“In the Realm of Hungry Ghosts” explores the nature of addiction. Gabor Maté is a physician and activist who serves those ground down by the War on Drugs, personalities blown around the streets like loose-leaf sheets. Recognizing and frustrated by the addict’s inability to sustain self-care, Maté was forced to investigate their motivations. In constructing a collage of their behaviors, he was humbled to discover the same pages in his own personality. He argues that many of us would be susceptible to their condition, if denied the binder of family and culture. The insanity of the War on Drugs is to systematically remove those supports.

Maté opens his work with vignettes that humanize the addicts that he treats. Each recognizes the inherent grace of every individual, whether as a carrier of spiritual legacy, a discerning social critic, a pure voice, or a loyal peer. What burdens them all are childhood experiences that devalued them. That could be removal from the family unit for their own protection, exposure to chaotic caregivers, or physical and sexual abuse.

These events condition the brain to survive under the assumption of deprivation. The most serious impacts are in the part of the brain – the prefrontal cortex – that regulates impulses and organizes healthy relationships. In healthy minds, recreational drug use is a temporary fixation, easily suppressed when the costs begin to outweigh the novelty. Full addiction usually arises only in minds damaged by prior experience

Maté elaborates the interaction between addictive substances and those stunted networks. The dopamine network evaluates the importance of signals received from our environment, motivating us to preserve well-being. When our environment is chaotic, the dopamine network is suppressed, and motivation disappears. Every addictive substance heightens the sensitivity of the dopamine network, signaling that “what comes next is important” and relieving boredom. The endorphin network is activated when our needs are addressed, suppressing pain, and generating satisfaction. In addicts, this network is underdeveloped, and so emotional pain runs unchecked. Under these conditions, the expectation system in the prefrontal cortex is tuned for suffering, and so allows the expression of impulses that seek restlessly to change the addict’s condition. Unfortunately, compliance with treatment orders is a casualty.

Laboratory studies of mammals validate these theoretical observations. Fortunately, these studies demonstrate not only that deprivation distorts the mind, but that satisfaction of basic needs allows the mind to not just recover but also strengthen.

It is upon these insights that Maté builds his critique of the War on Drugs. Motivating by a moralizing perspective that addicts are irremediably corrupt, the social policies that target addicts reject them as human refuse. Their attempts to escape emotional pain through self-medication expose them a society dominated by exploitative criminals. The damage to their minds is aggravated, rather than relieved. And that psychological harm eventually extends to medical conditions such as hepatitis, sepsis, and sexual disease.

As Maté documents, what works is decriminalization of use under medical supervision. Distribution would remain illegal, but addicts would take clean drugs using clean equipment. Check-in presents an opportunity for evaluation of other medical or social needs. Where adopted, these policies are less costly, preserve family and professional engagement, and lead more rapidly to recovery.

The single largest impediment to their adoption, unfortunately, is pressure mounted by the US government against anything other than “abstinence only” recovery programs. That those programs fund for-profit incarceration programs and disenfranchise minority voters is not lost on the sophisticated critic.

Maté concludes his book with a review of therapies for addictive behaviors. He explicitly recognizes mindfulness practices, but also seems to align with cognitive behavioral strategies that condition the mind to say “no” to self-abusive thoughts.

I sympathize strongly with Maté’s sociology, and greatly benefited from reading this book. However, there is a single effect in the psychology of mental balance that he overlooks, and this effect is the foundation of my therapies. The prefrontal cortex has two capacities in the regulation of impulse and emotion: to say “no” to harmful thoughts and behaviors, and to say “yes” to harmonious thoughts and behaviors. In the chaos of disrupted childhoods, harmony cannot be sustained, and so the prefrontal cortex leans into “no.” The addict suffers because to continuously say “no” leads inexorably to self-destruction.

From this, I hold that the most powerful therapies guide the mind into harmony and encourage the prefrontal cortex to say “yes” to that experience. When communicated in trance and followed by dream therapy that stimulates rewiring of the brain during the deepest states of sleep, this strategy leads directly to behaviors that our intimates receive gratefully. The “yes” inside becomes “yes” outside.

I highly recommend Maté’s wonderful treatise. Its insights will be of benefit to all those hoping to see humanity freed from the consequences of our personal, social, and institutional addiction to “no.”