The Opioid Crisis: Treating Root Causes of Addiction

Jerri-Lynn here:  Trump last week declared the opioid crisis a national emergency, but is unlikely to support policies that will treat the root causes of addiction. This Real News Network interview with Vancouver-based doctor Gabor Maté discusses what an effective policy should target.

AARON MATÉ: It’s The Real News, I’m Aaron Maté. The opioid drug crisis is the deadliest in US history. On Thursday, President Trump indicated he will formally declare it a national emergency.

DONALD TRUMP: The opioid crisis is an emergency and I’m saying officially, right now, it is an emergency. It’s a national emergency. We’re going to spend a lot of time, a lot of effort, and a lot of money on the opioid crisis.

AARON MATÉ: Joining me now is Dr. Gabor Maté, a physician and author of several books, including, “In the Realm of Hungry Ghosts: Close Encounters with Addiction.” Full disclosure, he is also my father. Hello there.

GABOR MATÉ: Hi.

AARON MATÉ: Thank you for joining us. Let’s start first with what this crisis is. The figures on overdose deaths in the US are something like 140 every single day, two-thirds from opioids. Describe for us what kind of crisis we’re dealing with here.

GABOR MATÉ: As the President’s Commission said, every three weeks in the US you have the equivalence of a 9/11, so that every year, currently, you have 14, 15 9/11s happening. In that sense, it’s reasonable to speak about it as an emergency. Another sense, of course, it’s been going on for a long, long, long time, it’s just that the numbers have increased in the recent years.

AARON MATÉ: The numbers and also in terms of who the victims are, right, demographically?

GABOR MATÉ: Yes. It’s now been found that the life expectancy of the white, working, and middle class is decreasing because of alcoholism and drug overdoses. It’s a question of who it’s hitting. It was always certain sections of the population, but now it’s hitting the mainstream.

AARON MATÉ: The implication there is that that’s the reason why it’s perhaps getting so much more attention and resources now?

GABOR MATÉ: Well, there was an article in New York Times earlier this year which said exactly that, that because it’s now hitting the white middle class, people are really starting to wonder what it’s all about, and what else can you do beside the usual ineffective responses. It’s interesting enough that, in the 2016 election, Trump got some of the biggest support in areas that are hardest hit by alcoholism and the opioid crisis and suicides.

AARON MATÉ: Why do you think that is?

GABOR MATÉ: That speaks to the very heart of addiction and what drug use is all about. It’s all about an attempt to escape from desperation. Those areas are the areas of the country with the greatest desperation. Those are the ones that most were susceptible to Trump’s message.

AARON MATÉ: Okay, let’s talk about that. You talk about addiction being an attempt to escape desperation. You’ve worked with addicts over many years. You were a physician at the Portland Hotel Society, which is a residential and hospice service for residents of Vancouver’s downtown east side, an area with a huge drug problem. Talk more about that, addiction being rooted in an attempt to escape adverse conditions.

GABOR MATÉ: If you look at the opioids, what are they? The opioids have been used in medicine for thousands of years. Used for what? Used for pain relief. They’re the most powerful pain relievers that we have. They don’t only soothe physical pain, they also soothe emotional pain. It turns out that the same area of the brain that experiences suffering from physical pain also experiences suffering from emotional pain. In other words, the primary question in any addiction, but especially in opioid addiction, is not why the addiction, but why the pain?

We have to look at what is the pain that people are trying to escape from. For that, there are two major causes. One cause is childhood trauma. We talk about how childhood trauma actually affects the brain in such a way as to make it more susceptible to addictions later on. Childhood trauma is one source of deep pain and all the addicts I worked with have been traumatized significantly so. That’s what the large scale studies in the US shows about it, the more trauma in childhood, exponentially the greater the risk of addiction. Childhood trauma is a huge problem in our society and in American society.

The other question is, what’s going on right now? That’s stress. What we also know is that stress makes the brain more susceptible to addiction and stress also makes people more desires of escape from the stress. If you look at what’s happening socially, economically, politically, culturally, is increasing insecurity, increasing stress, increasing uncertainty, increasing difficulty for people. Therefore, people will turn to short-term measures to escape those difficulties, or at least the awareness of them, by escaping into addictions, including drug use. What we’re looking at is, A, childhood trauma, and B, severe social stress. It’s not surprising that the areas where Trump got the greatest support are areas of great social stress.

AARON MATÉ: Right. Taking your analysis and looking at this response now, Trump poised to, it appears, declare this a national emergency. Looking at how this problem is discussed, what do you think is missing from the conversation and from the actual policy choices that are being made to respond to it?

GABOR MATÉ: The conversation in the mainstream media and political circles, and I would say even in medical circles, largely excludes the central importance of trauma and stress. They talk about the problem of addiction as it was simply a matter of a choice that somebody makes, in which case, two things you can do. One, is you can try to deter people or at least dissuade them from making that choice. That’s what your attorney general, the American Attorney General Jeff Sessions talked about, about reviving the old Nancy Reagan “Just Say No” ethic, where you’re just telling people how bad drugs are and then they won’t use them [crosstalk 00:06:30]-

AARON MATÉ: You know what? I’m going to cut in. It wasn’t just Sessions, it was also Trump. This is him speaking just a few days ago. Let’s hear what he says and you can respond to this as well.
DONALD TRUMP: The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place. If they don’t start, they won’t have a problem. If they do start, it’s awfully tough to get off. We can keep them from going on and maybe by talking to youth and telling them, “No good. Really bad for you in every way.” If they don’t start, it will never be a problem.

AARON MATÉ: “If they don’t start, it will never be a problem.”

GABOR MATÉ: Yes. That, again, is based on the view that just telling people how bad drugs are will keep them from using them. If that strategy worked, why do we have the crisis right now? If the Nancy Reagan “Just Say No” and telling people how bad it is to use drugs strategy worked, why has the heroin use rate in the US gone up five-fold in the last 10 years and why the current crisis? Clearly, that doesn’t work.

The reason it doesn’t work is is drug addiction is not a choice that anybody makes. Nobody chooses to do that. The real question is, how do we get that information across? The problem is that the children, the young people who are listening to adults, are not the ones at risk. The ones who are at risk are not listening to adults. It doesn’t matter what we tell the kids, because again, the ones that don’t need it, they’ll get it, and the ones who need the information won’t get it, because they’re the hurt ones, and the abused ones, and the alienated ones to whom this kind of message falls on deaf ears. Yes?

AARON MATÉ: No, go ahead.

GABOR MATÉ: Well, the second perspective is that addiction is this disease that people inherit. Again, that excludes looking at people’s lives, looking at their childhood trauma history, at the family history, of modern generational trauma perhaps, and looking at all the social factors that put stress on people. While the addiction to the brain looks like a disease to the brain, it’s truly not.

What the disease [inaudible 00:08:44] is that that disease is the result of life experiences and social factors. Simply talking about trying to stop or prevent the addiction without looking at those social factors and those personal historical factors and then when you treat people without treating their trauma and treating their pain, you [inaudible 00:09:08].

AARON MATÉ: What about the side, though, that says the main problem is the supply, especially from in the case of opioids from big pharmaceutical companies? Purdue Pharma, it’s well known that they entered Oxycontin into the market in the mid ’90s. They concealed some of the impacts of it and that did lead to a huge spike in addictions and overdoses.

GABOR MATÉ: It’s certainly true that the pharmaceutical companies profit, and very happily, over the overuse of pharmaceuticals. That’s true. It’s also true that Purdue, which engaged in subterfuge that contributed to the deaths of hundreds of people, paid a very small price and none of their executives went to jail, contrary to a small-time drug dealer who’s responsible for much less degradation.
That’s true, however, as an American judge very astutely said that you can no more control or suppress the law of supply and demand than you can suppress or control the law of gravity. The real issue is not just the availability, because people will use something. People that need to escape will use something. If they will not use available prescription drugs, they’ll use illicit heroin. There’s a lot of cheap heroin available in the United States right now.

If they will not use that, they’ll use crystal meth. They’ll use cocaine. They’ll use alcohol. They’ll use something. Ultimately, while it’s certainly true that the pharmaceutical companies have contributed to this, and it’s also true that physicians have contributed to it because of their insufficient understanding of chronic pain and how to deal with it, ultimately we still have to look at the broad social factors. In individual cases, we have to address those factors when we’re treating people.

AARON MATÉ: Right. On the issue of treatment, I went to a event recently where I heard people who have experienced dealing with rehab facilities, having loved ones who are in rehab facilities. It was just a series of complaints about these facilities did not properly address their loved ones’ issues. Specifically, there was very little therapy and attempts to address people’s internal pain. I’m wondering your thoughts on that, the issues that the rehab approach and then treatment in general might face?

GABOR MATÉ: The problem is that most addiction specialists, physicians, psychiatrists, and counselors do not get trained in trauma. In fact, it’s quite possible, for most training physicians in the United States or in my country, Canada, to graduate without ever hearing the word “trauma,” let alone learning how to deal with it.

It’s not surprising that, when people go to rehab facilities, the attention and the emphasis is put strictly on the behavior of addiction and trying to get them to stop the behavior and not on the causes that made them addicted in the first place. People go to rehab and then they’re never helped to integrate and deal with their emotional pain, with their trauma. They’re never given the help to learn and to help them rewire their brains in such a way that they can go out there and deal with stress more effectively and more consciously, with more awareness.

AARON MATÉ: Right. As we wrap, I have two questions about the psychological dynamics of addiction. The first is one that you touched on a bit earlier. What is the neuroscience of addiction? Why is someone with trauma, with unaddressed childhood pain, more wired to become addicted?

GABOR MATÉ: Well, first of all, because of the pain itself. All addictions, in my view, are an attempt to escape from emotional pain, discomfort, distress. The more distress, discomfort, pain, shame you have, the more likely you’ll want to escape from it through addictions. That’s an impact of trauma. Secondly, the childhood experience itself wires the brain. This is not controversial, this is just state of the art brain science, how the human brain develops depends very much on your early environment and, particularly, the emotional atmosphere, so how connected and attuned and emotionally present or, on the contrary, how stressed, absent, perhaps traumatized themselves the parents are will actually affect the wiring of the brain.

For the healthy brain development, you need a calm, connected and non-stressed parenting environment, which is less and less available to American kids or with social circumstances. Then, thirdly, if you look at the brain circuits involved in addiction, the opioid circuits where the opioid medications work, over the incentive motivation circuits where all the drugs and all the behaviors of addiction, from gambling, to sex tend to network, if you look at the circuits of emotional stress regulation and self-regulation, if you look at the circuits of impulse regulation, where we can make decisions not to engage in something even though we want to, if we know that it’s bad for us, all these circuits develop or don’t develop in response to the early environment.

In other words, the greater the early stress and the trauma and the less calm and supportive the early environment, the greater the risk that person is at for addiction later on. Not to mention not only for addiction, also for mental health problems. As this interim report by the President’s Commission pointed out, about 40% of substance users also have correlated mental health issues, which also need to be addressed. By the way, I would say 40% is a gross underestimate. It’s probably closer to 80, 90%.

AARON MATÉ: Quite likely, they’re using drugs to deal or cope with those mental health issues?

GABOR MATÉ: Very often drugs are, apart from the general escape that provide from stress and emotional pain and distress, they’re also specifically self-medications for diagnosable mental conditions such as post traumatic stress, such as depression, such as anxiety, such as attention deficit hyperactive disorder, such as bipolar illness, such as social phobia and so on. Again, these conditions and their basis in trauma all have to be addressed if we’re to help addicts, addicted people really overcome their problem.

AARON MATÉ: Okay, so a final question, and it’s also about psychology, I’m curious your thoughts on what is the psychology of those who stigmatize addicts, who have a hard time seeing them as people in need, people with pain, more seeing them from a criminal perspective? What, in your view, is going on there?

GABOR MATÉ: That’s a great question. I think there are three levels that we can distinguish here, one is on the level of thought. They just don’t understand. They haven’t actually looked at what drives addiction. They see it as a moral question, because this is how they’ve been taught, and they have no other perspective. [inaudible 00:16:59], it’s just shallow thinking based on a lack of information.

On the level of emotion, though, there’s a tremendous hostility towards drug users and addicts in a part of a lot of people. What is that all about? I think what that’s all about is something that Jesus talked about, when he said, “Don’t judge, lest ye be judged.” Basically, he points out that all the judgements you make of others are always, in the end, come back to ourselves.

If you look at American society or Western society in general, it’s a highly addictive culture. People have all kinds of addictions. There’s not really a deep difference between drug addictions, and sex addiction, and gambling addiction, and shopping addiction, and eating additions, in terms of their causes, in terms of their brain circuits, and in terms of negative impact. What I’m saying is [crosstalk- 00:17:52]-

AARON MATÉ: Well, but listen, a lot of people would push back on that and say, “You can’t compare the impact of heroin use to the impact of gambling or sex or whatever else.”

GABOR MATÉ: Well, first of all, we can make a more direct comparison if we look at cigarettes use or alcohol use. You can make a direct comparison between cigarette use and alcohol use and, on the one hand, in heroin use and the other. You know what the comparison says? The comparison says that heroin use is far safer. In other words, if you take a thousand people who smoke or drink heavily or who inject heroin, as long as they don’t overdose, 30 years from now, there’ll be a lot more disease, a lot more death in the alcohol and cigarette groups than in the heroin group.

AARON MATÉ: This is assuming, though, that the heroin is clean, right? Obviously, street heroin is far different.

GABOR MATÉ: That’s what I’m saying. We have this arbitrary decision as to what drugs are acceptable and what drugs are not. What I am saying is that people don’t have the same [inaudible 00:18:59], the same negative, hostile response to smokers and people who drink. In fact, drinking is publicly advertised on the Superbowl. It’s totally arbitrary.

In other words, it’s fueled in emotional reaction. What I’m saying is that the emotional reaction is based on the fact that addictions are so rife in our society, we just don’t want to admit it, so we want to see the addict as somehow different. We want to see them as inferior to us. Now, if we want to judge them, and then we can feel superior, and that’s on the emotional level.

On the neurological level, this part of the brain here, in the front part of the brain, the mid frontal cortex, has a function which is called “response flexibility,” which means that when we are confronted with the situation, we can consider the facts. We can calmly evaluate what’s best and respond from a flexible, rather than an emotional reactive point of view.

Now, for a lot of people in our society, that response flexibility is not available. They tend to react from an emotional-based patterned reactive ground. They don’t have the equipment themselves. They’re not mindful enough to really consider what’s actually going on. Instead of being responsive, they’re being reactive. That reaction is an emotional one of hostility.

AARON MATÉ: Okay. Very quickly as we wrap, because we haven’t talked about it yet, but it relates to what we’re talking about right now, which is that clean heroin is provided to people at safe injection sites, like the one that you worked at in Vancouver’s downtown east side. I’m wondering if you could talk about that quickly and the impact that that has had on the community?

GABOR MATÉ: Well, the first thing you have to realize is that much of the negative impact of drug addiction is due to the illegal situation, where people have to use unreliable supplies polluted by whatever, what medication, particularly fentanyl, which is lethal. Nobody’s advocating that drugs should become legal, in the sense of being freely available on the streets or corner stores, like cigarettes or alcohol is, but there are programs in Canada and in Europe, which have provided clean heroin to confirmed addicts who cannot be helped by methadone or suboxone or other medications. These people actually get a prescription, not that they take home, but they inject in the clinic.

It’s been shown over and over again that people who are given access to such programs have much less disease, passed on much less disease to other people, far more economically viable, they have better family lives and far fewer health risks and incur far smaller health cost to the system.

What I’m suggesting is that, although supplied heroin will not be the answer to most people or certainly not to everybody, but there needs to be response flexibility in the healthcare system. Right now, the approaches are way too narrow, way too reactive, and way too limited. If we actually looked at all the possible ranges of what we already know is available to us and all the programs that we could actually use here, we will do much better than we’re doing right now.

AARON MATÉ: Just to clarify, in Vancouver, there’s two facilities, right? There’s the facility where people are provided with prescription heroin and one where they’re not provided with heroin, but they can go and inject safely. I believe, in both these facilities, the overdose deaths around that area have declined sharply, right?

GABOR MATÉ: There are two clinics, yes. One is the Supervised Injection Site, where people bring their illegal drugs, but they inject them under supervision with no harassment from the police. They’re given clean needles, sterile water. In other words, they don’t pass on or receive disease from other people. If they overdose, they’re actually resuscitated. A lot of lives have been saved.

At another clinic, just one clinic in Vancouver, they prescribe and supervise prescribed heroin to people under the principles I just explained. Now, unfortunately, Vancouver’s also seen a great increase in the overdose deaths and the clinics have not been able to keep up with that because of the introduction of fentanyl and still because of the retrograde drug laws that drive people underground. We’re far from having solved the problem in Vancouver, but those two initiatives have demonstrated, in many studies, a lot of promise.

AARON MATÉ: Dr. Gabor Maté, physician, author of several books, including, “In the Realm of Hungry Ghosts: Close Encounters with Addiction,” thanks very much.

GABOR MATÉ: Thanks for having me.

AARON MATÉ: Thank you for joining us on The Real News.

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31 comments

  1. JEHR

    Toronto has started the same kind of injection sites (illegally) as in Vancouver and the police are leaving them alone because these sites save lives. I think Canada should now look to Portugal and think about making all drugs legal and use Portugal as a guide. Portugal monitors drug treatment (the use of methanol, clean needles,etc.), gives after-care help and re-integrates addicts into society. Addiction is not a legal problem; it is a health problem and should be treated like an illness.

    1. Kurt Sperry

      The Portugal model seems to deliver the best empirical results. It’s not intuitive, but it seems to work.

  2. Tomonthebeach

    “It’s NOT the drug, stupid!” should be where government officials start to attack the problem.

    “Well, the first thing you have to realize is that much of the negative impact of drug addiction is due to the illegal situation, where people have to use unreliable supplies polluted by whatever, what medication, particularly fentanyl, which is lethal.”

    This remark advances the medical myth that opiate and opioid deaths are accidental, and/or due mainly to drug laws. Gee, if only they got the FDA-approved “good” dope, the death rate would drop. This silly explanation overlooks that opioids are all sufficiently neurotoxic that large doses of even pharmaceutical-grade dope will KILL YOU on the spot – normally via respiratory arrest. At least, as M.A.S.H theme song goes: “Suicide is painless.” [Google the entire lyrics – they speak volumes.]

    As Maté stated earlier, addictions start and are sustained by a life of hopelessness and emotional pain. Recovery hinges on getting addicts into a new environment free of the stress and strain that led to seeking pharmaceutical escape. There is nothing in life that creates more hopelessness than being unemployed with no apparent path to regaining the self-respect derived from work.

    Some people try to cope by blaming “globalization,” as if Trump or anybody can somehow switch off the reality that market competition has ALWAYS been global (think the silk road). Others might blame minorities, especially immigrants, who cannot fight back. “THEY are stealing my job.” even though the unemployed would never consider cleaning hotel toilets or picking tomatoes in the hot sun. Likewise, they lack the education to do jobs educated immigrants do, like writing code or working as lab technicians.

    Thus, when POTUS encourages such world views, it may play to his so-called base, who are looking for ways to rationalize their plight. However, it does not change their lot – they are still hopeless.

    If the government wants to make hopeless people’s America great again, he has to restore jobs, and that means bringing back things like Roosevelt’s Works Projects Administration; not declaring some phony medical/law-enforcement emergency that will squander tax dollars better spent on eradicating the root cause of addiction: hopelessness.

    1. ChiGal in Carolina

      There are many paths to addiction, and as many paths out. Emotional pain is one way in, and in previous work with an outpatient methadone clinic I found that properly assessed, almost all of the patients had undiagnosed trauma in their backgrounds. Few of them had not been abused, witnessed horrific violence, or subjected to chronic and terrifying instability in their younger years.

      So as per the interview, although the gold standard in substance abuse treatment is to integrate it with mental health treatment, in practice this often does not happen, especially for the poor. Additionally, if diagnosed with a psychiatric disorder, most had been given one that focuses on the disruptive behavior (bipolar is a common one) rather than the causes (such as PTSD). Studies have shown that an overwhelmingly large percentage of addicts have diagnosable anxiety disorders, likely left untreated.

      It is also possible to become addicted after having been prescribed opioids for an injury or surgery. It is true that the drug itself changes your brain to want more and then this is the dynamic that has to be addressed.

      But it is straight-up pernicious to say that it doesn’t make a difference to administer opioids safely and legally. As I have said before on this site, heroin is MUCH LESS DAMAGING to the organs than alcohol, cocaine, or nicotine. The issue with opiates is that the therapeutic dose is so close to the lethal dose. Supervision allows for immediate reversal of an overdose and saves lives.

      1. Terry Flynn

        Indeed! Though I have a fairly publicly known anxiety disorder – whilst I am glad it *was* diagnosed, so as to help me avoid addictive behaviour, as my psychiatrist (and the more honest clinicians I’ve worked with who know the literature backwards) said, “in truth, there is little we can do for anxiety that is not worse than the condition itself, in anything but the long-term”…plus, from the article:

        They’re never given the help to learn and to help them rewire their brains in such a way that they can go out there and deal with stress more effectively and more consciously, with more awareness

        That’s because this takes time and a LOT of resource-intensive work over years, as you note.

    2. Yves Smith

      Another factor that leads to death with addictions (not just opioid) is the user gets clean for a while, then goes to take the drug, and takes the same dose he did right before he quit. In many cases, the user worked up to that dose, as in he took more and more to achieve the same high, as his body had developed tolerance. But taking that dose stone cold is another matter.

      One of my friends jokes that’s why Keith Richards is still alive, he famously takes all kinds of drugs but has never stopped taking them.

  3. Kokuanani

    Although published in 2009, Nick Reding’s Methland: the Death and Life of an American Small Town is still relevant and well worth reading.

  4. Ping

    The pharma should be picking up the expenses for this crisis. They flooded the market with opiods and misrepresented the addictive aspects.

    Since politicians are on the take from pharma, the cost for cleaning up the mess and treatment is shifted to taxpayer. I guess a couple states are suing pharma but MSM has gone mute on that too, wouldn’t want to jeopardize enormous drug advertisement revenue I guess.

  5. LyonNightroad

    In my personal experience, getting an opioid prescription for serious pain without apparent physical cause is quite challenging. I’ve had back pain many times worse than when my impacted wisdom teeth were extracted. Yet, they don’t hesitate to give pain pills out for wisdom teeth but refuse to for back pain. In the end the pain went away like most back pain does. However, I really didn’t need to suffer so much, my productivity at work took a massive hit. I worry that it’s just going to get harder to get relief when you genuinely need it. However, I have noticed that more elderly relatives have a much easier time getting pills for every ache and pain. It seems the older they are, the more likely the doctor is to accept claims of pain without apparent physical signs.

    1. Yves Smith

      In NYC, doctors hand out meds like candy. I have hip pain and I guarantee my MD would give me opioids if I merely said NSAIDs (naproxen, aspirin) weren’t giving me any relief, and her posture is normal. I’ve been astonished at how I’ve said things to doctors just to fill in the medical picture and they’ve acted as if I were asking for drugs in code when I was doing no such thing….and they were eager to “help” . It’s a real proof that this is class related. Doctors here assume you are/were a “member of the 10%” professional and are responsible about this sort of thing.

      1. ambrit

        Agree with the class related to prescribing meds comment. Down here, NSAIDs are almost the only relief offered to the ‘deplorables’ cohort of the medical victims population. I once had an MD tell me to my face that she did not want to risk losing her license to practice medicine because of a whiny construction worker wanting to get high. (I had gone in to the clinic two days after having an on the job accident that required stitches in my hand. The couple of tylenol 3s the ER staff had given me had worn off and that hand hurt like H—. So that the sub-contractor didn’t have to report a “lost days injury,” I was doing ‘walking wounded’ level jobs around the jobsite the next day and onward.) I guess that I “fit the description” for her.
        To steal a line from Richard Pryor: “Deplorable was seen in the vicinity.”

  6. Kat

    I am glad to see this interview of dealing with ones emotional pain and the correlation with addiction and childhood trauma. I have been involved the past thirty years with a group in my town that helps teen and adult survivors of child sexual abuse heal . We have one of most comprehensive programs in the United States for survivors. We were one of the pioneers of the”lets deal with the child sexual abuse trauma directly and help people” model. The quality of one’s life can be substantially improved when the original trauma(s) are dealt with. Kaiser did a study called the Ace Study, that shows the more negative experiences in childhood, the more health issues that adult has (anxiety, depression, diabetes, high blood pressure, etc etc). We do not live in a society that encourages us looking at ourselves and dealing with our childhood wounds. But I can tell you, in my experience, many people that do do that healing work have better lives. There was a study recently done for our county that showed something like 70% of women in jail were sexually abused as kids, as well as early domestic violence, neglect, physical abuse, etc. Our prisons and mental health facilities are filled with early childhood trauma survivors. I live close to Silicon Valley, addiction issues aren’t just small town, disenfranchised poverty stricken communities. Our rehab cents are filled with folks dealing with addiction issues. One thing locally that has really shifted especially the last few years is an emphasis on trauma informed care and models of care based on the fact that early childhood traumas have a huge impact on us as adults and how to address those traumas. I am grateful to see this change happening,albeit slow. Local rehab facilities have changed their model to the trauma informed model because the recidivism rate was so high, people being in treatment and then going back to the self medicating, and cycling in and out of treatment.

  7. Chauncey Gardiner

    Having seen the effects of addiction in my community and on families, I appreciate this post about underlying causes. Recently spoke with the owner of a mini-storage and truck & trailer rental franchise who was installing video cameras and motion detector lights around the fenced exterior of his property in a fairly affluent nearby mid-sized town. He said that he had been having problems with attempted break-ins and has found used needles on the grass around his property. He said heroin is cheap, and shared the view expressed here that one of the causes is lack of economic opportunity and despair. He said the local police are unable to keep up with the flood.

  8. VietnamVet

    Yes, you cannot treat addiction without dealing with the stress and trauma. Also, there has to be de-tox and sobriety. The mind hates pain; emotional as much as physical. It is a real trickster to keep you medicating yourself to feel good.

    I also believe men need to be trained to leave their parents. A year working with the Conservation Corps sets up the right habits and skills. If there are no schemes to provide jobs and a meaning to life; the elite and their politicians are blowing smoke until society collapses.

  9. Aumua

    As a recovering addict, I can say that Dr. Gabor is completely right. Addiction is a societal illness. The thing is, really addressing the root causes of addiction implies looking at the very foundation of how we live, and society doesn’t want to do that. Denial is not just something that addicts do. In my recovery I have had a chance to get under the surface and look at my own root causes and the patterns of behavior that come from them, but that has first of all taken a willingness to do the work around it, and not everyone is ready for that.

    I think that there is another factor that hasn’t been mentioned much, which is our consumerist way of living, and the advertising industry that has impacted most people with high tech psychological manipulation. We are programmed from a very young age to need something outside ourselves to be complete. Advertisement creates a sense of need, and then offers a product to fill that need. Is it any wonder that addicts have this hole that they try and fill with drugs? It’s evil stuff, and we should stop subjecting ourselves and especially our children to that kind of programming. You can see just how far we are from that level of thinking right now as a society though.

    1. sierra7

      Great comment!
      It will take a revolution to overthrow the continuing cabal that gives the push to entice our society to purchase (or steal) useless crap to make themselves feel good (momentarily). A true revolution.

  10. wilroncanada

    Two stories:
    I had many discussions in the 1980s with a friend about the number of people going before courts for minor offenses. He was a minister in the United Church of Canada who had started a drop-in centre/food bank/help centre in our Island city. He related the large number of times he had appeared as a “character” witness for people (mostly men at the time) who had diagnosed mental illnesses, but who had been dumped into the street when mental institutions (warehouses) were closed. The public was told that henceforth they would be looked after “in the community.” Instead they had been frequently given meds and dumped. The total, he indicated, was probably 70-75% of those either in court or in emergency wards as victims.

    My daughter is a psychologist in a private clinic who specializes in working with children and teens. The clinic had to hire a second specialist to begin to handle the load. The traumas she has related to me (without names) are amazing. Mate is right about that. Her load includes only those who can afford the fees for a private clinic, or those covered by insurance. Referrals from the education system for those who may have severe learning disabilities often come only after a multi-year wait, the learning disability ignored, when the child has become a danger to self or others.

  11. cripes

    Key insight “the primary question in any addiction, but especially in opioid addiction, is not why the addiction, but why the pain?”

    Even Gabor, who knows neolliberal societies will not invest in communities and people, offers half-solutions that rely on the patient to cure himself: “(Addicts are) never given the help to learn and to help them rewire their brains in such a way that they can go out there and deal with stress more effectively and more consciously, with more awareness.”

    Heaven forfend we should try to ameliorate the causes of crushing, deadly financial, institutional, individual and community stresses like, say, in war or natural disasters.

    Oh wait, we don’t! (see Katrina)

    There is also the incredible aspect of class oppression, nowhere as punitive as the USA, where the children of the poor are demonized, imprisoned, called thugs and branded with the Mark of Cain for petty entrepreneurial dope peddling while the children of the elite (and their retainers) are shielded from legal and financial consequences and can grow up to be preznit (see Shrub).

    I have seen, and probably many of you have, that learning institutions and workplaces operate the same, calling the wrath of the law down on the warehouse worker with weed and coddling crack smoking executives with employee wellness vacations at Malibu rehabs.

    “We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin. And then criminalizing both heavily, we could disrupt those communities,” Ehrlichman said. “We could arrest their leaders. raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”

  12. cripes

    “This is not just about an unemployed, homeless person shooting up in an alleyway. There are kids in blue blazers, people you meet here in the street,’ said the mayor (of Kettering, a professional suburb of Dayton), Don Patterson. ‘We need to help them and treat them.”

    Oh well, then, we should get right on that.

  13. Wade Riddick

    Where to start with what’s wrong in this interview?

    Childhood trauma aside, pain pills can themselves cause pain. Regular NSAID use can generate a feedback effect creating chronic pain instead of relieving it.

    Opiates trigger a TLR4/mu opioid circuit that must be broken in the brain. Perfectly healthy people can and do take opiates and then wind up complete addicts for reasons that have little to do with their childhoods. This is a chemical issue. Go look at the literature on the beta-arrestin complex.

    These drugs, like the sugar in our diets, are deliberately marketed to customers to generate repeat business. Perdue deliberately lied about the addictive nature of its product, encouraged doctors to prescribe outrageous amounts in order to boost sales quotas and tailored doses to maximize withdrawal pains. They’ve repeated these actions so often, it has to be standard business practice.

    NSAIDs and antibiotics disturb the gut. The gut is the greatest GABA synthesis site outside the brain. Lose GABA and you lose the brakes on pain signals. Flora in the gut also regulate cannabinoid (CB1 & CB2) and opioid (mu) channels. These bacteria also limit inflammation and keep us sensitized to insulin. Whether pain doctors or addiction specialists admit it or not, these are all factors in chronic pain. Cutting your pain levels in half may not sound like much, but it can make all the difference. Yet doctors routinely avoid addressing these factors that have been well known for over a decade. Specialty addiction clinics are the worst. They ignore the science because they are often plagued by their own profit issues (i.e., why cure a client when the bottom line is made up of repeat business?).

  14. jimbo

    For anyone who is interested, here is an excellent comic that goes through the research of the social aspects of addiction:

    http://www.stuartmcmillen.com/comic/rat-park/

    For what’s it worth, I also agree with Wade, above: there are a few things going on, here. Yes, the increased dislocation (especially in rural areas) means that people will find whatever they can to self-medicate, but there is also the fact that we have a culture of marketing that pursues, as it’s highest good, getting the most people addicted to whatever it is you are selling as you can. Most of the money in “addiction” research comes from companies that want to figure out new and better ways to get people hooked and keep them hooked.

  15. Larry Coffield

    Considering NC deals with political economy, a few readers might understand that the real root cause of the opiate epidemic is profit motive emanating from criminogenic prohibitions. Trauma plays a very important role, but a causal approach must reduce availability to quash epidemical demand..There have been three epidemics: heroin in the Sixties via Vietnam, cocaine-crack that spread from the Colombian civil war into Contra trafficking, and now corporate drug slingers carving market share for a two-year inventory of Afghan heroin.

    Demand inelasticity prevents deterrence if addicted to high-powered opiates or cocaine. Thus if afflicted with opiumism or cocainism, the fear of drug deprivation obviates fears of retributive justice, lethal STDs, and lifestyle sacrifices. Epidemics result from dealing and stealing, Suburbs and other areas where the drug war is politically verboten can pursue the universal crime of choice, low-profiles sales yielding epidemical demand via convenience-store availability.

    There is a new system that serves as a public option to remove cartel competitors. but poor health prevents putting it out. A collaborator would be welcome. It disconfirms the convention wisdom that no quick-fix can significantly reduce crime and drugs. If not enlightened law reform, then Duterte remedies become the default choice.

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