Dr Gabor Maté “90 of people are addicts 10 are lying to themselves”

Good evening or perhaps morning or afternoon if you're joining from different time zones. Can I just politely remind you all to press mute on your microphones because otherwise everybody else in the talk might be able to hear the goings-on in each of your individual homes. Thank you so much and it's wonderful to see so many of you here with us. I'm sorry that especially for this event which no doubt will touch on the critical importance of connectivity and of humans as social creatures. We can't all be together in one room but I'm delighted we can all get together in this way and we will of course be seeing more of your faces and you will be able to participate as Esme said when we get to the Q&A section later on. So it's my very great pleasure to welcome you on behalf of the How To Academy to explore the notion of, as the event is titled, a compassionate approach to addictive and self-destructive behaviour. We want to look at what such an approach looks like, why we should aspire to it and in order to get there really how we can understand addiction, what drives it, where it originates, what makes it so hard to overcome and nevertheless how we might try. There really are few people better placed to comprehensively and sensitively answer these questions and many more than our guest this evening. He's one of the world's most revered experts in the study of addiction, now retired physician who after 20 years of family practice and palliative care experience worked for over a decade, as I'm sure we will hear more of, in Vancouver's downtown east side treating some of the people with the most severe cases of drug addiction and mental illness. He's an internationally renowned speaker, I'm sure many of you will already know this very well, I'm sure many of you will have heard him speak and the author of a number of best-selling books including the award-winning book which I'll probably miss reading now, In the Realm of Hungry Ghosts, Close Encounters with Addiction, which I'm afraid I've sort of battered and bruised over its reading over the last few days. It's as relevant now as when he first wrote his first edition which was a while ago now but it is the book on which we from which we'll just draw much of our discussion over the next hour. So really I must stop talking, there's a lot to get through and to ask him. Gabor Mate, thank you very much indeed for joining us. Pleasure to be here, thank you Hannah. So we tend to think of addiction often as relating to drugs and to sort of harmful substances and I'm sure many people have signed into this event thinking they want to know more, perhaps help a loved one, but not necessarily because they think themselves an addict. But once you're done I expect many people might think differently, so I wonder if I could just jump straight in there and ask you to do what you define so well, which is what is an addict in your terms, what qualifies as addiction? Yes, there's as you say a common myth that addiction has to do with drugs and of course it does, but not only with drugs. An addiction, the source of the word itself is a Latin word for a kind of slavery, so an addiction is any behavior that we're slaved to. So my definition of addiction, which by the way right away obviates the question is this a good addiction, it's like asking is this a good slavery? No there isn't. An addiction by definition, by my definition, it's a complex process but it's manifested in any behavior, any behavior that a person finds temporary pleasure or relief in and therefore craves, suffers negative consequences as a result of, but doesn't give it up or refuses to or cannot despite negative consequences. So the hallmarks of addiction are craving, pleasure, relief, short-term, long-term harm, inability to give it up. That's what an addiction is. That definition says nothing about drugs, it includes any human behavior that is characterized by those features that could be eating, shopping, gambling, self-harm, bulimia, work, extreme sports, pornography, sexual addiction, internet gaming, the internet itself, in other words anything. And this is where if I was in a room with participants and I would ask people to raise their hands if they recognize some addictive pattern in my life, in our society 90% of people will put their hand up and they usually do. And the other 10% most of them are lying to themselves or they don't know themselves well enough. But by and large an addiction is a right throughout our society according to my definition. One of the things that in your definition you talk about repetitive and it's something that your mind fixates on, you keep doing it in a repetitive pattern, but you emphasize it has to have a harmful impact on either yourself or on others. So if you are looking at some of those things you mentioned, so for example, I don't think you mentioned it, but caffeine or exercise, those are passions, are they addictions? There's no negative side effect necessarily from those things. Well that's the key point. If there's no negative harm, if there's no negative consequence, if there's no harm, it's not an addiction, it's a passion. But you can't tell from the outside, it's the internal relationship to it that matters. I mean I talk in my book very openly about my own addiction to shopping for classical music. Now classical music itself can be a passion, you can just love it. But the addiction wasn't to the music, it was to the shopping. I had to keep going back and back and back, despite the fact that I never even listened to much of what I had on my shelves already. And despite the fact that it cost money that was not reasonable to spend, $8,000 one week, that I was lying to my wife about it, that I was neglecting my family life for it and even my work for it. So on the outside you can just say this guy just loves classical music. Well he does, but his relationship to it is an addictive one. So it's that internal relationship that matters. And same with work, you can do work passionately as long as you're conscious and it has no negative consequences, or you can be addicted to it. So it all depends on the internal relationship and whether or not there's actual harm. I'll finally say that sometimes people don't know the harm. They might say there's nothing wrong with me exercising all the time. Well, they might not be aware that it's taking a toll on their relationships. They might not be aware that it's diverting them from their anxiety. Instead of dealing with the anxiety, they're diverting themselves. So sometimes people have a hard time telling the harm. But having said that, you can relate to something passionately, which is not addictive, or you can relate to it addictively, which is a totally different matter. I'd like to come back certainly to that point about what you're escaping. But what you're getting at is this idea that you talk about a lot in your book and in your talks that addiction, you have a unitary view of addiction, there's one universal addiction process, and you just mentioned your compulsion to buy CDs. But does that not diminish, for example, the seriousness of a heroin addiction or addiction to harmful substances if they're all on the same scale? Well, it's a continuum, isn't it? And I'm writing a new book now, the title is The Myth of Normal, Illness and Health in an Insane Culture. And I'm saying it's on a continuum. So there's many different points in a continuum. Now, I do say in my book that my addictions wear kind of white gloves compared to the addictions of my clients who were addicted to heroin and who had HIV and Hepatitis C and whose lives were in daily danger. So the differences are obvious. But it's the similarities that are insignificant. It's the similarities that most of us like to deny. Interestingly enough, my patients in the downtown Eastside, when I would tell them about my addictive patterns, which had to do with work, and it had to do with shopping and so on, they wouldn't say, Doc, how dare you compare your little habit to our life-threatening addiction? They'd say, hey, Doc, we get it. You're just like the rest of us. And the point is, we are. We're all just like the rest of us. And the same pattern of denial and deceit and shame and guilt and subterfuge, they show up in all the addictions. Not only that, on the neurophysiological level, if you look at the brain structures involved in the addictive behaviors, they're the same, whether they're addicted to heroin or cocaine or to shopping or to gaming on the internet. So that is just a universal process with different targets, with different outlets. But ultimately, we're all looking for the same thing. And one of the things that you, of course, look at, because you worked, as you say, with people with sort of severe addictions to drugs, and the way society looked upon those people, the way society looks upon drug addicts, so differently to, for example, people, those who are addicted to cigarettes or to alcohol. Why do you feel we have to ask this so that we can look at how to change it? Society has morally judged and almost demonized the latter so much more. Well, so that's a really crucial question. Because from the medical point of view, I'm going to tell you something shocking. And one of my British colleagues, Dr. David Nutt, actually got into a lot of trouble for saying this a few years ago. He lost his government position because he pointed out the obvious. Give me a thousand people who drink heavily for 20 years, or who smoke heavily for 20 years, or who shoot heroin four times a day without overdosing for 20 years. At the end of the 20 years, guess one which will be by far the healthiest group? It'll be the heroin group. There'll be much more illness and death and dysfunction and disability in the nicotine and alcohol groups than in the heroin group. So therefore, what we decide is legal or illegal, and what we ostracize and what we condemn is highly arbitrary, and it's purely a cultural question. It's got nothing to do with biology, or with medicine, or with rationality, or with science. Now, why do we do it? Well, first of all, they're respectable corporations making a lot of money out of alcohol and nicotine. Not only that, they lie through their teeth about the impact of their products. They have for decades. We know this. But because they're in positions of power, their products are respectable. Number one. Number two, when I worked in the Downtown Eastside, as I mentioned, I saw everything in myself that I saw in my clients. But I think it takes a certain degree of openness to self-examination to recognize the similarities. Most people have a hard time doing that kind of self-inventory, and so it kind of pays off to ostracize the drug addict precisely because we don't like that stuff in ourselves, and we want to acknowledge it, so we get to feel superior to somebody by denying it. But it has nothing to do with the realities of actual who gets addicted, and why, and the actual harm. It has to do with psychological denial, and cultural prejudice, and economic privilege. That's all. One of the strongest narratives of perhaps all of those things, the cultural prejudice, the denial, is the notion that an addict can choose to end an addiction when they want. It's a cultural idea that it's their fault, that they can do something about it, they can decide to turn their lives around, something that you categorically dispute from all that you've seen and heard. And you say it's not a choice, it's not a disease, it's not about genes. Perhaps you could tell us more about why that is so. Well, so just to adjust my comments a bit, I don't say that people can't turn it around. People can turn it around. What I'm interested in is what conditions are required for people to turn it around. And the worst conditions are being outside the law and being ostracized. Those are the worst conditions to impose on people if you really want them to turn their lives around. So yes, people can turn their lives around, but very few can do so simply by an act of will. I mean, I know with my own non-substance addiction how difficult it was. And here I was, you know, a middle-aged, middle-class, well-earning, married, respectable physician, and I couldn't just turn it off like that. I tell you, I couldn't. Now, as to what it's really all about, let me ask your audience a question. And Hannah, let me ask you a question. You're standing for the audience here, so if you're okay, can I pose a question to you? You can decline if you wish. But the question I would pose to everybody is, given my definition of an addiction as a dynamic that involves temporary relief and pleasure and craving, long-term harm, difficult to giving it up, I'm going to ask all of you, all of you participants, and Hannah yourself, have you ever had an addictive pattern in your life? I don't care what or when or how long. I'm just asking, have you ever had an addictive pattern in your life according to that definition? Are you willing to answer that question? Yeah, well, I'm sure, well, A, firstly, we can certainly open that up when we come to it at the end, and B, yes, of course, and reading your book has, you know, really highlighted the patterns. I would say that they don't have harmful effects, and that's why I brought that up at the beginning. So I would say, for example, that, you know, I would have repetitive patterns, something I feel I do every day, like drink coffee, go running, and I could never not do them. I don't feel like they have harmful effects. No, no, in themselves, they don't know. If there's no negative pattern, it's not an addiction. It's just a habit or a passion, but it's not an addiction. So I'm asking about patterns that involve relief and craving, inability to give it up, despite harm. That's what I'm asking about. So maybe you might say that for yourself, you haven't had that. Is that the case? I mean, I probably have, but I feel… Okay, well, that's all right. I'm going to bring in the audience to answer those as well at the end and move on a little bit. Well, here's what I would ask. Unless this goes against your ground rules, can people put on the chat line answers to this question or not, or would you prefer that they don't? No, they certainly can. I'm wondering can we re-ask it in around half an hour's time? Okay, that's fine. All right. Well, then let me move on. What I would like to say is just to move on to the same idea, which is that all addictions that you're talking about, essentially, they soothe pain directly or distract from pain. So the important question that you want answered all the time is not about why would you be addicted, but why you feel the pain that caused the addiction. Well, this is why I wanted to ask my question, because in a given audience, wherever I speak, when I ask, people have these patterns, most people put their hand up, and then I ask them, I don't want you to tell me what you're addicted to or when or how long. I just want you to tell me what you got from it in the short term. What did it do for you? And people say things like, if I ask this audience, I can predict the answers. There would be relief from pain. They'd say numbing. They'd say escape from reality. They'd say pleasure. They'd say a sense of control. They'd say a sense of meaning. They'd say connection with other people. These are the kind of answers people usually give. And then I'd say, well, are those good things or bad things? And yes, connection with other people, sense of control, relief from pain, numbing when there's pain, like when you go to a dentist, stress relief, peace of mind, relief of anxiety. Number one, these are all forms of emotional pain. And number two, it's a good thing to get relief from them. In other words, the addiction is not the primary problem. The addiction is an attempt to solve a problem of human suffering. And that's why my mantra, which is, the question is not why the addiction, but why the pain? And if you want to look at people's pain, you can't look at their genes and you can't look in isolation and you can't look at their brains in isolation. And you can't look at their quote unquote choices, because nobody chooses to be in pain. We have to look at their lives. Something happened to create the anxiety, to create the emotional pain, to create the isolation, to create the joylessness, to create the loss of control. Something happened. And that something has to do with people's lived experience in the world, beginning from conception. And I can expand on what I mean by that later.