In the realm of hungry ghosts. Close encounters with addiction

OVERALL RATING Excellent

STRENGTHS Personal and patient stories interwoven with the neurophysiologic, philosophic, and sociopolitical edges of addiction

WEAKNESSES Continual shifting from sedating physiologic discussions to riveting clinical scenarios

AUDIENCE Physicians, addiction workers, and politicians

Gabor Maté works with heavily addicted patients in Vancouver’s Downtown Eastside. He “learned much” about himself from this authorship. He discovers his own addictive tendencies by defining addiction as a continuum that extends from the disheveled street person using injectable drugs—whom we might avoid on street corners—to the well-dressed, successful workaholic, like a physician, who is addicted to recognition, fame, and self-promotion. Addiction “arises near our emotional core,” and Maté holds up a stark mirror, challenging many “comfortable pew” perspectives.

The book begins with stories of patients who have spent their lives addicted to heroin, cocaine, and crystal methamphetamine. Maté outlines the neurobiology and physiology that inform these stories, from birth to struggling adulthood. The stories of abuse and neglect are also informed by a focused literature review, which examines dopamine deficiency, poor self-esteem, absent coping skills, and behavioural patterns extended from childhood. The author points out that drug abuse is a solitary coping mechanism to survive a life many would not otherwise be able to. Biologically low serotonin levels and undiagnosed attention deficit hyperactivity disorder leave addicts described in this book medically undertreated and socially outcast. The authenticity of the work comes from the author’s self-disclosure and his ongoing care of addiction patients.

The work shares and educates. Political and social realities and perspectives about addiction are explored. The reader learns there is no easy way to cope with this complex biological, medical, social, and spiritual situation. Many addicts might remain addicted for the rest of their lives. The challenge for caregivers is to understand the “addicted mind and to support healing.” Maté discusses treatment and harm reduction with some specifics, and references other treatments and resources. Like the patient, treatment is complex. “Addiction floods in where self knowledge and divine knowledge are missing… spiritual and psychological work both are necessary to reclaim our true nature.”

The book is an excellent scientific and personal read, and a solid starting point to developing an informed perspective on addiction.

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