Treating addiction requires both science and compassion, says Dr. Gabor Maté

Dr. Gabor Maté reflects on his bestselling book on addiction, In the Realm of Hungry Ghosts, as it turns 10.
In the Realm of Hungry Ghosts is a bestselling nonfiction book on addiction by Dr. Gabor Maté. (Michael Moster)

Dr. Gabor Maté drew from his experiences treating addicted men and women in Vancouver's Downtown Eastside when he published the bestselling nonfiction book In the Realm of Hungry Ghosts a decade ago. Supplementing his personal insights with medical research, Dr. Maté offered a compassionate perspective on addiction that continues to resonate with readers.

Below, the Order of Canada member answers a few questions reflecting on the book's 10th anniversary, which is being marked with an updated edition of the book.

1. What surprised you most when the book first came out?

"Repeatedly people told me that the book 'humanized' addicts for them, by which they meant the Skid Row drug-dependent individuals I depict in the opening chapters of Hungry Ghosts. It surprised me how many well-meaning and compassionate humans, including health care workers, acknowledged their difficulty seeing some others as human. It's a problem we all share, I think, if we are honest with ourselves.

"Even more surprising has been that many grieving parents whose sons or daughters had died of overdoses would thank me for helping them understand what had happened to their children. It is not obvious that such parents would be grateful to an author who points to multigenerational family trauma at the core of all addictions. It is inspiring to see how truth, however painful, is what matters most to many people."

2. What was the most memorable reaction you received from a reader?

"That's an easy one. One woman wrote me that her husband, 20 years clean of alcohol, had never wanted to have children for fear of passing on the 'alcoholism gene.'

"She said, 'Reading your book convinced him that his drinking addiction had been due not to genes but to his childhood trauma. We now have a beautiful three-month old baby girl. We are both in our mid-40s and we are thrilled!' I have been told many times that this book saved people's lives, but this is the only instance I know of it having helped to bring a new life into the world." 

3. How do you feel about the fact that this book is still relevant today?

"I expect Ghosts to be relevant for decades yet, since the social conditions and traumatic experiences that give rise to addiction will not likely abate and since an approach to addiction that combines science and compassion will not any time soon become mainstream social or medical policy. I also believe that the book's insights into the human psyche will be of interest for a long time."

4. What are some of the biggest changes of the past decade when it comes to addiction in society and how it is treated medically?

"I wish I could report major changes in social attitudes toward addiction and in the medical treatment of it. There have been some: a wider acceptance of harm reduction practices, such as supervised consumption sites, for example, and a more open political discussion in some circles of the need to abandon the so-called War on Drugs, really a war on traumatized people. In the past 10 years I have also seen a much greater interest in the study of trauma.

"On the downside, the legal system continues to punish people for becoming addicted to escape the pain of their lives and the medical system still does not train its practitioners to understand the sources of addiction — or of mental illness in general — in human suffering. Nor are physicians taught to appreciate the neurobiology of addiction, either in the substance addict or in those with non-substance related behaviours such as gambling, eating disorders, overeating or sexual compulsions. The scientific understanding that the neurobiology is a product of early life experiences has yet to seep into medical theory or practice."

5. What book would you recommend to readers of your book?

"Dr. Bruce Alexander's The Globalization of Addiction: A Study in the Poverty of the Human Spirit is a seminal work that puts addictions in their proper context, not as individual failure or malaise, but as a response to social circumstances that erode human connection, meaning and belonging. As to a fictional representation of addiction, there is no more gripping or harrowing a depiction than Hubert Selby's Requiem For A Dream."


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