Gabor Mate, MD

Addiction is a complex psychophysiological process, but it has a few key components. Addiction manifests in any behavior that a person finds temporary pleasure or relief in and therefore craves, suffers negative consequences from, and has trouble giving up. So there’s craving, relief and pleasure in the short-term, and negative outcomes in the long term, along with an inability to give it up. That’s what an addiction is. Note that this definition says nothing about substances, it could be to anything—to religion, to sex, to gambling, to shopping, to eating, to the internet, to relationships, to work, even to extreme sports. The issue with the addiction is not the external activity, but the internal relationship to it. Thus, one person’s passion is another’s addiction.

An addiction always serves a purpose in people’s lives: it gives comfort, a distraction from pain, a soothing of stress. Addiction serves a valid purpose. Of course, it does not serve this purpose effectively, but it serves it as a valid purpose.

If it has negative consequences, if you’ve lost control over it, if you crave it, if it serves a purpose in your life that you don’t otherwise know how to meet, you’ve got an addiction.

Addiction is not a brain disorder, it is an attempt to solve a life problem, usually one involving emotional pain or stress. It arises out of an unresolved life problem that the individual has no positive solution for. Only secondary does it begin to act like a disease. Addiction is not a primary disease.

From there, we have to go to your childhood because that’s where the origins of emotional pain or loss of self or lack of agency most often lie. It’s just a logical, step-by-step inquiry. What’s the problem you are trying to solve? And then, how did you develop that problem? And then, what happened to you in childhood that you have this problem?

The largest population study concluded that nearly two-thirds of drug-injection use can be tied to abuse and traumatic childhood events. And that’s according to a relatively narrow definition of trauma.

Everybody who becomes addicted was traumatized. (not everyone who is traumatized becomes addicted). Addiction isn’t the only outcome of trauma. If you look at the ACE Study, it clearly shows that the more trauma there is, the greater the risk for addiction, exponentially so. Of course, there are traumatized people who don’t become addicts. You know what happens to them? They develop depression or anxiety, or they develop autoimmune disease, or any number or other outcomes. Or, if they’re fortunate enough and get enough support in life to overcome the trauma, then they might not develop anything at all.

It’s not unusual to have somebody stand up and say, “well you know, I had a pretty happy childhood, and I became an addict.” Sometimes I may ask if either parent drank and I hear, “Yeah, dada was an alcoholic.” Everybody in the room gets that you can’t have a happy childhood with a father who’s an alcoholic. But the person can’t see that because they dealt with the pain of it by disassociating and scattering their attention. May be they developed ADD or some other problem on the dissociative spectrum. They shut down their emotions, and now they’re no longer in touch with the pain that they would’ve experienced as a child. That’s an obvious one. Less obviously, I might ask about being bullied. And when a person says, “Yeah, I was bullied as a kid,” or just sometimes felt scared, or alone, or in emotional distress as a child, I ask to whom they spoke about such feelings. The answer is almost uniformly “nobody.” And that in itself is traumatic to a sensitive child.

Trauma can be understood in the sense of ACE criteria: emotional, physical, sexual abuse, a parent dying, a parent being jailed, a parent being mentally ill, violence in the family, neglect or divorce. Or it can be understood in the sense of relational trauma. That means you don’t have to be hit or physically abused. If the parents were stressed or distressed or distracted, if their own trauma got in the way of their attuning with the child, that’s enough to create the lack of self in the child. Or it’s enough to interfere with the development of a healthy sense of self, and with normal brain development itself. This point must be emphasized.