This is the most comprehensive book about addiction I’ve ever read. The author is a family physician in Canada and involves as a staff physician at Portland Hotel, Vancouver which is a community charity centre that provides housing, healthcare and harm reduction services for the underprivileged. In the first part of this book, he shares his personal stories managing various substance use disorders patients. Second part is more academic, where he discusses the pathophysiology of addiction, drug policies and steps towards sobriety. He himself was diagnosed as having addiction to shopping for classical music.
Substance abuse requires 3 factors to occur:
“Thus, we might say that three factors need to coincide for substance addiction to occur: a susceptible organism; a drug with addictive potential; and stress.”
Adverse Childhood Experience (ACE) along with maternal depression are the important factors in addiction risks.
“The hormone pathways of sexually abused children are chronically altered. Even a relatively "mild" stressor such as maternal depression —let alone neglect, abandonment or abuse-can disturb an infant's physical stress mechanisms. Add neglect, abandonment or abuse, and the child will be more reactive to stress throughout her life.”
We are most likely to blame genetics for our inadequacies.
“We human beings don't like feeling responsible: as individuals for our own actions; as parents for our children's hurts; or as a society for our many failings. Genetics that neutral, impassive, impersonal handmaiden of Nature would absolve us of responsibility and of its ominous shadow, guilt. If genetics ruled our fate, we would not need to blame ourselves or anyone else. Genetic explanations take us off the hook. The possibility does not occur to us that we can accept or assign responsibility without taking on the useless baggage of guilt or blame.”
According to him :
“The precursor to addiction is dislocation, according to Bruce Alexander, professor of psychology at Simon Fraser University. By dislocation he means the loss of psychological, social and economic integration into family and culture; a sense of exclusion, isolation and powerlessness. "Only chronically and severely dislocated people are vulnerable to addiction,” he writes.”
In terms of brain conscious control :
“Drugs damage the parts of the brain—already impaired to begin with—that exercise conscious will. Dr. Nora Volkow, Director of the National Institute on Drug Abuse in the U.S., has written, "This aberrant behavior has traditionally been viewed as bad 'choices' that are made voluntarily by the addict. However, recent studies have shown that repeated drug use leads to long-lasting changes in the brain that undermine voluntary control."
Social stigma is the main issue in rehabilitation :
“The current set of public beliefs and institutional beliefs about substance abuse are impediments to the application of high-quality successful intervention," says Dr. Perry. "The more we dehumanize and vilify substance abusers, the more it is impossible to put in place the kind of interventions that will help them."
Definitely, addiction is a disease of the society as manifestations of many social ills :
“It is no coincidence that addictions arise mostly in cultures that subjugate communal goals, time-honoured tradition and individual creativity to mass production and the accumulation of wealth. Addiction is one of the outcomes of the "existential vacuum," the feeling of emptiness engendered when we place a supreme value on selfish attainments.”
His final words are :
“All adults concerned with the care of young people need to remember that only healthy, nurturing relationships with adults will prevent kids from becoming lost in the peer world—a loss of orientation that leads rapidly to drug use.”
Dr Mate was born to a Hungarian Jewish family and his grandparents were killed in Auschwitz during Holocaust when he was five months old, before his family migrated to Canada. However, he has called for an end to occupation and persecution of Palestinians, as well as the return of Palestinian land.
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