Victoria Maizes: Hi, Andy.

Dr. Weil:  Hi Victoria.

Victoria Maizes: Today we're going to be tackling a really tough subject, which is addiction, but we have one of the leading thought figures on this topic.

Dr. Weil: Dr. Gabor is a friend and colleague I've known for a long time. I think he's one of the great experts on addiction. It's understanding it it's treatment and I'm really looking forward to having a conversation with them.

Victoria Maizes: Well, let’s welcome him.

Intro Music

Victoria Maizes: Dr. Gabor Mate worked as a family physician for two decades and then served as medical coordinator of the palliative care unit at Vancouver Hospital. He spent 12 years working in Vancouver's downtown east side with patients challenged by hardcore addiction, mental illness, and HIV. Gabor is internationally known for his work on mind, body unity and health and illness on attention deficit disorder and other childhood developmental issues and on his breakthrough analysis of addiction as a psychophysiological response to childhood trauma and emotional loss. He's the author of four bestselling books, including when the Body Says No. And In the Realm of Hungry Ghosts: Close Encounters with Addiction, he has a new book coming out next fall, The Myth of Normal, welcome Gabor.

Well, I'd love to start with the basics. You have a definition of addiction that you like people to really be clear about and I'd love for you to start there.

Gabor Mate: Sure. I don't think it's a very controversial definition, but it's it's an inclusive one. So I define addiction as a complex psychophysiological process that manifests in any behavior in which a person finds temporary relief or pleasure and therefore craves, but suffers negative consequences in the long-term and has difficulty giving up despite those negative consequences. So craving pleasure relief in the short-term harm in the long-term, inability to give it up. That's when the addiction is any addiction.

And as I point out that can include [00:02:00] drugs, but it goes way beyond drugs. That includes obvious addictions that have been acknowledged as such, such as pornography, sexual acting out, gambling, shopping, eating, internet gaming, work. of course, as many physicians will tell you and, and so on. So that's when the addiction is and to define addictions by that target rather than by the process, I think is a mistake.

Dr. Weil: It seems to me that if addiction is not universal, it’s certainly widespread. And the only reason I think more people don't see that is that many addictions are socially acceptable, and we don't see them for what they are.

Gabor Mate: Well, exactly. You know, there's an American writer who talked about two young fish swimming and an older fish comes along and he says, let's stop. How's the water boys. And two younger state. What the heck is water? You know, like when it, when it surrounds us is David Foster Wallace, who said that.

And when it surrounds us just as you say, we take it for granted. We no longer recognize it. That's obvious. So, we concentrate and focus on the hardcore drug addicts as the ones who are addicted. And we ignore the fact that as the book title says, not my book, somebody wrote a book called When Society is Addicted and I just hope it is.

Victoria Maizes: How does it change our perception by recognizing that most of us have one addiction or another? [00:04:00] I mean, obviously it can give us greater compassion towards people with hardcore addiction, perhaps. Although I think we often separate ourselves, you know, if we have an addiction to coffee or if we are a workaholic.

Or something else that perhaps is more socially acceptable. We don't necessarily see ourselves in the large world of addiction.

Gabor Mate: Well, I think Victoria that shift in compassionate alone is not a trivial thing because right now addicts or identify that it's treated in society in general is pretty brutal. And even in the medical profession, even with our somewhat more advanced you, which should, I don't agree that addiction is some kind of a brain disease, but even given that which, which is a, certainly more compassionate than a more forward-looking even then a lot of physicians, hospital, emergency departments healthcare professionals in general, three addicts with a fair bit of contempt and rejection. So that shift and compassion alone if we saw that we're all in the same boat would be a huge step forward in terms of treatment.

But also, you know, that recognition, I would also, I think implore us to start looking a bit more deeply as to the causes of addiction. Like once we recognize that addictions can be expressed in all kinds of processes, so-called process addictions, there goes to genetic drug brand disease model. And we realize all of a sudden, that's just not an adequate model where they know that model reflects some aspects of reality, but it's not broad enough and not deep enough to account for all the addictions out there.

So then what does, so that question immediately arises.

Victoria Maizes: In your model and also in some of the ways in which we train our fellows motivational interviewing [00:06:00] is a way of talking to people to help understand what may be motivating. One of the first questions you ask is what do you like about fill in the blank?

You know, what do you like about smoking? And people sometimes say fascinating things. I remember a patient who said it makes me feel like a rebel, or what do you like about drinking? And I remember a patient who said. And she had a really tough life. She said it helps me forget. So you talk about a lot about how the addiction serves, what it does in our life.

That's actually really useful. Can you, can you speak to that?

Gabor Mate: Sure so that is my very first question. I don't call what I do motivation into you. I'm not trying to motivate anybody. I'm just trying to get to know them. You know. If they weren't motivated, they will be in my office, you know, but I do begin with not what's wrong with the election, which we all know, but what's right about it.

What does it do for you? And just like real answers that you've listed people say it gives me a sense of inner peace, a sense of control. Reduces my anxiety level. It lower stress levels. It needs to be far more warmhearted and connected to other people. It smooths the pain. It numbs me. It distracts me well, when do people need to be numbed and distracted inside all these states?

A lack of joy, lack of connection. Overwhelming. So these are stress of emotional pain. And so really the answer we always get if we ask it is we get pain relief, emotional pain relief. And hence, my mantra is not why the addiction, but why the pain. And, and so that, that first question, and also of course, when people give the answers such as you've got and I got. I right away will say, you know what? I get those. I want those things too, who doesn't, who doesn't want peace of mind, who doesn't want a stress relief? Who doesn't want numbing of pain? I mean, you know, [00:08:00] you go to a dentist, that's what they do, you know? So the question is what gave you pain in your life?

Why do you have so much stress that you have to distract yourself? What happened to you? So, one question is though,

Dr. Weil: So it seems to me, that in my reading and thinking, that Buddhist philosophy comes closest to, to providing an answer to that since it states that the essence of human experiences is suffering, which may be as better translated as incompleteness or unfulfillment.

And there's a sense that in order to feel content or fulfilled, we need something outside of ourselves whether it's a cigarette or a drink or a reward from a slot machine. So to me, that has been the most useful answer that I've come up with as to the root of addictive behavior.

Gabor Mate: Well, it's interesting you should mention Buddhist philosophy because the Buddhists talk about attachment don't they? There's the attachment to these externals that grace, and then not the mere existence of these externals butter fervid attachment to them.

Now I agree with that. And that's one of the addiction is, so the Buddha talked about being addicted to circuses and bells and, you know, dancing and, you know, he listed a whole lot of things. But the word attachment, I think is key here because there's another meaning for the word attachment, which is a more psychological sense.

So that should means the caring, nurturing relationship between infant and parent. My contention is, is that when that attachment need is not met, that's when we developed these attachments in a negative sense. So the lag, the lack of meeting over attachment needs creates our need to fulfill ourselves or philosophic on the outside.

Indeed, the title of the book In the Realm of Hungry Ghosts, it's about the the Buddhist cosmology Tibetan Buddhist cosmology. The realm of hungry [00:10:00] ghosts is one of beings with large empty bellies and tiny mouse and small scrawny gullets so that it can never say satiate

Victoria Maizes: Gabor, talk more about that early unmet need for attachment. And we now speak a lot about ACEs, adverse childhood events and that it doesn't have to necessarily be some horrific thing. It could just be the parent and child aren't matched somehow… the child's needs are not being met by the parent.

Gabor Mate: Well, you know, there was an article published in the in, in the Journal Pediatrics. This is in 2012. And the article came from the Harvard Center on the Developing Child and basically summed up or the human brain develops. I like to cite that article in response to this question So they, they talk about brain development, then this circle and the, and they summarize. decades of brain research. By the time this article is published in the official Journal of the American Academy of Pediatrics this wasn't new information, but it did sum up the previous decades of brain research. And I just read you the one sentence from it, the interactions of genes and experiences, literally shapes the circuitry of the developing brain.

And it's critically influenced by the mutual responsiveness of adult child relationships, particularly in the early childhood years, in other words, the very development of our brain depends on our early attachment relationships and that actually affects [00:12:00] us, not only psychologically or emotionally, but it actually affects our receptors for endorphins and dopamine. All of which are implicated in the addictions. Someone has early attachment relationships are troubled that has both a psychological and a physiological impact on our develop. And so that  unsatisfactory relationships, not because the parents don't love their kids or they don't do their best, but because let's say they're stressed, traumatized, economically troubled politically under threat for any set of reasons The children, the parents are not able to meet those attunement needs of the child. That's going to have a negative impact on the child. So yes, you can hurt kids by the ACE criteria, you know, physical, sexual, emotional abuse of parent dying, a being jailed violence in a felony, a parent being addicted and so on and so forth. But you can also hurt kids just by not meeting their emotional needs.

Not because you're not trying to, but because you might not be capable, let's say you're depressed. Depressed parents have difficulty tuning with their kids. So postpartum depression becomes the risk factor for mental health problems in their child later. Not because the mother didn't love the child.

Dr. Weil: Gabor what about treatment of addictions? That can be very frustrating. And my experience has been that you can shift addictive behavior towards things that are better for you rather than worse for you. But it's very hard to get to the root of addictive behavior and change that. What's your experience

Gabor Mate: Well, look, I worked with people in Vancouver’s east side, which you've probably seen it cause you to be seeing it's a shocking place to anybody that's the sees for the first time. People injecting, inhaling, ingesting drugs of all kinds out in the street, then horrific scene. And these people would lose [00:14:00] everything, their health, their teeth, their relationships, and they will not give up their addictions.

But I would maintain that energy because neither the social system or the treatment system fully understands addiction. So, you know, if you took your car to a mechanic that didn't understand the machinery of the car, You're very frustrating to watch the work on your car and not getting it going.

And I maintain that our profession does not understand addiction deeply enough. And, and furthermore, our profession works in a social context that is inimical to providing good care to people who are addicted. So, so the part of the frustration is not just in the nature of addiction itself, but in how we approach the problem.

Victoria Maizes: Now you have put it out into the world. Some of the things you do think are helpful from appreciative inquiry to internal family systems EMDR, emotional freedom therapy, and more recently psychedelics and some situations. I'm wondering if you would like to speak to any of those in any particular order.

Gabor Mate: The first one I can't claim any studies because there haven't been any, and I'm not interested in studies anyway. I mean, I know I'm not putting down studies, but I think something works. I just do it. You know, I'm not going to wait until 20 years later, somebody proves it and publishes in the paper. So, I developed a method called compassionate inquiry, which just means asking the right question to help people find the truth within themselves. And more researched modality in Dick Schwarz’s internal family systems model. I am in both of our models or whether they are mine the addiction is not the primary person. The addiction is an attempt to solve the problem of emotional pain and suffering.

Dick Schwartz’s addictions like firefighters there, they come along to put out the flame of emotional pain when it's overbearing. And a firefighter of course is a bit ruthless. He doesn't care if he destroy the house He just, he just wants to put out the flame.

He wants to save the house. But he'll destroy the house if he asked it to from from spreading. So addiction is in a sense of firefighters in his view and once you get their proper role and then you no longer approach them as an enemy, but as something that's trying to do something for you, which is also my approach as well then, because I believe that addiction is not a religious belief. I'm convinced based on my own clinical experience, my own lived experience within my own body. And also, by all manner of scientific research that addictions are rooted in trauma. Therefore, I think that any good trauma therapy would add to the addiction treatment armamentarium, nothing by itself is sufficient. I don't think, but certainly we have to bring in good trauma care and all these other methods you mentioned the EMDR and some others or can be helpful as trauma resolving approaches. The psychedelics or and, you know, I'm talking because I'm one of the pioneers of North America going way back.

But the psychedelics are, are really promising and in my experience more than promising modality to help people deal with addictions and they're being seriously studied again after decades of neglect, now they’re serious subject of study, again, with more than encouraging results, I would say.

And I've personally seen people transformed from heavy addiction, the nicotine addiction, alcoholism, sex addiction through their, through the use of, to the judicious use of psychedelics in the proper settings.

Dr. Weil: I have a question on of the one of the psychedelics, which I have personal firsthand experience with as iboga the African plant

And that has a particular reputation for helping with addictive behavior. Can you tell me anything about that?

Gabor Mate: Well, I'll just say psychedelics help to deal with traumatic imprint, but iboga, which I had the experience of, and it's not for the faint-hearted let me tell you.

Also it has to be done in a good medically vetted context, but it does have a unique capacity, which is that it obviates eliminates opiate withdrawal. So you could be on heroin for 20 years and within four days you have no withdrawal symptoms. If, if the proper use of iboga. Which is astonishing, but too, and it's been researched.

So you think that this is a modality, which in the US is illegal. We should be all excited about it because as you and I both know, there's nothing in the Western Pharmacopia that even remotely can do that. So which means that somebody could be on heroin and if you put them in a proper iboga providing setting they wouldn't have to go on Suboxone or methadone. Now, does that work a hundred percent of the time? No, maybe only 40 or 50% of the time. Show me anything that's even close.

Victoria Maizes: So, given what you said as the root of addiction, which is an attempt to solve a trauma and emotional problem, how do you think that the psychedelics and I realize it may be different for different ones? Are solving that problem so that the need for the drug goes [00:20:00]away or, or the, whatever the, the sex addiction, whatever, what is happening?

Gabor Mate: Well if you think something like sex addiction, what does the person after? They’re not after  sex?

Because if that's all there was to it. You would just find another sex static to partner up with. Then you could have all the sex interactions for the rest of your life and only to be facetious, it's a serious condition, but the solution is not about sex. It's about being wanted and the dopamine hit of triumph and the pursuit, you know, a great neuroscientists Jack Panksepp talked about these different bands circus that we share with other mammals and there's one called the seeking system.

And the seeking system and he capitalized these seeking and the seeking system runs on document. So the behavior addicts like the gamblers, not after the money, is she because if she did, when she won the money, she'd never go back to the casino, but she's back the next morning. So it was not about the money and sex addiction is not about the sex.

It's about the shopping addict. It's not about what you personally, not about what you're buying it's about the thrill and the hunt and the seeking system is just enlivened by the dopamine hit. So take sex addiction now in a psychedelic. If you realized why your vitality has been subdued by some traumatic imprint, and as you can reconnect your true self, where your vital being has never been destroyed.

Well guess what? You don't have to go seeking anymore. It's all within you and that simplistic and perhaps idealized. But that's what happens in the proper psychedelic setting is that people's defense is going to get out of the way and they get to experience both the deep pain that they've been running [00:22:00] from.

And maybe also the deep joy that they're suppressed along the road. And when you do it, you no longer have to keep looking to the outside that, that external search that Andy was talking about, Now can… is no longer necessary. And it's not that simple, but that's the essence of it.

Victoria Maizes: Andy, did you want to say more about that from, as you, as Gabor pointed out your deep experience around psychedelics.

Dr. Weil: My experiences that they can show you possibilities that otherwise you wouldn't have believed in. So even if that experience doesn't last, even if it's temporary, it gives you a glimpse of a way of being that may motivate you to work toward a thing that more of the time. And I don't know anything else that really has that potential.

If, if, if the situation is structured properly.

Gabor Mate: I totally agree. I would only say that for some people they can achieve such states through deep spiritual work without psychedelics. Then in those cases, it's probably, although not necessarily even that it's not even that it's not necessarily lasting.

These are glimpses or portals into the doors of perception of as somebody said, but then you have to integrate them into your life. And whether it's a spiritual experience, whether it's a psychedelic experience that integration over time is the real challenge.

Victoria Maizes: One thing I guess I'm hearing is that in the psychedelic experience is the potential to know yourself as love as a perfect, complete, thank you. Yes. So that the seeking is unnecessary,

Gabor Mate: But also as love itself. I mean, so many people have told me [00:24:00] that, you know, I have to say sinner that I am, I've never had that depth of experience.

I've led retreats and facilitate other people who've experienced nothing but love, you know what I'm saying? Why can't I feel that, you know, but but yeah, people not, not that I'm loved, but also that I'm love and, and you know, it's not hokey.

Victoria Maizes: Yeah, I look forward to a time when this becomes legal and available. You know, ketamine is now legal in the U S and Canada, but I hope that soon we'll have a much wider range of options. I want to ask a question about prevention. For many people the COVID pandemic is certainly creating all sorts of trauma, including in the U S alone there are 140,000 children who've lost a parent or caregiver. What can we do to prevent them from growing up you know, with a great need for addictive behaviors to solve the pain.

Gabor Mate: Well, here's the title of my next book comes in, you know subtitled the Myth of Normal, then the subtitle, Trauma Illness and Healing in a Toxic culture.

So I think in a toxic culture, this is what happens. One of the toxicities of our culture is the isolation of parenting and family. I don't know how we evolved as human beings was in small band hunter-gatherer groups and literally hominids and hominins even before the advent of our own species lived in this small band groupings where parenting wasn't an individual or a nuclear family task, it was a cumulative task.

So, and children's attachments or too many nurturing adults. So if the parents did die, it was not, it was maybe sad, but it wasn't a trauma because the child, the child was still held in a extended family, communal context. [00:26:00] Then our isolated society where parents barely even see their kids. And most of the time only because they both have to go to work but should one die, or there's just not the backup there's not the whole. So the trauma is not simply what happens external to you. It's what happens inside you. So two children losing a parent, it'll be traumatic to one, painful, but not traumatic to the other, depending on the kind of holding and support they receive. And so in our society, there's a lot of trauma by default because we don't have the social holding of one another that our human nature actually expects and demands.

Victoria Maizes: We have a lot of work to do as a society. Don't we?

Gabor Mate: Yeah, we do. We're definitely geared to go the other way you know, we're like, we're organized to go the other way. We organized towards more isolation, more aggressiveness, more competition more individual rather than the more human and I say more human.

I mean, hunter gatherers is how we lived until about all of us until about 11,000, 15,000 years ago. Now, if human, if just take our own species, which is not the first human species, but just take our own species. We've been on say 150,000 years ago. That means that if, if our species has been around for 60 minutes, then for the last six minutes, we'd been living, not as hunter-gatherer.

It's totally unnatural. When I say [00:28:00] unnatural, I don't mean that it's bad or it shouldn't have happened. I mean, evolution and transformation happens, but it needs to, we haven't adjusted to that, to what we've lost

So when you're talking about prevention, in my book on addition, I have an appendix, some prevention, and what I say is that prevention needs to begin at the first prenatal visit, because why do I say that? Because in that same Harvard article that I quoted for you, the previous sentence that says the architecture of the brain is constructed through an ongoing process that begins before birth, continues into adulthood and establishes either a sturdy or a fragile foundation for all the health learning and behavior that follows all the health planning and behavior. That means the brain is constructed already in utero, and that needs that we know that the stresses on the month. Actually, I'm going to physiologically affect the baby's development stress hormones have a negative impact on brain development. We notice in human studies and animal studies, you can expose pregnant animals to loud noises. One hour weak in the second trimester. Their offspring will be more likely to smooth themselves with alcohol and cocaine as adults. So the prevention of addiction really needs to begin if you have to start somewhere, it needs to begin at the first prenatal visit. And, you know, let's face it as physicians are. We trained to ask those questions? When a pregnant woman comes to me and I trained, I'll do the ultrasound and the blood test and, you know, measuring the weight and the usual screens and all that.

But will they ask about her? How are you feeling? How's your marriage? What kind of stresses are you under on the job? What support do you have in your life? [00:30:00] Are there, are you carrying any unresolved pain from your childhood that you think might affect how you relate to this child? You know nobody asked those questions cause we're not trained to, and yet that's where you need to begin the prevention.

Victoria Maizes: Yeah, you're actually speaking with someone who wrote a book called Be Fruitful, the Essential Guide to Maximizing Fertility and Giving Birth to a Healthy Child. And in the book, I speak to the need to prepare before conception because from the moment of conception, that neurological system of the baby is already developing.

And so you want to be as healthy as possible. And have your stress management and have your your tribe who's going to help support you, you know, before. But I agree. I don't think that that's commonly talked about.

[Remove long pause]

So, I'm going to ask another really challenging question, which is, what can you advise the loved ones of a person who's really struggling? Let's say with a hardcore addiction that's perhaps destroying their life.

Gabor Mate: Well, let me ask you guys first from an integrative medicine point of view that, that you both pioneer and teach, what would you say to people?

Victoria Maizes: Yeah. I mean, I, I find that it's incredibly hard and, and you know, what I usually hold is to Provide as much compassion as you can. Not believe you can change the person. Cause change comes from within that person and do what you can not to enable the person to make it easier for them to continue in the behavior.

And that's, that's you know, a lot to ask.

Gabor Mate: I won't dispute that. Do you guys know Lewis Mehl-Madrona?

Victoria Maizes: Yes. He's taught at our center over the years.

Gabor Mate: Wonderful. So it was, you know, he's a part Lakota [00:32:00] physician and psychiatrist. And I was talking to Lewis not long ago. And he says in a Lakota tradition when somebody gets sick the community kind of says, well, thank you.

You're manifesting some dysfunctional you're manifesting sentence function in the whole community. Therefore your healing is our healing and that kind of integrative approach. That's why I asked about what you would say is that kind of integrative approach that's pretty much taken for granted in indigenous cultures.

What I would say to people, I would say that okay, look, I know you're suffering because your loved one is addicted and then they're manipulating. They might be lying to you. They're certainly hurting themselves and that hurts you. I get your pain, but the addiction didn't arise out of the novel, out of nothing that their addiction reflects dynamics in the whole community and the whole extended family usually reflects multi-generational trauma.

Then maybe the sensitive who downloaded that trauma, then maybe the Canary in the mine, but they're reflecting traumas that didn't originate with them. And that you're all a part of, not as culpable beings, but as parts of that family system. And therefore, I would suggest that you guys all recognize that and you undertake healing and invite your addicted relative or friend to join the healing process with you, not as the demand or as one of these harsh interventions.

But as look, your problem, your pain that you're soothing with your particular way is all of our pain and we all need to heal. So can we all join together? And we're going to undertake that whether you're ready right now to join us or not, but you're always welcome. So that's how I would approach them.

Dr. Weil: Yeah. That is one of the principles of integrative medicine is that people are more than physical bodies. They are mental, emotional beings, spiritual entities, and community members. And all of those things have to be taken into [00:34:00] account to understand health and illness.

Gabor Mate: Right. And, again, indigenous traditions tend to understand that intuitively.

Like when you get the medicine wheel, which involves the psychological, spiritual, the physical and the social, they don't ignore any of those things. And, I I'm sure your frustration, both of you in line with our profession is precisely that splitting, splitting of what cannot be split in real life.

I know we've been doing it really worked for a long time and it's got a fair bit of acceptance and there's a lot of people studying it, but it's still an outlier when it comes to the practice of medicine, how do you deal with, how do you guys deal with that? That you're saying something that's so clear and so obvious and stuff that is self evident and scientifically verifiable.

And yet it's still not penetrating the mainstream…

Dr. Weil: But time is on our side, because the conventional healthcare system is failing it's in shambles. And the worse it gets, the more institutions open to the philosophy that we've been teaching. So even though so many things are stacked against us, especially the priorities of reimbursement at the moment, I really feel that that all is going to change.

Victoria Maizes: I want to answer the way you just answered about addiction and that's that one of my mentors, Rachel Naomi Remen said, if you want to change a culture, develop a subculture and model a different way. And at this point we have close to 2,000 doctors, nurse practitioners, physician assistants, who have gone through our fellowship training.

And so we have a community who really share beliefs. And we have shorter programs for allied health professionals. And so at our Center, you know, we have 50 people. Big enough to feel [00:36:00] that sense of community and tribe which means we're not actually that often confronted with the absolute skepticism that still exists in pockets. We are bolstered by the support of our community.

Gabor Mate: Yeah, well, that's great to hear and certainly inspiring to see and it w it, it is true that desire as this shifting, let's say, take the issue of trauma, which particularly engaged in. It would have been unconceivable 10 years ago that a book on trauma would be a New York Times bestseller for years, but there’s Bessel Van Der Kolk’s book and Bruce Perry's new book, with Oprah about what happened to you.

So that, you know, that doesn't mean that the profession is changing, but it certainly means that the profession is increasingly in an environment that's going to demand. And I also think that changed sometimes comes from the outside, you know, and there's enough of a groundswell that demands. It is more likely to happen.

Victoria Maizes: This has been such a rich conversation.

Victoria Maizes: Thank you so much Gabor, because when you say the zeitgeists is changing, you are one of the people who have helped change it. I think that you have been such a pioneer in changing our understanding of the mind body connection, of ADHD, of why addiction happens, of the influence of trauma so I just want to honor all that you have contributed to help human beings be healthier and happier.

Gabor Mate: Well, thank you. That's kind of you to say, and certainly very happy for me to hear, so thanks so much. All right. Take care.