Throughout my life I have seen people struggle with addiction. I’ve seen their substance abuse change how they behave, influence the choices they make, and impact their physical and mental health. I’ve also seen people regularly use substances in a non-addictive manner. What’s the difference? And why is are tens of millions of Americans struggling with addiction?
The American Psychiatric Association (who puts out the Diagnostic and Statistical Manual of Mental Disorders, or DSM) defines addiction as “a brain disease that is manifested by compulsive substance use despite harmful consequence.” The APA also says that “many people experience both mental illness and addiction,” and that the mental illness “may be present before the addiction or the addiction may trigger or make a mental disorder worse.” And, the APA says that people “can recover from addiction and lead normal, productive lives” if they start by recognizing and acknowledging the problem (that substance abuse is bad) and then utilizing medication, hospitalization, in-patient and out-patient rehab programs, and groups such as AA.
In short, the APA views addiction as a disease that can be prevented through education and healed through medical treatment and/or sober communities.
Why, then, is addiction an on-going epidemic? Why do so many treatments fail?
I recently read this article by Dr. Gabor Maté, Fixing fentanyl means treating trauma that creates addicts. It’s from the CBC’s 2017 series, The Fentanyl Fix, which examines the opioid crisis in British Columbia.
Dr. Gabor Maté is a retired family practice and palliative care doctor from Vancouver. His expertise is on addiction, stress, and childhood development. He now does public speaking, and aims to empower people to promote their own healing and that of those around them. He co-founded the non-profit Compassion 4 Addiction, whose mission is “to change the way people view and understand addiction through combined methodologies of compassion and cutting-edge science. “
In that CBC article, Maté said the “suffering of psychic pain is experienced in the same part of the brain as that of physical pain. Hence, the first question when dealing with opiate-dependent human beings should be not ‘why the addiction’ but ‘why the pain?'”
His answer: trauma.
He says that addiction is not a disease, but rather our attempt to control our experiences by using an external remedy. We likely have not been shown the tools at navigating and healing our trauma, and so we do whatever we can to stifle and numb the debilitating pain we experience.
“It is not a fault, not a moral lapse, not a sin, not a failure of will, nor yet even an inherited disease, but a complex response to suffering. It is not a legal problem but a human problem, to which the solutions need to be humane in every possible way.”-Dr. Gabor Maté
When we are thinking about addiction – in ourselves, in a loved one, in our community – we must ask “What is the problem this addiction is attempting to resolve?”
Maté discusses how there are, essentially, two leading causes for the trauma that leads to addition. The first is childhood adversity (most often through neglect or sexual abuse.) The second is trauma induced through colonialism, referencing the current-day lived experiences of oppressed and marginalized First Nations people.
Maté and Compassion 4 Addiction use a biopsychosocial approach to understanding and treating addiction. “Treatment must begin with an acknowledgment of the fundamental problem the addiction is attempting to resolve in the person’s life. Addicts already know that their habits are body and soul-annihilating, not to mention socially nihilistic. They require validation, not for the way the addiction wants to meet their needs (self-acceptance, relief of pain, peace of mind, social connection, and a sense of power and place), but for the fundamental needs themselves.”
So, the key approach to healing from addiction is to look at how we help people legitimize their needs without resorting to self-harm.
On the non-profit’s site they explicitly say the answer to addiction “resides neither in genes nor in ‘choices,’ but in the lives and experiences of the addicts.” They also state that “stresses on pregnant women help to potentiate addictive patterns in the developing child.” But, if we are to consider that the lived experiences of First Nations people is a leading cause for addiction, and that a mother can impact her developing child, then we must also consider the role that historical trauma / transgenerational trauma has on addiction.
“Only when compassion is present will people allow themselves to see the truth.”– A.H. Almaas