Are 12-Step Programs and Traditional Rehab Not Helping?
This past week I had the pleasure to spend a day in workshops with internationally-acclaimed physician and addiction expert Gabor Maté and the renowned physician and researcher Dr. Vincent Felitti, an expert on childhood trauma.
If twelve-step programs and traditional addiction therapy haven’t worked for your loved one, it may help you to hear about Dr. Maté’s theory of addiction–how and when addiction begins, and how we can best help people who are addicted to substances or behaviors.
Dr. Maté does not subscribe to the “medical model” (substance abuse as a disease) for addiction. Rather, he believes that all addiction “begins as a coping mechanism”. Addicts are using street drugs to self-medicate for mental issues such as ADHD, depression, PTSD and Anxiety.
We need to stop treating the symptom (substance abuse), he says, and start treating the underlying causes–depression, ADHD, PTSD, and anxiety.
Addiction is not who you are, just how you coped.
How Does Addiction Begin?
Dr. Maté believes that people become addicted to substances like opiates or stimulants, and behaviors like gambling, using pornography, and shopping, because of early childhood experiences.
Three different kinds of early experiences can be traumatic to a child:
1. Something that happened to the child, like physical, sexual, or verbal abuse.
2. Stress that is experienced by the mother, even during her pregnancy.
3. Something that didn’t happen to the child–they didn’t receive the loving response they needed, when they needed it.
Dr. Maté is quick to explain that his model is not meant to blame the primary caretakers, but rather to understand how a child develops addictive behaviors. He believes the fault lies mainly in a societal system that stresses out mothers, that doesn’t provide pre-natal, infancy and early childhood support, and that requires mothers to go back to work and separate from their young children.
Dr. Maté points out that when an infant is traumatized by something that didn’t happen, it is much easier to overlook. Developmental trauma can occur when an infant repeatedly does not get their needs met by their primary caregiver.
What makes an experience traumatic for an infant is the infant or child’s own experience of what is happening.
“Trauma is not what happens outside of you, but what happens inside of you”
Some of us may be born with a genetic predisposition, a sensitivity to trauma. This may mean you are more susceptible to the pull of addiction if your environment does not provide you with a healthy way of soothing.
Here’s Some Brain Science About Addiction:
Neurobiologically, Maté tells us, all addiction is related to the circuits in the mid-frontal cortex of our brains. These are:
1. Endorphins, the brain’s own internal opiate system for mental and physical pain
2. Dopamine, the “motivation and vitality hormone”
3. Impulse regulation
Interestingly, it can be especially illuminating for those of us who have loved ones addicted to behaviors like watching pornography, gambling, or sex, that it’s not actually the pornography, the gambling or the sex per se that the addict is targeting. Rather, they actually have a chemical addiction to the dopamine rush they get when they engage in these behaviors.
When we have early trauma, sometimes as early as in the womb, the brain doesn’t develop the circuitry to have a healthy response to stress. We may have difficulty regulating our emotions, showing empathy, modulating our fear.
These physiological changes that cause us to be less able to handle stress, will necessarily predispose us to become addicted to substances or behaviors.
How Does Trauma in Our Childhood Affect Our Adult Behavior?
Dr. Maté’s theory is supported by the research of Dr. Vincent Felitti and the Adverse Childhood Experiences (ACE) study.
The ACE Study was done with over 17,000 patients at Kaiser Permanente San Diego in the 1990’s, and many of the original participants have been followed for over 20 years. The study asked questions about childhood abuse, neglect, and other situations like mental illness in the household and separation or divorce.
The findings show a strong correlation between childhood trauma and addiction and alcoholism. There was also a strong correlation to mental health issues like depression, domestic violence, financial stress, and risk for sexual violence. Additionally, physical illnesses like heart attacks, COPD, liver disease and STD’s showed a strong correlation to ACE’s.
However, the Kaiser researchers also found something very interesting. The patients who took the ACE test had 35% fewer outpatient visits and 11% fewer emergency room visits than the control group who didn’t take the test.
So what happened? Did these patients get any special treatment?
Here’s what they got. 1. They took the test. 2. When they answered “yes” to one or more of the questions, the doctor said “I see on the questionnaire that you said “yes” to _______. Can you tell me how that’s affected you later in your life?”
Then the doctors simply listened without judgment.
Dr. Felitti reported that many patients were moved to tears. They reported that no one knew about these experiences from their childhood. No one had ever asked.
Just asking and listening without judgment made all the difference.
What Needs to Change About How We Think About Addiction?
Maté’s “Harm Reduction” model for treating people with addictions involves meeting them where they are. Abstinence is not necessary. He sees addiction as a problem of society, not the individual. In order to address this problem we need societal answers like widespread training for physicians, lawyers and judges, law enforcement, etc. We need accessible facilities for detox, treatment and long-term support. And we need to train and support mothers from the time they are thinking about getting pregnant.
How Can I Use This Information to Help the Ones I Love?
1. Use the information from Dr. Maté to help you understand the person(s) in your life who are addicted to substances or behaviors. You can read his book on addiction, In the Realm of Hungry Ghosts, or pre-order his new book, The Return to Ourselves if his theory resonates with you.
2. Use the findings of the ACE study to remind you of the importance of asking someone for their story, and the power of just listening without judgment. Don’t underestimate your ability to make a difference!
You can read more about the ACE results here.
You can take an abbreviated version of the ACE test here.
If You Need Some More Help Dealing With A Loved One Who Has an Addiction
Therapy can help! Give me a call at 323-999-1537 or send me an email at email@example.com and we can have a chat about how therapy might be right for you. If that’s not a fit, I am happy to point you to other resources that might be helpful.