I can reach for it whenever I want. I can also choose music that reflects my mood, or if I want, helps to soothe it. As for forays to Sikora’s, music-seeking offers excitement and tension that I can immediately resolve and a reward I can immediately attain—unlike other tensions in my life and other desired rewards. Music is a source of beauty and meaning outside myself that I can claim as my own without exploring how, in my life, I keep from directly experiencing those qualities. Addiction, in this sense, is the lazy man’s path to transcendence.

My sense of worth, unavailable to me for who I am, has come from work. And in the practice of medicine I found the perfect venue to prove my usefulness and indispensability.

Like any addict, I used my addictions to help regulate my moods, my internal experience. On weekends when the beeper fell silent I felt empty and irritable—the addict in withdrawal.

Although it is commonplace to blame the current epidemic of obesity on junk food consumption and sedentary living, these are only the behavioural manifestations of a deeper psychological and social malaise.

Except in rare cases of physical disease, the more obese a person is, the more emotionally starved they have been at some crucial period in their life. As a novice family doctor I used to believe that all people needed was basic information. So all I had to do was to teach overweight individuals how excess body fat would overburden the heart, plug the arteries and raise the blood pressure, demonstrating my insights with naïve pencil drawings scratched on prescription pads, and they would leave the office grateful and transformed, ready for a new, healthier lifestyle. I soon found out that they left the office asking for their files to be transferred to some other physician less pedagogically zealous and more understanding about the ways of human beings. I learned that preaching at people about behaviours, even self-destructive ones, did little good when I didn’t or couldn’t help them with the emotional dynamics driving those behaviours. Invariably, people who eat too much have not only suffered emotional loss in the past, but are also psychically deprived or highly stressed in the present.

Emotional energy expended without perceived reward is compensated for by calories ingested. Similarly, many people who quit smoking begin to overeat because their craving for oral soothing is no longer eased by their cigarette and the loss of their stress reliever, nicotine, leaves them dopamine-deprived.

Children whose emotionally nourishing relationship with adults gives them a strong sense of themselves do not need to soothe themselves by passively taking in either food or entertainment.

The roots of sex addiction also reach back to childhood experience.

Being held and cuddled is so important to us that we’ll associate love with whatever gives us that warmth and contact. If a person feels wanted only sexually, as an adult she may look to sex to reaffirm that she is loveable and wanted. Sex addicts who were not abused as children may have had more subtle forms of sexualization projected on them by a parent or they may have felt so unloved or undesirable that they now look to sexual contact as a quick source of comfort. The so-called nymphomaniac, the female sex addict, is not addicted to sex at all, but to the dopamine and endorphin rewards that flow from the feeling of being desired and desirable.

The dopamine and endorphin rewards that love is meant to provide are obtained by having sex—but, as with all addictions, only temporarily. The craving for contact is, perversely, accompanied by a terror of real intimacy because of the painful instability of early relationships. That’s why a relationship with a sex-addicted person won’t last.

You don’t know how depressed you’ve been until you know what it feels like not to be depressed.

Stressed parents have difficulty offering their children a specific quality required for the development of the brain’s self-regulation circuits: the quality of attunement. Attunement is, literally, being “in tune” with someone else’s emotional states. It’s not a question of parental love but of the parent’s ability to be present emotionally in such a way that the infant or child feels understood, accepted and mirrored.

A parent can be fully attached to the infant—fully “in love”—but not attuned. For example, the infants of depressed parents experience physiological stress not because they are not loved, but because their parents are not attuned with them—and attunement is especially likely to be lacking if parents missed out on it in their own childhoods. Children in poorly attuned relationships may feel loved, or be aware that love is there, but on a deeper and essential level they do not experience themselves as seen or appreciated for who they really are.

A person with good self-regulation will not experience rapidly shifting extremes of emotional highs and lows in the face of life’s challenges, difficulties, disappointments and satisfactions. She does not depend on other people’s responses or external activities or substances in order to feel okay. The person with poor self-regulation is more likely to look outside herself for emotional soothing, which is why the lack of attunement in infancy increases addiction risk.

In our extraordinarily fragmented and stressed society, where parents often face the childrearing task without the support that the tribe, clan, village, extended family and community used to provide, misattuned parent–child interactions are increasingly the norm.

While it’s true that overt episodes of hostility between the parents may damage the child, so may repressed anger and unhappiness. As a rule, whatever we don’t deal with in our lives, we pass on to our children. Our unfinished emotional business becomes theirs.

Also at risk are kids who fall under negative peer influence during the vulnerable teen years. In such cases, however, there is usually a disruption in the parent–child relationship before the peer effect can assert itself.

The addict is never satisfied. His spiritual and emotional condition is one of impoverishment, no matter how much he achieves, acquires or possesses. In the hungry-ghost mode, we can never be satiated.

A powerful person’s self-esteem may appear to be high, but it’s a hollow shell if it’s based on externals, on the ability to impress or intimidate others. It’s what psychologist Gordon Neufeld calls conditional or contingent self-esteem: it depends on circumstances. The greater the void within, the more urgent the drive to be noticed and to be “important,” and the more compulsive the need for status. By contrast, genuine self-esteem needs nothing from the outside. It doesn’t say, “I’m worthwhile because I’ve done this, that or the other.” It says, “I’m worthwhile whether or not I’ve done this, that or the other. I don’t need to be right or to wield power, to amass wealth or achievements.” Self-esteem is not what the individual consciously thinks about himself; it’s the quality of self-respect manifested in his emotional life and behaviours. By no means are a superficially positive self-image and true self-esteem necessarily identical. In many cases they are not even compatible. People with a grandiose and inflated view of themselves are missing true self-esteem at the core. To compensate for a deep sense of worthlessness, they develop a craving for power and an exaggerated self-evaluation that may itself become a focus of addiction.

The men and women I work with have had every possible negative consequence visited upon them. They have lost their jobs, their homes, their spouses, their children and their teeth; they have been jailed and beaten, abused and raped; they have suffered HIV infection and hepatitis and infections of the heart valves and of the back-bone; they have had multiple pneumonias and abscesses and sores of every sort. They have seen close friends die young of overdose or disease. They are far from naïve about the seriousness of the matter and require no more convincing or coercing. And yet they will not, unless something transforms their perspective on life, abandon their compulsion to use drugs. We, as a society, cannot respond to their predicament with unenforceable laws, moral preaching and medical practices that do not employ the full range of possible options.

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. It’s important to note that decriminalization does not mean legalization. Legalization would make manufacturing and selling drugs legal, acceptable commercial activities. Decriminalization refers only to removing from the penal code the possession of drugs for personal use. It would create the possibility of medically supervised dispensing when necessary. The fear that easier access to drugs would fuel addiction is unfounded: drugs, we have seen, are not the cause of addiction.

Decriminalization also does not mean that addicts will be able to walk into any pharmacy to get a prescription of cocaine. Their drugs of dependence should be dispensed under public authority and under medical supervision, in pure form, not adulterated by unscrupulous dealers. Addicts also ought to be offered the information, the facilities and the instruments they need to use drugs as safely as possible. The health benefits of such an approach are self-evident: greatly reduced risk of infection and disease transmission, much less risk of overdose and, very importantly, comfortable and regular access to medical care. Not having 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.

Addicts should not be coerced into treatment, since in the long term coercion creates more problems than it solves. On the other hand, for those addicts who opt for treatment, there must be a system of publicly funded recovery facilities with clean rooms, nutritious food and access to outdoors and nature. Well-trained professional staff need to provide medical care, counselling, skills training and emotional support.

Thus, for all the valid reasons we have for wanting the addict to “just say no,” we first need to offer her something to which she can say “yes.” We must provide an island of relief. We have to demonstrate that esteem, acceptance, love and humane interaction are realities in this world, contrary to what she, the addict, has learned all her life. It is impossible to create that island for people unless they can feel secure that their substance dependency will be satisfied as long as they need it.

Healing, then, must take into account the internal psychological climate—the beliefs, memories, mind-states and emotions that feed addictive impulses and behaviours—as well as the external milieu. In an ecological framework recovery from addiction does not mean a “cure” for a disease but the creation of new resources, internal and external, that can support different, healthy ways of satisfying one’s genuine needs. It also involves developing new brain circuits that can facilitate more adaptive responses and behaviours.

So there are two ways of promoting healthy brain development, and both are essential to the healing of addiction: by changing the external environment and by modifying the internal one.

If changing external circumstances can improve brain physiology, so can mental effort. “Intention and attention exert real, physical effects on the brain,” Dr. Schwartz explains.

The greatest damage done by neglect, trauma or emotional loss is not the immediate pain they inflict but the long-term distortions they induce in the way a developing child will continue to interpret the world and her situation in it. All too often these ill-conditioned implicit beliefs become self-fulfilling prophecies in our lives. We create meanings from our unconscious interpretation of early events, and then we forge our present experiences from the meanings we’ve created. Unwittingly, we write the story of our future from narratives based on the past.

Addiction confers invulnerability because it allows us to soothe vulnerable emotions like pain or fear or the aching for love with behaviours, objects or substances whenever we choose. It’s a way to avoid intimacy.

The four steps should be practised daily at least once, but also whenever an addictive impulse pulls you so strongly that you are tempted to act it out.

Be fully aware of the sense of urgency that attends the impulse and keep labelling it as a manifestation of addiction, rather than any reality that you must act upon.

The addictive compulsion says nothing about you as a person. It is not a moral failure or a character weakness; it is just the effect of circumstances over which you had no control. What you do have some control over is how you respond to the compulsion in the present. You were not responsible for the stressful circumstances that shaped your brain and worldview, but you can take responsibility now.

Once more, don’t allow yourself to be frustrated when what you have let go returns. It will—probably soon. When it does, you will re-label it and re-attribute it: “Hello, old brain circuits,” you say. “I see you’re still active. Well, so am I.” If you change how you respond to those old circuits, you will eventually weaken them. They will persist for a long time—perhaps even all your life, but only as shadows of themselves. They will no longer have the weight, the gravitational pull or the appeal they once boasted.

Rather than engage in 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. Instead of giving in to the siren call of the addiction, go for a walk. If you “need” to drive to the casino, turn on the TV. If you “need” to watch television, put on some music. If you “need” to buy music, get on your exercise bike. Whatever gets you through the night—or at least through the next fifteen minutes.

But the important thing is that whatever activity you choose, it must be something you enjoy doing.” The purpose of Re-focus is to teach your brain that it doesn’t have to obey the addictive call.

And accept that the addiction exists not because of yourself, but in spite of yourself. You did not come into life asking to be programmed this way. It’s not personal to you—millions of others with similar experiences have developed the same mechanisms. What is personal to you is how you respond to it in the present.

Life, until now, has created you. You’ve been acting according to ingrained mechanisms wired into your brain before you had a choice in the matter, and it’s out of those automatic mechanisms that you’ve created the life you now have. It is time to re-create: to choose a different life.

There are two ways of abstaining from a substance or behaviour: a positive and even joyful choice for something else that has a greater value for you or forcing yourself to stay away from something you crave and are spontaneously attracted to. This second type of abstinence, while it requires admirable fortitude and patience, can still be experienced in a negative way and contains a hidden danger. Human beings have an ingrained opposition to any sense of being forced, an automatic resistance to coercion (counterwill). It is triggered whenever a person feels controlled or pressured to do someone else’s bidding—and we can generate counterwill even against pressure that we put on ourselves.

A part of creating external structures to support recovery is the avoidance of environments and environmental cues that trigger addictive thoughts and feelings. Those cues and environments vary from person to person, from addiction to addiction but for all addicts they are powerful in setting off addictive behaviour.

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. The ecological approach to recovery must, therefore, address the stresses in one’s life. It’s impossible to cool the circuitry of the addicted brain if we leave it heated by chronic stress.

We may also take on chronic stresses because of ingrained beliefs of how we “ought” to be. Some people, for example, may find themselves unable to say no to work demands or the emotional expectations of their spouse, adult children or family of origin. Something has to give—and what gives, if not our physical health, is our mood or peace of mind. Addiction comes along as an “antidote.”

A therapist once said to me, “When it comes to a choice between feeling guilt or resentment, choose the guilt every time.” It is wisdom I have passed on to many others since. If refusal to take on responsibility for another person’s behaviours burdens you with guilt, while consenting to it leaves you eaten by resentment, opt for the guilt. Resentment is soul suicide.

A tremendous step forward, albeit a very difficult one, is for people who are in relationship with the addict not to take his behaviours personally. This is one of the hardest challenges for human beings—and that is precisely why it’s a core teaching in many wisdom traditions. The addict doesn’t engage in his habits out of a desire to betray or hurt anyone else but to escape his own distress. It’s a poor choice and an irresponsible one, but it is not directed at anyone else even if it does hurt others. A loving partner or friend may openly acknowledge his or her own pain around the behaviour, but the belief that somehow the addict’s actions deliberately betray or wound them only compounds the suffering.

All possible resources should be mobilized to help her experience a pregnancy that is emotionally, physically and economically as stress-free as possible. Employers and governments need to appreciate the crucial importance of these gestational months to the infant’s developmental well-being and, even more so, the crucial importance of the first months following birth and the first years.

Children who are emotionally well nurtured and brought up in stable communities do not need to become addicts.

When it comes to drug education, most governments appear to view prevention largely as a matter of informing people, especially young people, that drugs are bad for them. A worthy objective, certainly, but like all behavioural programs, this form of prevention is highly unlikely to make a significant impact. The reason is that the children who are at greatest risk are the least open to hearing the message, and even if they do hear it, they are the least capable of conforming to it. Intellectual knowledge, while important, is a poor competitor for deep-seated emotional and psychological drives.