The Vancouver method: Treat addicts as people

Dr. Gabor Maté offers advice based on his life treating street addicts in Vancouver. Seattle and pro-legalization advocates could take some lessons in policy and relating to individuals.
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A Tibetan chakra or <a href="">wheel of becoming</a>

Dr. Gabor Maté offers advice based on his life treating street addicts in Vancouver. Seattle and pro-legalization advocates could take some lessons in policy and relating to individuals.

One of the six realms in the Buddhist Wheel of Life is the Realm of Hungry Ghosts, in which people try to fulfill their yearnings or relieve their pain in ways that only deepen their misery. In his book, In the Realm of Hungry Ghosts: Close Encounters with Addiction, Dr. Gabor Maté leads us through this dark territory, beginning with stories about the many individuals he has treated at his clinic for street addicts in Vancouver, BC.

He also tells about the self-medicating habits he developed in his own life, in a way that ultimately makes his personal history the reader's story as well. Although most of us manage (like Maté) to avoid substance addictions, we do get hooked on striving for social success, romance, power, wealth, approval, or material possessions. “Misplaced attachment to what cannot satisfy the soul is ... the common condition of mankind,” he writes.

We've read Buddhism-inspired teachings about the necessity of surrendering our illusions and ego attachments before. What distinguishes Maté’s book is that its wisdom sneaks up on you, being woven into the author’s project of turning what he views as a wasteful, destructive War on Drugs into a more humane and effective, as well as far less costly, social system of approaches to drug addiction.

Maté presents some of the scientific research showing why people keep trying to self-medicate with behaviors or substances that end up making them wretched. He explains how early neglect or abuse affects children’s brain development, in particular the system of self-soothing brain chemicals (such as endorphins and serotonin) that is a natural part of the healthy human organism. As Maté makes clear, this internal chemistry develops (or doesn’t) early on through a child’s relationship with adults: “We know that the majority of chronically hardcore substance-dependent adults lived, as infants and children, under conditions of severe adversity… Their predisposition to addiction was programmed in their early years. Their brains never had a chance.”

In short, people lacking a well-developed brain chemistry that provides internal comfort, self-restraint, and positive energy end up seeking external ways to self-medicate. Those who were more seriously deprived readily turn to drugs. Maté quotes Dr. Nora Volkow, Director of the U.S. National Institute on Drug Abuse, who has concluded from recent brain-imaging studies that “drug addiction is a disease of the brain, and the associated abnormal behavior is the result of dysfunction of brain tissue, just as cardiac insufficiency is a disease of the heart.” Drug use disrupts “brain regions that are important for the normal processes of motivation, reward and inhibitory control in addicted individuals.”

If drug addiction is a disease, why, asks Maté, doesn’t society commit to treating it and easing the pain of those afflicted instead of hounding and punishing them? Because we’re not so different from the addicts who stay on paths they realize will lead to their own destruction. As he says, “Reason and education can’t compete with deep-seated emotional and psychological drives.” So to temper the force of these drives we need to practice what he calls “compassionate curiosity” about our own motives, our choices, and our sometimes needlessly moralistic reactions to others. A “compassionate curiosity” about his patients and their lives is also what helps Maté practice medicine as he does.

The Portland Clinic, where Maté has worked for 8 years, is part of the Portland Hotel Society (PHS) in the gritty Downtown Eastside neighborhood of Vancouver. To supplement its core mission of housing homeless people, PHS has established a free dental clinic, a hospital ward where antibiotics can be used to treat deep-tissue infections intravenously, a bank, an art gallery, and the controversial Insite, North America’s first supervised injection site. Housing at PHS is low-barrier, with residents accepted as they are instead of forced to renounce addiction first, and services follow principles of harm reduction. The overall approach resembles palliative medicine, the care of the terminally ill, in that staff do not directly aim at curing their patients. Maté writes that he and his colleagues try mainly “to ameliorate the effects of drug addiction and its attendant ailments and to soften the impact of the legal and social torments our culture uses to punish the drug addict.” He worries that with the Winter Games coming to Vancouver this year, city policies will make life even harder for street populations.

Still, Maté said at Town Hall last week, he does not recommend decriminalizing drugs, even so-called “less dangerous” ones such as marijuana, which some members of the Washington State Legislature had been seeking to do through bills killed on Wednesday. Instead, he would create policies that strictly regulate addictive substances, that “stop punishing people for their addictions,” and that expand the medical practice of harm reduction. This would include establishing supervised injection sites and would guarantee, for any addict desiring them, rehab followed by housing with wraparound support.

Such services would be affordable if we stopped funding the War on Drugs, says Maté. Many experienced corrections personnel concur. Former Seattle police chief Norm Stamper introduced Maté at Town Hall and, in his own book, Breaking Rank (2006), argues that the War on Drugs is a “war on poor people.” It costs the U.S. more than $69 billion per year, yet succeeds mainly in criminalizing disease, increasing crime, and incarcerating innocents, Stamper says. Current White House drug czar Gil Kerlikowske, also a former police chief in Seattle, has agreed, declaring in an interview last year, “We’re not at war with people in this country.”

How do Maté and his colleagues care with such dedication for so many people in pain who can’t or won’t change their ways? Maté quotes a co-worker as saying, “I try to take my own value system out of it and look at the value something has for them.” Instead of thinking how different an addict’s life could be without the drugs, she said, “I try to take people as they are at any moment and support them that way. Not judge them or think of an alternative reality they could have, because we could all have alternative realities.”

At the same time, writes Maté, “the human potential for transformation” is always present, so we need to “support the addict’s motivation and capacity to choose freedom” over addiction. The neuroplasticity of the brain lets us “promote healthy brain development later in life when the conditions for it have been lacking from earliest childhood onward.” With treatment and with companionship from members of the community who care, some addicts can find the strength to recover. Maté illustrated by reading from Thomas Merton during a meeting at King County United Way the morning after his talk at Town Hall: "To gain possession of ourselves we have to have some confidence, some hope of victory. And in order to keep that hope alive, we must usually have some taste of victory.’” Then Maté said, “An addict with someone relating to him as if he were a person, just the way he is and not ‘if I stop drinking,’ can think, ‘maybe I’m not unlovable the way I am.’ That is a taste of victory.”

The beautifully formal yet sensitive black-and-white photographs of Maté’s patients in his book give readers a chance to relate to the ineradicable personhood of each individual. This is a taste of a different kind of victory — over our own impulses to leave “undeserving” souls outside the human circle of affection and good will.


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