Gabor Mate is a retired physician who after 20 years of family practice and palliative care experience worked for over a decade in Vancouver’s Downtown Eastside with patients challenged by drug addiction and mental illness. His book on addiction, In the Realm of Hungry Ghosts, received the Hubert Evans prize for literary nonfiction. For his groundbreaking medical work and writing, he has been awarded the Order of Canada, his country’s highest civilian distinction.
When asked “what is addiction?” he says:
“I define addiction as a complex psycho-physiological process manifested in any behavior in which a person finds pleasure and relief and therefore craves, but suffers negative consequences without being able to give it up. So: craving, pleasure and relief in the short term, negative consequences in the long-term, and the inability or refusal to desist, that’s what addiction is.
“Note I have said nothing about substances, because clearly people can be addicted to drugs, nicotine, caffeine, crystal meth, heroin, alcohol, but also of course, to sex, pornography, work, power, profit, gambling, the internet, cell phones, and everything else you can think about. The issue is not the external target or the behavior — the issue is one’s internal relationship to it. If there’s craving, pleasure and relief in the short term, harm and inability to give it up, that’s what addiction is.“
He usually asks his audience: “And now I simply ask all those of you who recognize that at some time or another, you had some kind of an addictive pattern in your life to please raise your hands. Thank you. Hardly anybody leaves their hand down if they’re honest with themselves.“
It’s not addicts on one side and OK people on the other. Addiction is woven into the fabric of our society. There is a continuum, a wide range of ways in which we are affected.
Having placed addiction within this broader framework, Gabor Mate suggests a different focus, not the addiction itself, but the underlying pain:
“Your addiction was your attempt to solve a problem. That problem was that of emotional pain, and hence my mantra…Ask not why the addiction, ask why the pain.”
This is the spirit in which The Proactive Twelve Steps were developed.