in the realm of hungry ghosts

In the Realm of Hungry Ghosts by Gabor Mate

In the Realm of Hungry Ghosts by Gabor Mate is a riveting exploration of addiction. Mate’s vivid description of working with severely addicted patients in Vancouver’s skid row is not for the faint of heart. This book is deep dive into addiction, helping us understand what it is, how it happens, and what recovery entails.

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Chapter 2 – The Lethal Hold of Drugs

-On the physiological level, drug addiction is a matter of brain chemistry gone askew under the influence of a substance and, as we will see, even before the use of mind-altering substances begins.

Chapter 3 – The Keys of Paradise – Addiction as a Flight from Distress

-Far more than a quest for pleasure, chronic substance use is the addict’s attempt to escape distress.

-The research literature is unequivocal: most hard-core substance abusers come from abusive homes.

-Not all addictions are rooted in abuse or trauma, but I do believe they can all be traced to painful experience.

-Adults envy the openhearted and open-minded explorations of children; seeing their joy and curiosity, we pine for our own lost capacity for wide-eyed wonder.

-Boredom, rooted in a fundamental discomfort with the self, is one of the least tolerable mental states.

-Our emotions are an indispensable part of our sensory apparatus and an essential part of who we are. They make life worthwhile, exciting, challenging, beautiful, and meaningful.

-When we flee our vulnerability, we lose our full capacity for feeling emotion.

-Flooded with artificially high levels of dopamine triggered by external substances, the brain’s own mechanisms of dopamine secretion become lazy.

-Only long months of abstinence allow the intrinsic machinery of dopamine production to regenerate.

-Many addicts report similar improvements in their social abilities under the influence, in contrast to the intolerable aloneness they experience when sober.

Chapter 11 – What is Addiction?

-Addiction is a “chronic neurobiological disease …characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continue use despite harm, and craving.”

-The issue is not the quantity or even the frequency, but the impact.

Addiction is any repeated behavior, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others. Addiction involves:
1. Compulsive engagement with the behavior, a preoccupation with it;
2. Impaired control over the behavior;
3. Persistence or relapse despite evidence of harm; and
4. Dissatisfaction, irritability, or intense craving when the object — be it a drug, activity, or other goal — is not immediately available.

-How does the addict know she has impaired control? Because she doesn’t stop the behavior in spite of its ill effects

-Some addicts never recognize the harm their behaviors cause and never form resolutions to end them.

-Addiction has biological, chemical, neurological, psychological, medical, emotional, social, political, economic and spiritual underpinnings

-“The heart of addiction is dependency, excessive dependency, unhealthy dependency — unhealthy in the sense of unwhole, dependency that disintegrates and destroys.” – Father Sam Portaro

Chapter 12 – Do Drugs Cause Addiction?

-There is a misconception that taking a drug alone will lead to an addiction

-Medical evidence has repeatedly shown that opioids prescribed for cancer pain, even for long periods of time, do not lead to addiction except in a minority of susceptible people.

-Addiction is a human problem that resides in people, not in the drug or in the drug’s capacity to produce physical effects.

-Some people, a relatively small minority, are at grave risk for addiction if exposed to certain substances. For this minority, exposure to drugs really will trigger addiction, and the trajectory of drug dependence, once begun, is extremely difficult to stop.

-4.6 percent of Canadians have tried crystal meth, but only 0.5 percent had used it in the past year. If the drugs by themselves induced addiction, the two figures would have been nearly identical.

-There are no known examples of persistently addictive behaviors in the natural world

-Under certain conditions of stress many people can be made susceptible to addiction, but if circumstances change for the better, the addictive drive will abate. (Vietnam Veterans using opiates)

Three factors need to coincide for substance addiction to occur:  a susceptible organism, a drug with addictive potential, and stress.

Chapter 13 – A Different State of the Brain

-As we age, we develop more active connections and therefore more white matter. In the brains of cocaine addicts, the age-related expansion of white matter is absent. Functionally, this means a loss of learning capacity — a diminished ability to make new choices, acquire new information, and adapt to new circumstances.

-Cocaine and other stimulant-type drugs work because they greatly increase the amount of dopamine available to cells in essential brain centers. That sudden rise in the levels of dopamine, one of the brain’s “feel-good” chemicals, accounts for the elation and sense of infinite potential experienced by the stimulant user, at least at the beginning of the drug habit.

-Brains of chronic cocaine users had fewer than normal dopamine receptors. The fewer such receptors, the more the brain would “welcome” external substances that could help increase its available dopamine supply.

-Because dopamine is important for motivation, incentive, and energy, a diminished number of receptors will reduce the addict’s stamina and his incentive and drive for normal activities when not using the drug.

-It’s a vicious cycle: more cocaine use leads to more loss of dopamine receptors. The fewer receptors, the more the addict needs to supply his brain with an artificial chemical to make up for the lack.

-The brain is accustomed to a certain level of dopamine activity. If it is flooded with artificially high dopamine levels, it seeks to restore the equilibrium by reducing the number of receptors where the dopamine can act. This is how dependency happens and withdrawal.

-It can take months or longer for the receptor numbers in the brain to rise back to pre-drug use figures.

-All commonly abused drugs temporarily enhance the brain’s dopamine functioning. Alcohol, marijuana, opiates, heroin, and morphine, and stimulants such as nicotine, caffeine, cocaine, and crystal meth all have this effect.

-Food seeking can increase brain dopamine levels in some key brain centers by 50%. Sexual arousal will do by a factor of 100%, as will nicotine and alcohol. But none of these can compete with cocaine, which more than triples dopamine levels. Yet cocaine is a miser compared with crystal meth, whose dopamine-enhancing effect is an astounding 1,200 percent.

Chapter 14 – Through a Needle, a Warm, Soft Hug 

-Endorphins do for us exactly what plant-derived opioids can do: they’re powerful soothers of pain, both physical and emotional.

-For the distracted and soul-suffering person, a hit of endorphins, just like an infusion of opium products, “composes what has been agitated, concentrates what has been distracted.”

-Oxytocin is not an endorphin but it increases the sensitivity of the brain’s opioid systems to endorphins — Nature’s way of making sure that we don’t develop a tolerance to our own opiates.

-Why is it essential to prevent tolerance to our natural reward chemicals? Because opioids are necessary for parental love. The infant’s well-being would be jeopardized if the mother became insensitive to the effects of her own opioids.

-Nurturing mothers experience major endorphin surges as they interact lovingly with their babies — endorphin highs can be one of the natural rewards of motherhood.

-Addiction to opiates like morphine and heroin arises in a brain system that governs the most powerful emotional dynamic in human existence: the attachment instinct. Love.

-Attachment is the drive for physical and emotional closeness with other people.

-Opiates do not “take away” pain. Instead, they reduce our consciousness of it as an unpleasant stimulus.

-We “feel” physical and emotional pain in the same part of the brain — and that, in turn, is crucial to our bonding with others who are important to us.

-The less effective our own internal chemical happiness system is, the more driven we are to seek joy or relief through drug-taking or through other compulsions we perceive as rewarding.

Chapter 15 – Cocaine, Dopamine, and Candy Bars – The Incentive System in Addiction 

-Environmental cues associated with drug use — paraphernalia, people, places, and situations — are all powerful triggers for repeated use and for relapse, because they themselves trigger dopamine release.

-The role of the dopamine system in novelty-seeking helps explain why some people are driven to risky behaviors such as street racing. It’s one way to experience the excitement of dopamine release.

-Dopamine activity also accounts for a curious fact reported by many drug addicts: that obtaining and preparing the substance gives them a rush, quite apart from the pharmaceutical effects that follow drug injection.

Chapter 16 – Like a Child Not Released

-People with impaired prefrontal cortex (PFC) function will have poor impulse control and will behave in ways that to others seem uncalled for, childish, or bizarre.

-Through its access to memory traces, conscious and unconscious, the OFC (orbitofrontal cortex)  “decides” the emotional value of stimuli

-The OFC decides to what or whom we should devote our attention at any given moment

-The OFC is also deeply concerned with the assessment of interactions between the self and others plays a ceaseless game of “who loves, who loves me not?” It even gauges “How much does he/she love me or dislike me?”

-Because they pay heed to physical and emotional rather than verbal messages, young children and aphasiacs have a much better sense of when they are being lied to than most of us have.

-The OFC works abnormally in drug abusers, showing malfunctioning patterns in blood flow, energy use, and activation. No wonder, then, that psychological testing shows drug addicts to be prone to “maladaptive decisions when faced with short-term versus long-term outcomes, especially under conditions that involve risk and uncertainty.

-Salience attribution: the assignment of great value to a false need and the depreciation of true ones.

Part IV – How the Addicted Brain Develops

Chapter 17 – Their Brains Never Had a Chance

-ADD is a major risk factor for addiction

-Brain development in the uterus and during childhood is the single most important biological factor in determining whether or not a person will be predisposed to substance dependence and to addictive behaviors of any sorT, whether drug-related or not.

-The expression of genetic potential is, for the most part, contingent on the environment.

-To ensure that babies can make their way out of the birth canal, the bargain forced upon our ancestors was that the human brain would be relatively small and immature at birth. On the other hand, it would undergo tremendous growth outside the mother’s body.

-Outside the relatively safe environment of the womb, our brains-in-progress are highly vulnerable to potentially adverse circumstances.

-The three environmental conditions absolutely essential to optimal human brain development are nutrition, physical security, and consistent emotional nurturing.

-The third prime necessity — emotional nurture — is the one most likely to be disrupted in Western societies.

-Attachment establishes an interpersonal relationship that helps the immature brain use the mature functions of the parent’s brain to organize its own processes.

-Infants read, react to, and are developmentally influenced by the psychological states of the parents. They are affected by body language: tension in the arms that hold them, tone of voice, joyful or despondent facial expressions, and yes, the size of the pupils.

-The parent’s brain programs the infant’s, and this is why stressed parents will often rear children whose stress apparatus also runs in high gear, no matter how much they love their child and no matter that they strive to do their best.

-The long-term effect of parental mood for on the biology of the child’s brain is illustrated by several studies showing that concentrations of the stress hormone of cortisol are elevated in the children of clinically depressed mothers.

-At age three, the highest cortisol levels were found in those children whose mothers had been depressed during the child’s first year of life, rather than later.

-We know that the majority of chronically hard-core substance-dependent adults lived, as infants and children, under conditions of severe adversity that left an indelible stamp on their development.

Chapter 18 – Trauma, Stress, and the Biology of Addiction

-The three dominant brain systems in addiction — the opioid attachment reward system, the dopamine-based incentive-motivation apparatus, and the self-regulation areas of the prefrontal cortex — are all exquisitely fine-tuned by the environment.

-To various degrees, in all addicted persons these systems are out of Kilter. The same is true of the fourth brain-body system implicated in addiction: the stress response mechanism.

-Happy, attuned emotional interactions with parents stimulate a release of natural opioids in an infant’s brain. This endorphin surge promotes the attachment relationship and the further development of the child’s opioid and dopamine circuitry. On the other hand, stress reduces the numbers of both opiate and dopamine receptors.

-The presence of consistent parental contact in infancy is one factor in the normal development of the brain’s neurotransmitter systems; the absence of it makes the child more vulnerable to “needing” drugs of abuse later on to supplement what her own brain is lacking. Another key factor is the quality of the contact the parent provides, and this, depends very much on the parent’s mood and stress level.

-Premature babies who have to live in incubators for weeks or months have faster brain growth if they are stroked for just ten minutes a day.

-A child’s capacity to handle psychological and physiological stress is completely dependent on the relationship with his parent or parents. Infants have no ability to regulate their own stress apparatus, and that’s why they will stress themselves to death if they are never picked up.

-Studies of drug addicts repeatedly find extraordinarily high percentages of childhood trauma of various sorts, including physical, sexual, and emotional abuse.

-All stressors represent the absence of something that the organism perceives as necessary for survival — or its threatened loss. The threat itself can be real or perceived.

-Early stress establishes a lower set point for a child’s internal stress system: such a person becomes stressed more easily than normal throughout her life

-Three factors that universally lead to stress for human beings: uncertainty, lack of information, and loss of control. To these, we may add conflict that the organism is unable to handle and isolation from emotionally supportive relationships.

Chapter 19 – It’s Not in the Genes

-There is no such thing as a specific gene for alcoholism, obesity, or a particular type of personality…rather the issue at hand is to understand how certain genes and behavioral traits are connected.

-It’s not that genes do not matter — they certainly do. It’s only that they do not and cannot determine even simple behaviors, let alone complex ones like addiction. Not only is there no addiction gene, there couldn’t be one.

-It is the environment within and outside the body that determines which genes are switched on, or activated, in which cell.

-Stresses during pregnancy can already begin to “program” a predisposition to addiction in the developing human being.

-It has been demonstrated that both animals and humans who experienced the stress of their mothers during pregnancy are more likely to have disturbed stress-control mechanisms long after birth, which creates a risk factor for addiction.

-There is a psychological fact that, provides a powerful incentive for people to cling to genetic theories. We human beings don’t like feeling responsible: as individuals for our own actions; as parents for our children’s hurts; or as a society for our many failings.

-Genetic explanations get us off the hook

-If a phenomenon like addiction is determined mostly by biological heredity, we are spared from having to look at how our social environment  supports, or does not support, the parents of young children, and at how social attitudes, prejudices, and policies burden, stress, and exclude certain segments of the population and thereby increase their propensity for addiction.

Part V – The Addiction Process and the Addictive Personality

Chapter 20 – “A Void I’ll Do Anything to Avoid”

-Just as it’s possible to drink alcohol without being addicted to it, so one can engage in any activity without addiction. On the other hand, no matter how valuable or worthy an activity may be, one can relate to it in an addicted way.

-All addictions, substance-related or not, share states of mind such as craving and shame and behaviors such as deception, manipulation, and relapse.

-Like Drug addicts, gamblers have diminished levels of serotonin — a brain chemical that helps to regulate moods and control impulses.

-As with drug addicts, addictive eaters have diminished dopamine receptors; in one study, the more obese the subjects were, the fewer dopamine receptors they had.

-“The more expensive the product, the crazier the shoppers get. And when buying really expensive products, the part of the brain dealing with rational thought has reduced its activity to almost zero…..The stimulation of emotional centers shows that shopping is a stress relief.”

Chapter 21 – Too Much Time on External Things – The Addiction-Prone Personality

-No collection of personality traits will by themselves cause addiction, but some traits will make it much more likely that a person will succumb to the addiction process.

-People are susceptible to the addiction process if they have a constant need to fill their minds or bodies with external sources of comfort, whether physical or emotional.

-That need expresses a failure of self-regulation — an inability to maintain a reasonably stable internal emotional atmosphere.

-Self-regulation is a developmental achievement, we reach it only if the conditions for development are right. Some people never attain it; even in advanced adulthood they must rely on some external support to quell their discomfort and soothe their anxiety.

-Impulse control is one aspect of self-regulation. Impulses rise up from the lower brain centers and are meant to be permitted or inhibited by the cerebral cortex.

-Also characterized in the addiction-prone personality is the absence of differentiation which is the ability to be in emotional contact with others yet still autonomous in one’s emotional functioning.

-Lack of differentiation and impaired self-regulation reflect a lack of emotional maturity.

-Psychological maturation is the development of a sense of self as separate from inner experience — a capacity entirely absent in the young child.

-Emotional processes rule the addict’s perspective: whatever she is feeling at the moment tends to define her view of the world and will control her actions.

-The individuated, well-differentiated person can respond from an open acceptance of his own emotions, which are not tailored either to match someone else’s expectations or to resist them. He neither suppresses his emotions not acts them out impulsively.

-The addictive personality is a personality that hasn’t matured. When we come to address healing, a key question will be how to promote maturity in ourselves or in others whose early environment sabotaged healthy emotional growth.

Chapter 22 – Poor Substitutes for love – Behavioral Addictions and Their Origins

-When, owing to internal demons arising from their own childhoods or to external stressors in their lives, parents are unable to regulate — that is, keep within tolerable range — the emotional milieu of the infant, the child’s brain has to adapt: by tuning out, by emotional shutting down, and by learning to find ways to self-soothe through rocking, thumb-sucking, eating, sleeping, or constantly looking to external sources of comfort.

-People who cannot find or receive love need to find substitutes — and that’s where addictions come in.

-Except in rare cases of physical disease, the more obese a person is, the more emotionally starved they have been at some crucial period in their life.

-Invariably, people who eat too much have not only suffered emotional loss in the past but are also psychically deprived or highly stressed in the present.

-Emotional energy expended without perceived reward is compensated for by calories ingested.

-Similarly, many people who quit smoking begin to overeat because their craving for oral soothing is no longer eased by their cigarette and the loss of their stress reliever, nicotine, leaves them dopamine-deprived.

-Children whose emotionally nourishing relationships with adults give them a strong sense of themselves do not need to soothe themselves by passively taking in either food or entertainment.

-You don’t know how depressed you’ve been until you know what it feels like not to be depressed.

-Parenting styles are passed on from one generation to the next is known both from human studies and animal experiments.

-Stressed parents have difficulty offering their children a specific quality required for the development if the brain’s self-regulation circuits: the quality of attunement.

-Attunement is literally being in tune with someone else’s emotional states.

-It’s not a question of parental love but of the parent’s ability to be present emotionally in such a way that the infant or child feels understood, accepted, and mirrored.

-The lack of an emotionally attuned and consistently available parenting figure is a major source of stress for the child. Such a lack can occur when the parent is physically present but emotionally distracted — a situation that has been called proximate separation.

-Proximate separation happens when attuned contact between parent and child is interrupted due to stresses that draw the parent away from the interaction.

-The levels of physiological stress experienced by the child during proximate separation approach the levels experienced during physical separation.
The development of the brain’s neurotransmitter and self-regulating systems and, in particular , the stress-control circuits is then disrupted, and once entrenched, these physiological dysfunction increase the risk for addictions.

-As parents we make the natural mistake of believing that the intense love we feel for our kids necessarily means that they actually receive that love in pure form.

-Parents who did not have attuned caring as small children may not notice their difficulty attuning to their own infants, just as people stressed from an early age may not realize just how stressed they often are.

-While it’s true that overt episodes of hostility between the parents may damage the child, so may repressed anger and unhappiness. As a rule, whatever we don’t deal with in our lives, we pass on to our children.

Part VI – Imagining a Humane Reality – Beyond The War on Drugs

Chapter 23 – The Social Roots of Addiction

-When I am sharply judgmental of any other person , it’s because I sense or see reflected in them some aspect of myself that I don’t want to acknowledge.

-Many people are addicted to accumulating wealth; for others the compulsive pull is power. Men and women become addicted to consumerism, status, shopping, or fetishized relationships, not to mention the obvious and widespread addictions such as gambling, sex, junk food, and the cult of the “young” body image.

-5.5% of men and 6% of women appear to be addicted shoppers

-Whether we tally health expenditures, loss of human life, economic strain, or any other measure, the “respectable” addictions, around which entire cultures, industries, and professions have been built, leave drug addiction in the dust.

-Around the world tobacco kills 5.5 million people annually — claiming roughly the same number of victims each year as were annihilated by the Nazis’ genocidal attacks against Jews during World War II

-In may 2007, Purdue Pharma, a giant drug manufacturer, pleaded guilty to criminal charges that the firm had “misled doctors and patients” in claiming their product, OxyContin, was less addictive than other opiate medications.

-Why do we despise, ostracize, and punish the drug addict when as a social collective we share the same blindness and engage in the same rationalizations?

-We despise, ostracize, and punish the addict because we don’t wish to see how much we resemble him.

-Like the hard-core addict’s pursuit of drugs, much of our economic and cultural life caters to people’s craving to escape mental and emotional distress.

-According to a Statistics Canada study, 31 percent of working adults aged nineteen to sixty-four consider themselves workaholics who attach excessive importance to their work and are “overdedicated and perhaps overwhelmed by their jobs.”  They have trouble sleeping, are more likely to be stressed out and unhealthy, and feel they don’t spend enough time with their families,”

-At the core of every addiction is an emptiness based in abject fear

-The addict is not born but made. His addiction is the result of a situation that he had no influence in creating.

-The precursor to addiction is dislocation which means the loss of psychological, social, and economic integration into the family and culture — a sense of exclusion, isolation, and powerlessness.

-Research on both humans and animals has repeatedly demonstrated that extensive peer contact and the loss of adult attachments lead to a heightened propensity to addiction.

-The adolescents who rely on their peers for emotional acceptance are more prone to being hurt. They are far more stressed than are children who are well connected to nurturing adults.

-The drug addict is today’s scapegoat

Chapter 24 – Know Thine Enemy

Chapter 25 – “Ignorant Fanaticism” – The Failed War on Drugs

-An unintended but tragic consequence of the international campaign against narcotics is that through much of the underdeveloped world, opiates are not available for soothing physical pain.

-The U.S. government aggressively promotes its view of drug addiction internationally and brings enormous pressure on other countries to fall in line with its own opinions.

-If the goal of the War on Drugs is to discourage or prevent drug use, it has failed.

-The rate at which young Americans between the ages of 15 and 24 are dying from drug overdoses has increased dramatically, more than doubling between 1999 and 2005.

-The United States contains less than 5% of the world’s population but houses nearly a quarter of the world’s prisoners

-Drugs do not make the addict into a criminal; the law does.

-Most of the social harm related to drugs does not come from the effects of the substances themselves but from legal prohibitions against their use.

-The War on Drugs fails — and is doomed to perpetual failure — because it is directed not against the root causes of drug addiction or of the international black market in drugs, but only against some drug producers, traffickers, and users.

-The question is not why the War on Drugs is being lost, but why it continues to be waged in the face of all the evidence against. Many factors are in play, some psychological, some broadly political, others economic, and yet others driven by the natural if unfortunate moralizing tendencies we human beings share.

-In a society that habitually seems to find an enemy to loathe and fear, the addict serves as an ever-present candidate for the role.

-Given also the heavily disproportionate representation of minority peoples in prisons in almost all Western societies and most particularly United States, a punitive legal stance on drugs may also be seen as a form of imposing heavy-handed social control over disenfranchised and disaffected populations.

Chapter 26 – Freedom of Choice and the Choice of Freedom

-Freedom in society is gauged by our success in getting what we want and is conditioned by status and power, by race, class, and gender. In the internal world of the psyche, however, freedom means something very different. It is the ability to opt for our long-term physical and spiritual well-being as opposed to our immediate urges. Absent that ability, any talk of free will or choice becomes nearly meaningless.

-The dilemma of freedom in addiction may be phrased this way: a person driven largely by unconscious forces and automatic brain mechanisms is only poorly able to exercise any meaningful freedom of choice.

-In OCD, the neurological gears that would uncouple the engine of thought from the wheels of action are stuck.

-Much of what we do arises from automatic programming that bypasses conscious awareness and may even run contrary to our intentions.

-The stronger a person’s automatic brain mechanisms and the weaker the parts of the brain that can impose conscious control, the less true freedom that person will be able to exercise in her life.

-Although we do have freedom, we exercise it only when we strive for awareness, when we are conscious not just of the content of the mind but also of the mind itself as a process.

-People who have overcome severe addictions deserve to be celebrated, and they have much to teach, but their example cannot be used to condemn others who have not been able to follow in their footsteps.

-“If it is irrational and hypocritical to hold a minor to the same standard of behavioral control as a mature adult, it is equally unjust to hold a traumatized and neurologically impaired adult to the same standard as one not so afflicted,” says brain researcher Martin Teicher

-Given a certain set of life experiences, a human being will have either a lesser or a greater probability of having freedom in the realm of the psyche.

-In a well-functioning cortex the interval between awareness of the impulse is only one-tenth to one-fifth of a second. Amazingly, it’s only in this briefest of intervals that the cortex can suppress behavior it judges to be inappropriate.

Chapter 27 – Toward an Enlightened Social Policy on Drugs

-Medicine has been the most resistant professional group to absorb and integrate the emerging findings about brain development and the importance of early childhood.

-Institutions such as professional bodies, medical schools, and scientific associations tend to be deeply conservative, even if in some ways they are at the forefront of bold exploration. They mistrust new paradigms and resist moving outside the boundaries of a narrowly defined science-ideology that separates mind from body, human beings from their lifetime environments.

-Free choice only comes from thinking; it doesn’t come from emotions. It emerges from the capacity to think about your emotions.

-If we want to support people’s potential for healthy transformation, we must cease to impose debilitating stress on their already-burdened existence.

-Recall that uncertainty, isolation, loss of control, and conflict are the major triggers for stress and that stress is the most predictable factor in maintaining addiction and triggering relapse.

-“The War on Drugs is Cultural Schizophrenia,” says Dr. Panksepp. I agree. The War on Drugs expresses a split mind-set in two ways: we want to eradicate or limit addiction, yet our social policies are best suited to promote it, and we condemn the addict for qualities we dare not acknowledge in ourselves.

-Many people fear that decriminalization and controlled dispensing of drugs will lead to widespread substance use among people who are now deterred from becoming addicts only by existing legal prohibitions. Like other tenets of the War on Drugs, this view is entirely lacking in supporting evidence.

-People who do not suffer the searing emotional pain that drives hardcore drug addiction will rarely fall into dependency on chemicals, even if these were more readily available

-Creating an adequate drug rehabilitation system would be expensive but would surely cost less than what the war on drugs costs us

-To expect an addict to give up her drugs is like asking the average person to imagine living without all his social skills, support networks, emotional stability, and sense of physical and psychological comfort.

-Using drugs doesn’t make people criminals its the war on drugs that does

-The criminality associated with addiction follows directly from the need to raise money to purchase drugs at prices that are artificially inflated owning to their illegality.

-It’s interesting to learn that before the War on Drugs mentality took hold in the early twentieth century, a prominent individual such as Dr. William Stewart Halsted, a pioneer  of modern surgical practicw, was an opiate addict for over forty years.

-Most hard-core addicts could not function at such a high level given the social and psychological adversity of their life histories. But surely, if their substance needs were met, they would have a much greater opportunity to realize their potential to be creative and contributing members of society. At the very least, they would be a lesser burden.

-“Law enforcement consumed by far the largest chunk (73%) of the national drug strategy’s annual $245 million budget, with no demonstrated impact on curbing the use of illegal drugs. At the same time, 14% is spent on treatment, 7% on research, and 3 percent each for addiction prevention and harm reduction.” – 2007 study by the British Columbia Centre for Excellence in HIV/AIDS

-Both Holland and Switzerland and parts of Germany have changed policies and seen an enormous drop in the levels of drug-related crime.

-Would the decriminalization of drug use and the controlled distribution of drugs bring up a new set of problems? No doubt they would. But no foreseeable risk can to any degree resemble the tremendous harm currently being done.

Chapter 28 – Reducing Harm  

-Harm reduction means making the lives of afflicted human beings more bearable, more worth living.

-Although we are all responsible for our lives, no human or medical principle dictates that we refuse to help others whose own decisions have brought trouble upon their heads — unless we believe that in trying to help them, we are perpetrating greater harm.

-Short of extreme coercion there is absolutely nothing anyone can do to induce another to give up addiction, except — as discussed in the previous chapter — to provide the island of relief where contemplation and self-respect can, perhaps, take root.

-Harm reduction is as much an attitude and way of being as it is a set of policies and methods.

-We offer methadone maintenance to addicts not to cure them of their narcotic dependence but to transfer that dependence to a narcotic that is legal, that is safe if ingested properly, and that prevents them from having to prostitute themselves, steal, and beg to avoid withdrawal.

-As of this writing, the U.S. government refuses to support needle exchange programs on the grounds that it encourages addiction, as if the addict were just waiting for federally funded clean needles to embark upon and maintain his habit.

-To give someone a needle or methadone is seen as giving up on the idea that they can be ‘saved,’ and as a moral failure for both drug user and care provider.

-The swiss studies showed unequivocally that prescribing heroin produces substantial declines both in illicit drug use and in criminal activity for this most problematic group. In addition, they provided clear evidence of improved social reintegration, better housing, more gainful employment, fewer drug associates, and more contact with previously estranged families and friends.

-Insite ….injection facility in Vancouver


Part VII – The Ecology of Healing

Chapter 29 – The Power of Compassionate Curiosity

-We teach what we most need to learn — and sometimes give what we most need to receive.

-The acronym COAL has been proposed for this attitude of compassionate curiosity: curiosity, openness, acceptance, and love: “Hmm. I wonder what drove me to do this again.”

-The purpose is not to justify or rationalize but to understand

-Justification is another form of judgment every bit as debilitating as condemnation.

-We may believe we’re anxious about this or that — body image, the state of the world, relationship issues, the weather — but no matter what story we weave around it, the anxiety just is.

-Like addiction itself, anxiety will always find a target but exists independently of its targets.

-Incompleteness is the baseline state of the addict.

-A salient mental feature of ADD, the drive to escape the moment is a common, nearly universal human characteristic.

Chapter 30 – The Internal Climate

-No organism in nature is separate from the system in which it lives, functions, and dies, and no natural process can be understood in isolation from its physical and biological context.

-From an ecological perspective, the addiction process doesn’t happen accidentally; nor is it programmed by heredity. It is a product of development in a certain context, and it continues to be maintained by factors in the environment.

-In an ecological framework recovery from addiction does not mean a “cure” for a disease but the creation of new resources, internal and external, that can support different, healthy ways of satisfying one’s genuine needs.

-Intention and attention exert real, physical effects on the brain.

-Mindful awareness is the key to unlocking the automatic patterns that fetter the addicted brain and mind

-The dominant emotions suffusing all addictive behavior are fear and resentment — an inseparable vaudeville team of unhappiness.

-“Although the content of consciousness depends in large measure on neuronal activity, awareness itself does not. To me it seems more and more reasonable to suggest that the mind may be distinct and different essence from the brain.” – Wilder Penfield

-The automatic mind, the reactive product of brain circuits, constantly interprets the present in the light of past conditioning.

-What seems like a reaction to some present circumstance is, in fact, a reliving of past emotional experience.

-Implicit memory is active “when people are influenced by past experience without any awareness that they are remembering”

-Whenever a person “overreacts” — that is, reacts in a way that seems inappropriately exaggerated to the situation at hand — we can be sure that implicit memory is at work.

-Mental hygiene consists of noticing the ebb and flow of all those automatic grasping or rejecting impulses without being hooked by them.

-The greatest damage done by neglect, trauma, or emotional loss is not the immediate pain they inflict but the long-term distortions they induce in the way a developing child will continue to interpret the world and her situation in it.

-“Choice begins the moment you disidentify from the mind and its conditioned patterns, the moment you become present.” – Eckhart Tolle

Chapter 31 – The Four Steps, Plus One 

-OCD has a similarity to addiction in the driven nature of its behaviors. They are both impulse-control disorders. Deeper than that, they are both based in anxiety.

-Commitment is sticking with something not because “it works” or because I enjoy it, but because I have an intention that overrides momentary feelings or opinions.

The 4 step program:

1. Relabel – label the addictive thought or urge exactly for what it is, not mistaking it for reality. When we relabel, we give up the language. Say to yourself “I don’t need xyz ; I’m only having an obsessive thought that I have such a need. It’s not a real, objective need but a false belief. I may have a feeling of urgency, but there is actually nothing urgent going on.”
2. Reattribute – “In Re-attribute you learn to place the blame squarely on your brain. This is my brain sending me a false message.” In step two you state very clearly where that urge originated: in neurological circuits that were programmed into your brain long ago, when you were a child. It represents a dopamine or endorphin “hunger” on the part of the brain systems that, early in your life, lacked necessary conditions for their full development.
3. Refocus – rather than engage in the addictive activity, find something else to do. Choose something that you enjoy and that will keep you active: preferably something healthy and creative, but anything that will please you without causing greater harm.
4. Revalue – Remind yourself why you’ve gone to all this trouble. The addicted mind has been fooled into making the object of your addiction the highest priority. In the revalue step you devalue the false gold. You assign to it its proper worth: less than nothing.

-The real “value” of my addictive compulsion has been that it has caused me to betray my true values and disregard my true goals.

-Anticipate and accept. Anticipate that the compulsive drive to engage in addictive behavior  will return. And accept that the addiction exists not because of yourself, but in spite of yourself.

The 5th step: Recreate – choose a different life. What do you choose to create?

-What activities can you engage in to express the universal human need to be creative. Mindfully honoring our creativity helps us transcend the feeling of deficient emptiness that drives addiction.

-“What is in us must out otherwise we mat explode at the wrong places or become hopelessly hemmed in by frustrations.” – Dr. Hand Selye

Chapter 32 – Sobriety and the External Milieu

-As long as a person has a need to self-soothe — or from the biochemical perspective, to trigger dopamine release in their brain — one addiction may automatically substitute for another.

-For me personally, sobriety means being free of internal compulsion and living according to principle I believe in. Unlike abstinence, I don’t experience it as a constraint but as liberation.

-A deficient time sense is a well-known feature of attention deficit disorder

-Addiction is primarily about the self, about the unconscious, insecure self that at every moment considers only its own immediate desires. In all cases the process arises from the unmet needs of the helpless young child for whom this constant self-obsession appears, to begin with, as a matter of survival.

-My advice to anyone with addictive behaviors is to begin telling the truth. If you are not ready to drop the behavior, then choose it openly. Tell your spouse or friends what you are doing; keep it in the daylight.

-A part of creating external structures to support recovery is the avoidance of environments and environmental  cues that trigger addictive thoughts and feelings.

-Addictive may relieve stress in the short-term but fails to do so in the long term

-It’s impossible to cool the circuitry of the addicted brain if we leave it heated by chronic stress

-In our culture, the suppression of emotion is a major source of stress and therefore a major source of addictions.

-The release of addiction’s hold requires awareness: awareness of where we keep ourselves hobbled and stressed, where we ignore our emotions, restrict our expression of who we are, frustrate our innate human drive for creative and meaningful activity, and deny our needs for connection and intimacy. In the ecology of gardening it is not enough to pull out the weeds. If we want something beautiful to grow, we have to create the conditions that will allow it to develop. The same is true in the ecology if the mind.

Chapter 33 – A Word to Families, friends, and caregivers 

-While it is natural for the loved ones of an addict to wish to reform him, it cannot be done. The counterwill-driven resistance to any sense of coercion will sabotage even the most well-meant endeavor by one human being to change another.

-Contrary to popular misconception, confrontational “tough love” interventions are likely to fail.

-If refusal to take on responsibility for another person’s behaviors burdens you with guilt, while consenting to it leaves you eaten by resentment, opt for guilt. Resentment is soul suicide.

-The belief that anyone “should” be any different than he or she is is toxic to oneself, to the other, and to the relationship.

-It is not what we do that has the greatest impact but who we are being as we do it.

-Any person who wishes to make a difference in the life of the addict should first conduct a compassionate self-inquiry. They need to examine their own anxieties, agendas, and motives.

-Addiction represents a family condition not just because the behaviors of the addict have an unhealthy impact on those around him, but more profoundly because something in the family dynamic has probably contributed — and continues to contribute — to the addict’s acting out.

Chapter 34 – There is Nothing Lost – Addictions and the Spiritual Quest

-Early stress is a potent inducer of addiction not just because it impairs brain development and emotional growth but also because it destroys a child’s contact with her essential self and deprives her of faith in a nurturing universe.

-All of us human beings, whether we know it or not, are seeking our own divine nature.

-“All emotions are modifications of one primordial, undifferentiated emotion that has its origin in the loss of awareness of who you are beyond name and form” – Eckhart Tolle

-Addiction floods in where self-knowledge — and therefore divine knowledge — are missing. To fill that unendurable void, we become attached to things of the world that cannot possibly compensate us for the loss of who we are.

-In a state of spiritual poverty, we will be seduced by whatever it is that can make us insensate to our dread

-It is often asserted, cynically, that people who act in kindly ways, without any benefit to themselves, are doing so only to feel good. Neuroscience does not support that view: the brain area that lights up as a person performa an altruistic act is not the circuitry activated by pleasure or by the anticipation of reward.

-Addiction is one of the outcomes of the “existential vacuum,” the feeling of emptiness engendered when we place a supreme value on selfish attainment.

-We have seen that addiction arises out of dislocation. The absence of meaning is yet another dislocation that we human beings, spiritual creatures that we are, cannot well endure.

-Much of people’s resistance to the higher power concept is really the ego’s resistance to conscience and to spiritual awareness, to the part of us that recognizes truth and wants to honor it.

-The grasping ego fears its own annihilation in bowing to something greater, whether to “God” or to the needs of others or even to one’s own higher needs.

-There is only one story, Campbell showed, only one quest, one adventure, what he called “the monomyth.” And there is only one hero, though he or she may appear at different times in different cultures in a thousand guises.

-The hero is the human being who dares descend into the darkest depths of the unconscious — to the very source  of our creative power — and there confronts the monsters thrown up by the fright-stricken infant psyche. As the hero pursues the journey, the phantoms and dragons all vanish or lose power or even become allies.

-Spiritual awakening is no more and no less than a human being claiming his or her own full humanity.

-We may not be responsible for the world that created our minds, but we can take responsibility for the mind with which we create our world.

-Our most painful emotions point to our greatest possibilities, to where our authentic nature is hidden. People whom we judge are our mirrors. People who judge us call forth our courage to respect our own truth. Compassion for ourselves supports our compassion for others. As we open to the truth within, we hold safe a space of healing for others. They may do the same for us.