The current status of the opioid crisis as a health issue has and continues to leave its mark on communities here, at home and abroad. As noted by Dr. Gabor Maté, public alarm around addiction has “focused almost exclusively on drugs” (1). Addiction is said to cut “a much broader swath across our culture” (1). The truth of the matter is, most addicted people use no drugs at all; addiction cannot truly be understood if, as a society, we constrain our concept of it simply to substances, whether legal or illicit (1). The idea being presented is that addiction manifests in “any behaviour that a person craves, finds temporary relief or pleasure in but suffers negative consequences as a result of, and yet has difficulty giving up” (1).
In summary: there is a craving, there is a relief, there is pleasure, there is suffering, and there is impaired control. As Dr. Maté has described in many of his lectures and interviews, the definition provided is not confined to drugs. It may embody, as he explains, “almost any human behaviour, from sex to eating to shopping to gambling to extreme sports to TV to compulsive internet use: the list is endless” (1).
The Destigmatization of Addiction
The past several decades have brought about a significant shift in the popular attitudes toward addiction; radical destigmatization has occurred and continues to progress. The beginning of this shift has been ascribed by many to former first lady Betty Ford and her decision to go public about her addiction to alcohol and opiates soon after she and former President Ford left the Whitehouse (2). Betty Ford had never been a general irritant; she had never driven while under the influence, nor had she ever stashed bottles so that she could secretly drink when she was alone. Instead, Betty Ford openly addressed her addictions, leading her to become an outspoken advocate for rehabilitation through the Betty Ford Center (formerly the Betty Ford Clinic), changing the face of addiction (2). During this same period, a counselling education named Patrick Carnes was putting the finishing touches on his book Out of the Shadows. The book suggested compulsive sexual activity to be a form of addiction and universalized the concept that an individual could be addicted to something other than substances. Of course, Carnes’ notion of sex addiction made waves and splash in the widespread consciousness of society, including many mental health professionals. Treatments for sex addiction soon spawned, influenced by 12-step programs (2). As echoed by Dr. Maté, the decades that followed the notion of addiction grew to encompass behaviours such as overeating, gambling, shopping, kleptomania, and Internet overuse as well as gaming (1, 2). The notion of amplifying a behaviour to the point of addiction has reverberated through society, despite many mental health professionals having concerns for the implications.
The Origins of Addiction
Addictive patterns of behaviour are deeply entrenched in what is noted to be: “the alienation and emotional suffering that are inseparable from Western capitalist cultures, which, by favouring striving and acquiring over noticing and caring for one another, end up shortchanging” (2) often leading to the traumatization of children and families. While not every traumatized child will become an addict, every addict has been a traumatized child (2). Keeping this in mind, we come to understand that the more stressful an individual’s early years are, the more likely they are to become an addict later in life, substituting the lack of nurturing and connection that were never received. Returning to Dr. Maté’s definition of addiction, through this seemingly new understanding of addiction and lens through which to view addicts, the compassionate questions to ask is “not what’s wrong with addiction, but what’s right with it” (2). What are addicts getting from their addiction worth the price they pay? Why is the improved quality of behaviour or high so sought after and necessary for these individuals? What excruciating discomfort do addicts feel when sober that they can only find peace and control when they use?
The View of Addiction
The problem with viewing addiction through the disease model lens makes it easier for us to ignore the problematic societal and familial issues that underline the influence of addiction. Addiction is a desperate attempt to solve a problem in life; it only begins to act like a disease on a secondary level. Addiction is a complex psychophysiological process. The main issue is not the external activity but rather the internal relationship to it; therefore, one person’s passion can be another person’s addiction (2). Therefore, addiction is not a choice, nor is it an inherited disease. Regardless of the form addiction may take, it is essential to consider the following concepts when looking at addiction through a compassionate lens:
1. It is known to utilize the same neurological pathways and emotional patterns. The damage caused extends well beyond the suffering inflicted by the substance use expressly.
2. Ostracization of the addict as if somehow different from the rest of us is noted to be arrogant and arbitrary.
3. To treat addiction, which in many views is nothing more than a symptom of a more significant problem, without treating the underlying pain is to deal in effects rather than in causes, leading to ongoing cycles of suffering (2).
Childhood Trauma and The Relationship to Addiction
Collectively, when we hear the term childhood trauma, we almost invariably assume that what will be expressed and describe are horrifying events such as abuse, sexual exploitation, the death of parents, and domestic violence, to name a few. A body of research now reveals to us that the more a child has to bear experiences such as the ones previously listed, the more the risk of addiction is exponentially more significant for that child. Trauma, however, is not limited to horrendous experiences. Trauma also refers to “any set of events that, over time, impose more pain on the child than his or her sensitive organism can process and discharge” (2,3). Trauma can happen when parents are experiencing significant levels of stress, depression, are overwhelmed by economic worry, are considerably isolated to respond to a child’s emotional need to be seen, emotionally held, heard, validated and made to feel secure. Invariably, this is the reality of many ‘happy childhood’ stories once we begin to scratch the surface. One of the outcomes of trauma is the denial of one’s pain and the separation of distress from conscious memory (2). In the book, In an unspoken voice: how the body releases trauma and restores goodness, Peter Levine eloquently notes that “Trauma has become so commonplace, that most people don’t even recognize its presence” (4, 5). The unfortunate reality of our culture and society is that addiction, much like the trauma is so commonplace that most individuals do not recognize its presence. However, we are surrounded by it; addiction consumes many of us to the point that “our near-exclusive focus on the troubles of drug addiction is itself but another escape from reality” (2).
Advances in addiction treatment must arise from an understanding of trauma. We often think about trauma as the damaging or unhealthy event that an individual has experienced, such as being sexually abused, beaten, or experiencing parental abandonment or death. Trauma is the internal impact of harmful or unhealthy events experienced by individuals. It is a fundamental disconnection from the self and our bodies, and our gut feelings, as described by Dr. Maté (2). In short, trauma is the discomfort we feel, the inability to be in the present moment because the present moment is too painful. Therefore, if addiction is rooted in trauma, addiction treatment should go beyond stopping or altering behaviour. Keeping this notion in mind, we should then look upon addiction differently through a compassionate lens, enabling us to see the individuals behind the addiction and recognize and understand that there is more to their story as addicts. Addiction has never been a choice; it is merely an attempt to solve a life problem; we are all addicts in one form or another.
 Dr. Gabor Maté is a Hungarian-Canadian physician specializing in palliative care and addiction medicine and is the former medical co-ordinator of the Palliative Care Unit at Vancouver General Hospital. He spent twelve years practicing addiction medicine at Vancouver’s Portal Hotel Society, home to InSite, Canada’s first safe injection site.
 The origin of the word addiction comes from the Latin word addictus meaning to enslave.
 At the time when the DSM-5 added ‘gambling disorder’ to a new addiction heading that extended the moniker to behaviours, Allen Francis, then chair of the DSM-IV strongly objected, urging clinicians to reject the diagnostic change; noting in the Huffington Post that “if taken beyond its narrowest usage, ‘behavioral addiction’ would expand the definition of mental disorder to its breaking point and would threaten to erase the concept of normality” (2).
1. Lee S, Maté G. BEYOND DRUGS: The Universal Experience of Addiction [Internet]. Dr. Gabor Maté. 2017 [cited 2021Aug5]. Available from: https://drgabormate.com/opioids-universal-experience-addiction/
2. Dockett L, Simon R. The Addict in All of Us Gabor Maté’s Unflinching Vision [Internet]. Psychotherapy Networker. Psychotherapy Networker; 2017 [cited 7AD]. Available from: https://www.psychotherapynetworker.org/magazine/article/1102/the-addict-in-all-of-us
3. Maté Gabor, & Levine, P. (2020). In the realm of hungry ghosts: Close encounters with addiction. North Atlantic Books.
4. Levine PA. In an unspoken voice: how the body releases trauma and restores goodness. Berkeley: North Atlantic Books; 2010.
5. Wittels Wachs S. [Internet]. Trauma (with Dr. Gabor Maté). lemonada; 2020 [cited 2021Aug2]. Available from: https://lemonadamedia.com/podcast/trauma-with-dr-gabor-mate/