In the Realm of Hungry Ghosts by Gabor Maté

This book does a remarkable job of revealing that humanity, and demonstrating that addiction is not a choice, not a weakness, and not a moral failing. Yet underneath the addiction and the desperate behaviours that fuel it, the humanity is still there. Society often rejects its residents as less than human. The concentration of pain and suffering in one small neighbourhood can be overwhelming. I spent several years working in the same neighbourhood as the Portland Hotel.

It’s refreshing to see someone writing from a professional perspective incorporate their own vulnerability. He’s open about his own compulsive tendencies and work on self-compassion. Maté describes his approach to working with this patient population as compassionate curiosity. The book also covers the failure of the war on drugs approach, offering suggestions for a more humane alternative, including harm reduction as a necessary small step. Relevant research findings are incorporated in a reader-friendly manner. The book discusses the brain and body systems that are involved in addictions, including the way opioid use taps into primal attachment needs. Cravings will then cause them to compulsively seek out those drugs.

The author explains that drugs don’t cause addiction addiction happens when vulnerable people are exposed to potentially addictive drugs. Yet many prescribers are reluctant to give ADHD meds to people with additions. Likely, the stimulant use was an attempt to self-medicate. Maté argues that when people feel calmer after using stimulants, that’s almost a sure sign they have ADHD.

Fetal alcohol exposure, childhood sexual abuse, trauma on top of trauma, on top of trauma… As one chapter title says, “their brains never had a chance.” If one were to sum up the adverse childhood experiences scores of the Portland residents alone, the number would be massive. It’s easy to judge people whose lives are consumed by their addictions… until you hear their stories. Ultra-low barrier housing like this supports people with complex mental and physical health problems, addictions, and social problems people end up here after being evicted from everywhere else. It draws on his encounters with patients while working as a staff physician at the Portland Hotel, an ultra-low-barrier supported housing building in Vancouver’s downtown eastside, Canada’s poorest postal code. Gabor Maté offers powerful insights into the vulnerable, human side of addiction.

In the Realm of Hungry Ghosts by Gabor Maté