Gabor Maté: The Good, The Bad, and the Ugly
Gabor Maté is the revered physician who has ministered to Vancouver's inner-city addicted population. Although not a psychiatrist, Gabor is essentially a Freudian. The Hungarian-born Canadian has fashioned a best seller, In the Realm of Hungry Ghosts, that locates all addiction in childhood trauma and pain.
Here are the good, the bad, and the ugly of Gabor's approach. (Disclosure: I've met with Gabor and occasionally correspond with him.)
1. The Good. By noting that addiction isn't driven by a particular drug, or by drugs at all, Gabor directs the focus for addiction in the right direction—away from the addictive object and towards the experience of the individual. A man I respect, Gabriel Sayegh, of the Drug Policy Alliance, is indebted to Gabor for understanding his experience growing up and his becoming addicted to meth.
2. The Bad. In locating addiction in the pain people feel, Gabor strikes a chord for people. If you say to people, "Your are in pain," they will come up with painful memories. But some experiences are more traumatic than others and have more serious consequences, while people differ widely in their reactions to what may be traumatic, or may not be. In fact, a large majority of those who experience abuse don't become addicted to drugs or alcohol—thank God.
3. The Ugly. Gabor's is a disease theory. In order to sound scientific, he discusses potential neurologic consequences of trauma. But he casts his net so wide in locating childhood trauma that there is no way of deciding what is really traumatic and gradating the neurological impact of these stimuli/experiences.
The worst aspect of Gabor's theory is that locating addiction-causing experiences in neurological imprints of supposed trauma makes the causes of addiction seem permanent, even as most people outgrow addiction. Here is how I evaluate Gabor's theory in Recover! Stop Thinking Like an Addict:
As important as is Maté’s work with addicts, his simplistic vision of addiction in which abuse history and imagined biochemical changes become the essential causes of people’s self-destructive behavior can be as incapacitating as genetic neurochemical deficiency models. 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 world.
In the first place, the overwhelming majority of abuse victims and other trauma sufferers don't develop drug addictions or alcoholism. (Gabor would say they develop other forms of addiction or illness.) "Worst of all," Ilse Thompson and I write, "focusing on childhood as the determinant of addiction detracts from our awareness of people’s natural tendency to overcome abuse and addictive experiences."
As one person wrote me: "I am very fond of your writing and Dr. Mate's, and I can see your point very clearly about childhood trauma being the new disease theory. It shifts from disease to disability, which is wonderful for easing stigma, but disempowering for the addicted person." So, as empathic as Maté the theorist, writer, and helper can be, we need to get beyond his trauma—>brain damage—>addiction vision.
Ethan Nadelmann and the Seven Drug Czars
What will get us there? Right now, the future of addiction is not in the hands of addiction theorists, from Gabor to Nora Volkow, but those of policy advocates. As frightened as we are of non-medical drugs—egged on by Volkow and her ilk—we in the United States are engaged in the gradual process of decriminalizing drug use.
Much of this is due to one man, Ethan Nadelmann, whom I met when we both worked in Princeton in 1988-1989 when Ethan laid out the policies of drug decriminalization and harm reduction. As founder and director of the Drug Policy Alliance, Ethan has pursued a systematic, organizationally based approach to realizing that vision and, in a remarkable number of ways, it is now in action: medical marijuana, needle exchange, equalization of crack-powder cocaine penalties, marijuana legalization, drug use decriminalization.
It is funny to consider that, during this period, the Office of National Drug Control Policy was legislated with bipartisan support in 1988 and began operating in 1989. There have since been seven Drug Czars. Quick—what innovations have this group, individually and collectively, been responsible for in the time that Ethan and DPA have revolutionized drug policy? (Think of William Bennett, moral scold with a gambling jones, and General Barry McCaffrey, who opposed needle exchange, the delay in which contributed to tens of thousands of deaths.)
The Future of Addiction
Where do we go from here? Ethan—who unlike Maté, Volkow, and me, is not an addiction theorist—has put in motion the thinking that will emerge as a new way our society conceives addiction. The critical issue in this vision will be the idea of addictiveness as a lifelong trait or as an episodic part of the individual's life. As Ilse and I write:
Addiction is a response to life circumstances ranging from trauma to an inability to deal with everyday demands to being in a depressed-traumatic time in your life. It can be short-term and limited in time and place or a chronic pattern. The most important thing for you to know about addiction—knowledge the disease theory denies you—is that most people, sooner or later, naturally outgrow it.
Meanwhile, the DPA's harm reduction director, Meghan Ralston, has announced, as Ilse Thompson and I say in Recover!: YOU ARE NOT YOUR ADDICTION.
Let's watch as the warring notions of addiction proposed by Maté, Volkow, and me fight for supremacy in the 21st Century. I wonder which will win?
Stanton Peele has been at the cutting edge of addiction theory and practice since writing, with Archie Brodsky, Love and Addiction in 1975. He has developed the on-line Life Process Program for addiction. His new book (written with Ilse Thompson) is Recover! Stop Thinking Like an Addict with The PERFECT Program.
P.S. (April 16) Great news Gabor! You've convinced another fan that the neuological damage from "trauma" and abuse is permanent and that no one ever gets over addiction! Congratulations!
Submitted by Anonymous on April 15, 2014.
How do you explain all the research that shows that your brain is forever altered? Please sources?
Submitted by Stanton Peele on April 15, 2014.
Since 1991 four major national surveys of psychiatric disorders and their correlates have been published. Each found that most of those ever addicted to illicit drugs were “ex-addicts” by about age 30. Moreover, most of those who quit did so without professional help. Follow-up analyses reveal that the high remission rates were not temporary, [or] due to missing addicts [as through, for example, their deaths].
All that bullshit must be. . .bullshit.
Submitted by Anonymous on April 15, 2014.
They may have just been substance abusers, and not addicts though. There is a difference. You can read Richard Taite's blog on here. He explains it.
There are three responses I can think of to my critique of Gabor: (1) "You're crazy -- he doesn't say that" (see comment below); (2) "He says that, and he's right and you're wrong" (comment just above); (3) As in comment in the text above -- "I like Gabor, but you're right -- he's all about powerlessness."
Which of the three groups do you belong to?
Here's the "You're crazy" comment:
Submitted by Randi Narkevic on April 14, 2014
I believe that Dr. Peele completely misrepresents Dr. Mate's position. Anyone who is interested in Dr. Mate's work should read his work and not depend on the opinions of others, no matter how strong their credentials.
Now, here's the kicker -- I can't say whether Gabor himself would say, "You're crazy, I don't say that," or, "Yes, of course I say trauma's effects are permanent, and you can't ever recover, and you're crazy to question those truths."
One reason for my confusion is that Gabor and I have written blurbs for two books together -- in one, Amy Lee Coy failed over a dozen years in AA and 12-step rehab and quit her addictions herself after being sexually abused by her grandfather and abandoned by her mother. So I would guess this runs counter to everything Gabor says. Instead, he lauds Amy's book!
The other book Gabor and I both praise is Lance and Zachary Dodes' The Sober Truth, a boadside against AA. Yet I have heard Gabor praise AA to the heavens.
Please, dear readers -- which is the real Gabor?