Pubdate: Sun, 17 Feb 2008
Source: Toronto Star (CN ON)
Copyright: 2008 The Toronto Star
Contact:  http://www.thestar.com/
Details: http://www.mapinc.org/media/456
Author: Kim Hughes
Note: Kim Hughes is a Toronto freelance writer and editor.
Bookmark: http://www.mapinc.org/decrim.htm (Decrim/Legalization)

ANNALS OF ADDICTION

We're All Strung Out Somehow

A Vancouver Doctor Who Treats The Most Desperate Calls For Compassion 
And Common Sense In Our Approaches To Addiction

In the Realm of Hungry Ghosts: Close Encounters with Addiction

by Gabor Mate

Knopf Canada,

465 pages, $34.95

He would dispute it, pointing instead to a deep clinical 
understanding of the nefarious workings of addiction, but Dr. Gabor 
Maté is something of a compassion machine, hugely wary of casting the 
first stone.

How else to regard the one-man M.A.S.H. unit (a physician working 
Vancouver's squalid Downtown Eastside) whose pitiful patient roster 
includes hardcore drug addicts who can't stop using despite 
pregnancy, potential limb and digit amputation and even possible quadriplegia?

Maté's subjects are the living, breathing embodiment of the nation's 
grimmest statistics for HIV/AIDS, hepatitis, homelessness, crime, 
abuse, neglect, overdose and death. More than merely poor and 
disenfranchised, they are truly the lowest of the low, reviled by 
society and demonized by law enforcement.

Despite that, Maté sees them as people first, addicts second, and 
particularly deserving of love, acceptance and latitude, given the 
hell most of them have invariably suffered to arrive at this point.

What's more, Maté sees these front-line addicts as essential links in 
a cabal toward a complete rethink/revamp of the current approach to 
understanding and treating addictive behaviours of all stripes, 
including gambling, sex, shopping and eating disorders.

Sound heavy, progressive, nuts? There's more. With his powerful new 
book, In the Realm of Hungry Ghosts: Close Encounters with Addiction, 
Maté hopes not only to make the case for decriminalizing drugs but 
for changing the way society at large perceives addicts.

As Maté observes at the book's beginning, "Those whom we dismiss as 
`junkies' are not creatures from a different world, only men and 
women mired at the extreme end of a continuum on which, here or 
there, all of us might well locate ourselves."

And that means you too, mister socially accepted workaholic. 
Evidently, the so-called biology of addiction places you closer on 
the spectrum to the dope fiend than you may care to admit.

Basically divided into three parts, In the Realm of Hungry Ghosts 
first introduces us to many of Maté's most dire patients, those who 
steal, cheat, prostitute and otherwise harm themselves for their next 
hit despite debilitating illness, spiritual agony and the sure 
knowledge that other lives (children especially) are being destroyed.

Next, Maté wades through the vast learning behind the root causes of 
addiction, applying a clinical and psychological view to the physical 
manifestation and unearthing some surprising (to the layman anyway) 
answers for why people do such frightening and destructive things to 
themselves.

"In the words of one researcher, `maternal contact alters the 
neurobiology of the infant.' Children who suffer disruptions in their 
attachment relationships will not have the same biochemical milieu in 
their brains as their well-attached and well-nurtured peers.

"As a result their experiences and interpretations of their 
environment, and their responses to it, will be less flexible, less 
adaptive and less conducive to health and maturity. Their 
vulnerability will increase, both to the mood-enhancing effect of 
drugs and to becoming drug dependent.

"We know from animal studies, for example, that early weaning can 
have an influence on later substance intake: rat pups weaned from 
their mothers at two weeks of age had, as adults, a greater 
propensity to drink alcohol than pups weaned just one week later."

Finally, Maté takes aim at the hugely ineffectual, largely U.S.-led 
war on drugs, challenging the current wisdom of fighting the illicit 
trade rather than aiding the addict (or potential addict). He shows 
how controversial measures such as safe injection sites (including 
the one in downtown Vancouver), are measurably more successful at 
reducing drug-related crime and the spread of disease than anything 
the White House (or Parliament Hill) has going.

"As summed up in the Canadian Medical Association Journal, 
`Vancouver's safer injecting facility (known colloquially as Insite) 
has been associated with an array of community and public health 
benefits without evidence of adverse impacts.' The city's current 
mayor and his three more recent predecessors, including the present 
premier of British Columbia – no liberal when it comes to social 
policy – support the continuation of Insite. Despite initial 
scepticism, so do local merchants and the Vancouver Police Department."

In the Realm of Hungry Ghosts (the title refers to a point on the 
Buddhist Wheel of Life) is enormously compelling and Maté, as noted, 
is admirably, sometimes inexplicably, empathetic to all who cross his path.

But easy reading it's not. Addicted pregnant women who have already 
had children taken away and who continue using heroin and cocaine are 
repugnant no matter how pathetic their upbringing.

So too are guys shooting drugs into their necks and risking brain 
abscesses because they can't otherwise locate a useable vein without 
a doctor's help (you read that right). Furthermore – and Maté would 
probably admit this – when it comes to addiction, one size doesn't 
fit all. Not all addicts come from horrendous backgrounds. And not 
all people from horrendous backgrounds become addicts.

Moreover, Maté indulges some distracting tangents, chief among them a 
parallel exploration of his own "addiction" to the compulsive 
purchase of classical music CDs, which surfaces throughout the book. 
While Maté's attempt to refract the impulses of his drug-addled 
patients through the prism of his own rash behaviour is conceptually 
admirable, it also just seems kind of dumb by comparison. Ditto his 
musings on the reckless deeds committed by Conrad Black.

Still, there is no disputing Maté's core point that the current 
system for dealing with addicts – heavy on the policing and 
prosecuting, light on the treatment and R&D – simply isn't working.

This book won't itself spur the sweeping change and legislative 
reform needed to fix a woefully broken system. But it should get us 
thinking about how our tax dollars are being spent on ineffective and 
frequently unenforceable laws.

And it might engender some of Maté's truly noble compassion among 
those of us who would rather look away than consider the 
circumstances propelling a zoned-out streetwalker. When it comes to 
solving the illegal drug problem, every little bit helps.
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MAP posted-by: Jay Bergstrom