Maté maintains a human communion with his patients. He does so by describing his own maladies -- his ADD and shopping addiction -- which he puts on a level with severe drug addictions. Fair enough (although some think that as a successful middle-class physician Maté is stretching this connection).

Beyond this, Maté has a theory of addiction rooted in childhood abuse. Maté combines his clinical experiences with brain research claiming the source of addiction is in formative brain chemicals. For Maté, the first five years of life (and even the environment in the womb) dictate the likelihood of addiction. He then relates this theoretical point of view to studies connecting stress, abuse and lack of love and attachment to not only life problems (as they have been for some time) but to deficiencies in people's ability to process endorphins and dopamine -- the neurochemicals in our bodies that provide us with both pleasure and pain relief.

Maté then claims that addiction results from deficiencies (lack of receptors) in these neurosystems that cause people with addictions to self-medicate to replace their missing neurostimulation. In this sense, people are addicted to drugs as replacements for the brain chemicals their own bodies fail to process.  Those addicted to things other than drugs are reacting to the same internal chemistry, but with different external stimulants.

It is important to respect Maté's work with individuals living with addictions.  For this reason, people who work with clients from a harm reduction perspective -- that is, they accept people as they are, and seek to help those in need -- deeply admire Maté. In addition, Maté's exploring the root causes of addiction may in some sense represent progress out of a deterministic disease concept of addiction because it broadens the range of experiences that can lead to addiction and through which addiction expresses itself.

Unfortunately, however, Maté is fundamentally proposing a reductionist vision of addiction, where abuse history and posited biochemical changes are now THE essential causes of people's self-destructive action. It is not enough to say that this model is highly conjectural. It also isn't true -- that is, it makes little sense of the data. Vincent Felitti conducted a huge epidemiological study on early childhood experiences. He found that only a tiny group (3.5%) of people with 4 or more adverse childhood experiences became involved in injection drug use. So Maté's model is highly undiscriminating.  The percentage of addicts increases somewhat with the number of adverse experiences. Even so, this relatively minor elevation in no way presupposes the damage is caused biochemically, rather than simply by detrimental psychological consequences and deeply dysfunctional homes and environments.

One counterargument in favor of Maté's position might be that injection drug use is low among this population because so few people who have experienced abuse are exposed to injectable drugs.  But this argument does not hold either. Felitti has included alcohol in his research.  And, with drinking, the rates of dependence follow the same trajectory depending on the number adverse childhood experiences, but are still not much higher for abuse victims -- 16%.

Beyond this failure to find the distinct differences in addiction among abuse victims that Maté proposes, we must account for people's natural tendency to overcome abuse and addictive experiences. We might, after all, study what are the protective effects for the other 96.5 percent of abuse sufferers that prevent them from injecting drugs, and the 84% who do not become alcohol dependent. And, on top of this, what about the strong tendency that has been revealed -- time and again -- for people with addictions to naturally remediate. According to the National Institute on Alcohol Abuse and Alcoholism, three quarters of people who were at one time alcohol dependent fully recover, the large majority without treatment, many without ceasing to drink.

In fact, at the deepest level, Maté's views limit our approaches to, our understanding of, and even our respect for people living with addiction. Rather than expand our understanding of addiction, his views harm our ability to respond to it. For one thing, focusing solely on one risk factor and one very questionable source of addiction has led Maté to posit a potential ‘cure' for addiction -- Ayahuasca -- a brew made from South-American "spirit-vine" that is claimed to open the human conscious for a higher degree of introspection.  In fact, Maté's reliance on this treatment further confuses levels of analysis -- does introspection really remedy the absence of neuro-receptors in some straightforward manner?

In this context, that harm reductionists embrace Maté is extremely troubling. For, contrary to popular beliefs in these circles, Maté is actually diverting the addiction field from a more comprehensive and practicable view of addiction. Maté's embrace of Ayahuasca does not support the broad harm reduction goals of expanding the resources available to people with addictions like those in Vancouver, of developing their skills for functioning in their worlds, and of holding up the hope that they can improve their lives. Instead, this approach is reductive, monosyllabic, and really no different than the disease camp's fool's gold quest for an addiction vaccine in the forlorn hope that we can remedy addiction without improving human lives.

A true harm reductionist should accept a wide range of contributors in the development of addiction, but particularly those that human agency -- and particularly the person who is addicted him or herself -- can address and improve. Without this sense, we are lost.

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