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runs through the entire text–the one you?d mention if someone asked you:
?What is this piece/article about?? Unlike student essays, the main idea in
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throughout the piece or it may become fully apparent only at the end.
c. When summarizing a longer article, try to see how the various stages in
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Divide the article into sections if it isn?t done in the published form. Then,
write a sentence or two to cover the key ideas in each section.
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Unformatted Attachment Preview
ver the past several decades, popular attitudes toward addiction have
undergone a radical destigmatization.
Many attribute the beginning of this
shift to former first lady Betty Ford
and her decision to go public about
her addiction to alcohol and opiates soon
after leaving the White House. She hadn?t
been a public nuisance or a barfly. She?d
never driven drunk, she said, or stashed bot-
tion and popularized the notion that someone
could be addicted to something other than
substances. Carnes?s concept of sex addiction made a splash in the popular psyche and
among many mental health professionals, and
it spawned treatments that were influenced
by 12-step programs all around the country.
In the decades that have followed, the addiction label has ballooned in common usage to
include a list of behaviors such as overeating,
gambling, shopping, kleptomania,
and internet overuse and gaming.
The concept of overdoing a behavBY R I CH A RD S I M O N
ior to the point of addiction has
& LAU R E N DO C KE T T
resonated with the general public,
even as many mental health professionals have cringed at the implications. When the DSM-5 included gambling disorder under a new
addiction heading that extended the
moniker to behaviors, Allen Francis,
chair of the DSM-IV, objected strongly and advised clinicians to reject
the diagnostic change, writing in
The Huffington Post that ?If taken
beyond its narrowest usage, ?behavioral addiction? would expand the
definition of mental disorder to its
breaking point and would threaten
to erase the concept of normality.?
Today, as the debate over the wisdom of extending our notions of
what constitutes addiction continues, one of the most eloquent and
influential spokespeople for that
broader conception is a hauntinglooking, charismatic Canadian physician named Gabor Maté. As much
social critic as clinician, Maté is the
author of In the Realm of Hungry
Ghosts, a bestseller about addictions.
tles so she could drink secretly when she was His TED talk on ?The Power of Addiction
alone. But by openly addressing her problems and the Addiction of Power? has had almost
and becoming an outspoken advocate for 700,000 views. He insists that addictive patrehabilitation through the Betty Ford Clinic terns of behavior are rooted in the alienation
(now the Betty Ford Center), she helped and emotional suffering that are inseparachange the face of addiction. Perceptions of ble from Western capitalist cultures, which,
addicts as out-of-control gutter drunks and by favoring striving and acquiring over noticjunkies were replaced by images of glamor- ing and caring for one another, end up shortous celebrities like Liza Minelli, Mary Tyler changing?and too often traumatizing?chilMoore, and Elizabeth Taylor as they checked dren and families. He argues that the more
in and out of Betty Ford.
stressful our early years, the likelier we are to
While Ford?s clinic was opening, a counsel- become addicts later as a substitute for the
ing educator named Patrick Carnes was finish- nurture and connection we never received.
With his mop of wayward curls, heavily hooding Out of the Shadows, a book that proposed
compulsive sexual activity was a form of addic- ed eyes, and the Mick Jagger-ish concavity
in All of Us
Gabor Maté?s Unflinching Vision
of his thin frame, Maté is a striking figure on the workshop circuit
as he challenges his audience to ask
not what?s wrong with addiction,
but what?s right with it. What is the
addict getting from it that makes his
addiction worth the price he pays?
Why is the ameliorative quality of a
behavior or a high so necessary for
so many? If addicts can find peace
and control only when they?re using,
what agonizing discomfort must they
feel when they?re not?
Much of what Maté knows about
addiction he learned doctoring to the
hardcore drug addicts of Vancouver?s
Downtown Eastside, which has one
of highest concentrations of active
drug users in North America. His
former employer, the Portland
Hotel Society (PHS), is known
for its controversially permissive treatment, which helps
addicts get by while they?re
actively using by providing
food, shelter, and healthcare. PHS?s most radical service is a clinic called InSite,
which goes a step beyond
clean needle exchanges and
helps IV drug users shoot
up safely. It dispenses crack
pipes for a quarter in its
vending machines to reduce
the spread of disease.
Part of Maté?s appeal is his willingness to talk about his own addictive tendencies and his view that
most of us fit somewhere along
the addiction spectrum. He?s vocal
about being a workaholic: who is
he if not a doctor and an author
and an in-demand public speaker?
he asks. For years, he freely talked
about his inability to control the
urge to go on shopping sprees for
classical music CDs, referring to it
as an addiction that ?wears dainty white gloves.? He openly places
himself on an addiction continuum
where he believes compulsive shoppers and crack fiends can both be
located. Be it a need to score horse
tranquilizers in a scummy alley, or
escape by melding into the glorious fantasy world of an online video
game, or, in Maté?s case, plunking
down cash for a set of obscure violin concertos, the denial, the craving, the temporary pleasure, the
fallout?it?s all there.
Classical music thrills him, he says,
but it?s not the listening to it that
he?s addicted to: it?s the momentary thrill he gets from buying and
possessing it. As with any addict, it?s
the release he?s after: that adrenaline push when the drug is within
reach (as he approaches the door
to the music store) and the brief
endorphin flight of freedom when
he?s found and paid for what he
wants. But, he confesses, he?s barely left the store before he?s fixating
again on his next buy.
to them. Born to a Jewish family in
Nazi-occupied Budapest, he lived in a
household filled with fear. His father
was forced to labor with the brutally
abused Jewish battalions in Hungary.
His maternal grandparents died in
Auschwitz. An aunt disappeared.
Some treatment professionals
have publicly disagreed with Maté?s
pronouncements about the inevitable connections between addiction and trauma, including his statement that while ?every traumatized
child doesn?t grow into an addict,
every addict has been a traumatized
child.? And they take his disagreement with the current biomedical
model of addiction, and his flat-out
rejection of a genetic component, as
até insists that while every
traumatized child doesn?t
grow into an addict, every addict
has been a traumatized child.
When he was most deeply in the
throes of this addiction, Maté sometimes spent thousands of dollars in
a week on music that he never listened to. At one point, he left a
mother in the middle of active labor
to go on a shopping spree. Seeking
an answer to his bondage to this
kind of behavior, he attended AA
meetings in Vancouver, becoming
an addict among addicts, and sometimes being recognized.
Although the shopping addiction
has receded, Maté still struggles with
his workaholism. He?s clear that his
addictions have failed him, as they
fail all the addicts he knows, but he
recognizes that the trauma of his
childhood enhances his enslavement
P S Y C H O T H E R A P Y N E T W O R K E R n J U L Y /A U G U ST 2017
ill-informed and potentially dangerous. He counters that focusing on a
disease model makes it too easy to
ignore the thorny societal and familial issues that underlie the power
Whether he?s right about the devastating effects of early trauma, or has
gone so far into his cultural critique
that he?s lost sight of distinguishing differences among addictions
and other kinds of disorders, he
clearly has a gift for articulating the
suffering and desperation of people caught in the grip of deep inner
compulsions, no matter how innocent seeming or how darkly selfdestructive they may be. His work
forces us to look closely at the sense
of emptiness and the failed search
for meaning that characterize our
In the interview that follows, Maté
explores the meaning of addictions
and how he?s tried to come to terms
with the inner demons in his own life.
Let?s start off by talking about your
view of addiction. You?ve written that
?any passion can become an addiction.? What do you mean by that?
GABOR MATÉ: Addiction is a com-
plex psychophysiological process,
but it has a few key components.
I?d say that an addiction manifests
in any behavior that a person finds
temporary pleasure or relief in and
therefore craves, suffers negative
consequences from, and has trouble
giving up. So there?s craving, relief
and pleasure in the short term, and
negative outcomes in the long term,
along with an inability to give it
up. That?s what an addiction is.
Note that this definition says nothing about substances. While addiction is often to substances, it could
be to anything?to religion, to sex,
to gambling, to shopping, to eating,
to the internet, to relationships, to
work, even to extreme sports. The
issue with the addiction is not the
external activity, but the internal relationship to it. Thus one person?s passion is another?s addiction.
PN: Okay, but the whole subject of
addictions is shrouded in a certain
amount of controversy these days.
What do you think is the most common misconception about addictions?
MATÉ: Well, there are a number
of things that people often don?t
get. Many believe addictions are
either a choice or some inherited
disease. It?s neither. An addiction
always serves a purpose in people?s
lives: it gives comfort, a distraction
from pain, a soothing of stress. If
you look closely, you?ll always find
that the addiction serves a valid pur-
pose. Of course, it doesn?t serve this
purpose effectively, but it serves a
PN: Lots of people believe that the
term addiction has become too loosely applied. So what?s the difference
between saying ?I have an addiction? and ?I have bad habits that give
me short-term satisfaction, but don?t
really serve me in the long term??
MATÉ: The term addiction comes
from a Latin word for a form of
being enslaved. So if it has negative
consequences, if you?ve lost control
over it, if you crave it, if it serves a
purpose in your life that you don?t
otherwise know how to meet, you?ve
got an addiction.
PN: Some people are critical of the
term addiction because they believe it
medicalizes and pathologizes behavior in a way that?s not helpful.
MATÉ: I don?t medicalize addic-
tion. In fact, I?m saying the opposite of what the American Society of
Addiction Medicine asserts in defining addiction as a primary brain disorder. In my view, an addiction is an
attempt to solve a life problem, usually one involving emotional pain or
stress. It arises out of an unresolved
life problem that the individual has
no positive solution for. Only secondarily does it begin to act like a disease.
PN: What?s lost by just thinking of
addictions as bad habits?
MATÉ: It falls short of a full under-
standing of addiction. Let?s say a
person has a bad habit of picking
his nose in public. That?s a bad
habit, right? Frequently scratching
one?s genitals while giving a public talk would be regarded as a bad
habit. But neither of these things is
an addiction because nobody craves
doing them, nor do they particularly get pleasure from them. They?re
compulsive behaviors, perhaps, but
if there?s no craving involved and
no inability to give it up, there?s no
addiction. Some bad habits aren?t
addictions. But, for example, if
somebody can?t stop having affairs,
despite the negative consequences,
that?s not just a bad habit.
PN: The notion of trauma is closely
tied into your conception of addiction. Why is that?
MATÉ: If you start with the idea that
addiction isn?t a primary disease,
but an attempt to solve a problem,
then you soon come to the question: how did the problem arise? If
you say your addiction soothes your
emotional pain, then the question
arises of where the pain comes from.
If the addiction gives you a sense of
comfort, how did your discomfort
arise? If your addiction gives you a
sense of control or power, why do
you lack control, agency, and power in your life? If it?s because you
lack a meaningful sense of self, well,
how did that happen? What happened to you? From there, we have
to go to your childhood because
that?s where the origins of emotional pain or loss of self or lack of
agency most often lie. It?s just a logical, step-by-step inquiry. What?s the
problem you?re trying to resolve?
And then, how did you develop that
problem? And then, what happened
to you in childhood that you have
PN: Some people have challenged
your belief that addiction is inevitably
connected to trauma. Looking at the
research, they say that most addicts
weren?t traumatized, and most traumatized people don?t become addicts.
MATÉ: Then they?re not looking
at the research. The largest population study concluded that nearly two-thirds of drug-injection use
can be tied to abuse and traumatic childhood events. And that?s
according to a relatively narrow
definition of trauma. I never said
that everybody who?s traumatized
becomes addicted. But I do say that
everybody who becomes addicted
was traumatized. It?s an important
distinction. Addiction isn?t the only
outcome of trauma. If you look at
the Adverse Childhood Experiences
Study, it clearly shows that the more
trauma there is, the greater the
risk for addiction, exponentially so.
Of course, there are traumatized
people who don?t become addicts.
You know what happens to them?
They develop depression or anxiety, or they develop autoimmune
disease, or any number of other
outcomes. Or if they?re fortunate
enough and get enough support
in life to overcome the trauma,
then they might not develop
anything at all.
When I give my talks across
the world, it?s not unusual
to have somebody stand up
and say, ?Well, you know, I
had a perfectly happy childhood, and I became an
addict.? It usually takes me
three minutes of a conversation with a person like that
to locate trauma in their
history by simply asking a
few basic questions.
ddiction is an attempt
to solve a life problem.
Only secondarily does it begin
to act like a disease.
PN: What are they?
MATÉ: Sometimes I ask if either
parent drank and I hear, ?Yeah, my
dad was an alcoholic.? At that point,
the whole audience gasps because
everybody in the room gets that you
can?t have a happy childhood with
a father who?s an alcoholic. But the
person can?t see that because they
dealt with the pain of it all by dissociating and scattering their attention. Maybe they developed ADD or
some other problem on the dissociative spectrum. They shut down their
emotions, and now they?re no longer in touch with the pain that they
would?ve experienced as a child.
That?s an obvious one. Less obviously, I might ask about being bullied. And when a person says, ?Yeah,
I was bullied as a kid??or just sometimes felt scared, or alone, or in
emotional distress as a child?I ask
to whom they spoke about such feel-
ings. The answer is almost uniformly
?nobody.? And that in itself is traumatic to a sensitive child.
So trauma can be understood in
the sense of the Adverse Childhood
Experiences criteria: emotional
abuse, physical abuse, sexual abuse,
a parent dying, a parent being jailed,
a parent being mentally ill, violence
in the family, neglect, a divorce. Or
it can be understood in the sense
of relational trauma. That means
you don?t have to be hit or physically abused. If the parents were
stressed or distressed or distracted?
if their own trauma got in the way of
their attuning with the child?that?s
enough to create the lack of sense
of self in the child. Or it?s enough
to interfere with the development of
a healthy sense of self, and with normal brain development itself. This
P S Y C H O T H E R A P Y N E T W O R K E R n J U L Y / A UG U S T 2017
point must be emphasized: the physiology of the brain develops in interaction with the environment, the
most important aspect of which, to
cite a seminal article from the Center
on the Developing Child at Harvard
University, is the mutual responsiveness of adult?child relationships.
PN: Recently, more and more atten-
tion is being devoted to expanding our conception of addiction
to include behavioral addictions.
What?s the difference between substance and behavioral addictions?
MATÉ: First, let?s look at what?s
similar. The pattern of compulsive
engagement in the behavior that
one craves, finds temporary pleasure or relief in, but suffers negative
consequences from?that?s similar
across all addictions. Also, many of
the behaviors around both kinds of
addiction, such as denial, are similar. So workaholics will deny the
effect of workaholism in their own
life or the lives of their family members. There will often be subterfuge
and dishonesty about the addiction.
The sex addict isn?t going to be publicly talking about his addiction, or
even acknowledging it. Shame is the
common undercurrent in addiction,
whatever the object of the addiction
The other thing that?s common
among all addictions has to do with
brain circuits. I can?t overemphasize
this. It doesn?t matter if you look at
the brain of a fervent shopper or a
cocaine addict: the same incentive
and motivation circuits are activated, and the same brain chemicals
are being secreted. In the case of
the shopper or the gambler or the
sexaholic, it?s dopamine. If the sexaholic was only after sex, the solution would be simple: marry another sexaholic. You could have all the
sex that you wanted whenever you
wanted it. But what is it really about?
It?s about the hunt, the search, the
excitement of the chase. And that
has to do with the brain?s incentive
and motivation circuitry, the nucleus
accumbens and its projections to the
cortex, and the availability of dopamine, which is also what cocaine
and crystal meth and nicotine and
So what I?m saying is that on a biochemical and brain circuitry level,
there?s no difference between behavioral and substance addictions?or
more accurately, only a quantitative difference, not qualitative. It
all has to do with the brain?s pleasure-reward centers, pain-relief circuitry, incentive-motivation circuitry,
and impulse-regulation circuits. You
know that it?s not good for you, but
you can?t stop yourself. That?s the
same thing in all addictions.
Finally, there?s the matter of poor
stress regulation. When you ask people who have some addictive behavior, like gambling or sex or shop-
ping, what induced them to go back
to the behavior after having given it
up for a while, they usually say something stressful happened?which
means that their own stress-regulation circuitry isn?t fully developed.
They have to try to regulate it externally. And that, too, is an artifact of
childhood circumstances: these crucial circuits didn?t develop properly
for lack of the right conditions.
PN: What?s the distinction between
having addictions and OCD?
MATÉ: The person with OCD is
compelled to perform some behavior, but finds it unpleasant to have
to engage in it. It?s not egosyntonic.
The person doesn?t like it. There?s no
pleasure in it and no craving for it.
PN: And does their brain look dif-
ferent than the brain of an addicted
MATÉ: To really answer that, I?d
have to look over the research more.
But I suspect that, while there may
be certain similarities, the pleasurereward centers aren?t activated in
the person with OCD. I think OCD
is also rooted in trauma, a different
manifestation of it than …
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