Gabor Maté - Addictions & Corrections

I'm pleased to be on the panel with someone from the correctional service I'll provocatively state however that i'll be looking forward to find out What it is that the correctional service actually corrects... In my view very little and I completely agree the justice system is completely criminal and it should be studied, that way So what do we see when we look at addictions? Many of the addicts in the downtown east side, the ones that the police spend their time chasing in the streets are actually people who suffer from sever post traumatic stress disorder People self medicate depression Prozac is intended to increase the levels of Seratonin Cocaine also elevates Seratonin level People use Cocaine to self medicate depression What Dexadrine does, or Ritalin, is it elevates the level of Dopamine It actually calms down the hyperactive brain What does Cocaine do? What does Nicotine do? Or Crystal Meth, or Caffiene? It elevates Dopamine levels People self medicate ADHD. A good 30%of people in jail in this country suffer from ADHD. Thats why they're there! I mean, you do a brain scan on people who are experiencing a moment of emotional rejection... The same part of the brain will light up as if you stuck them with a knife So the first question is not: Why the addiction? But why the pain? You wanna know why the pain? I don't have a single female patient on the downtown east side who wasn't sexually abused as a child. Thats why the pain. Because all the addiction substances are actually pain relievers. Cocaine is a local anasctetic The men were also abused If not sexually, then physically, and emotionally and abandoned, and neglected. The child has got very limited means of surviving the trauma. One way to survive it is to deaden his emotions because otherwise they are too overwhelming he can't live with that much pain. Essentially what we're doing in this country, with our so called justice system, is we're punishing people and jailing them for having been abused in the first place. And this is what the canadian government is now spending 10 billion dollars on. Building more jails, for these people. While they're starving the social system of support For kids with learning disabilities, kids with family problems, kids with behavior problems. Those services are being cut in the name of economic... what? But why do we have receptors for a derivative of a poppy plant? Well of course the answer is we don't. We have receptors for our own opiates And theres a term for that Our own opiates are called endorphins Why do we have that? First of all, they're pain relievers, Physical and emotional pain relievers. You have to have pain in this life Pain is an important warning You also have to have some internal pain relief Because too much pain is unbearbale Number two, opiates are the reward and pleasure chemicals So when you have an esctatic, gleeful an orgasmic experience, whether physical or emotional, you have opiates. Now thats important for human life Because without pleasure and reward Life becomes, as you can imagine, rather difficult. The third function of opiates is also the most important one It can be summed up in one word: Love Without opiates there's no experience of connection, attachement, and love. Now thats not a luxury In fact love is a basic emotion without which life is impossible. Love is a basic emotion without which life is impossible. Now I want you to consider the following question: If a human being comes the the conclusion, That without this particular substance, He or she will have no experience of pain relief, pleasure and reward, love and connection, Just exactly how are you going to take that away from them? By putting up a billboard saying 'just say no'? Same with the Dopamine system It's essential in motivation and incentive So Dopamine flows whenever you're seeking food, seeking a sexual parter, exploring a novel environment Food seeking will increase your dopanime levels by 50%, sex by 100%, a shot of cocaine by 300%, and crystal meth by 1200% Imagine a kid then who comes to the intuitive conclusion that without that chemical, he has no experience of vitality, curiosity, aliveness, motivation and incentive. how are you gonna take that away from him? by putting him in jail? by punishing him? There are a number of brain circuits involved in addiction Impulse control is the capacity not to act on an impulse When you do brain scans on drug addicts, that's not functioning well So you're looking at people's brains that are actually not capable relatively speaking, of withstanding the impulse. Because along with the many myths around addiction, one of them is that durgs are addictive! Well clearly, that's ridiculous Most of you can go into a hospital and be given large quantities of morphine If you need it, and once the problem is dealt with, you're off the morphine and you barely even suffer withdrawal Nicotine, food, sex, gambling, shopping, None of these are inherently addictive. In other words the addiction doesn't happen because of the substance So the whole emphasis of the legal apparatus on interdicting the substance Is completely beside the point The real issue that I'm raising here is what makes somebody succeptible Turns out that the human brain, for the most part, develops under the impact of the environment. The persons stress response... It's when people are stressed that they go off and do something harmful to themselves, like eat too much, or do a drug. The stress regulation mechanism of the childs brain is actually programmed Because the dopamine receptors of the brain depend on the emotional states of the mother during pregnancy, and early in life. The neccessary condition for the development is the presense of non stressed, non depressed, emotionally available, parenting caregivers. Which is precisely what the addict never had. What's adverse childhood experience? Physical, sexual, or emotional abuse, death of a parent, a rancorous divorce, violence in the family, addiction in the family, a parent being jailed, for each of these adverse childhood experiences, the risk of addiction in the adult goes up exponentially. So that by the time a male child has had six of these adverse childhood experiences, his risk of becoming a substance dependant addict is 4600% greater. That's a 46 fold increase Based on childhood adversity These are then the people who's brains are susceptible who are lacking these systems when they develop when they meet a substance... (sighs) It's the answer to their life's prayer One sex trade worker She said, "The first time i did heroin it felt like a warm soft hug" and that's exactly what it was It follows therefore that choice has nothing to do with it It's all based on early experience Genes have nothing to do with it I shouldn't say nothing There are genes that predispose to certain behaviors predispose though is not the same as predetermine See the media love these genetic stories So as soon as somebody discovers the 'alcoholism gene' It goes on the cover of time magazine Three years later it turns out that nobody dicovered anything of the sort that goes in some back little article and the violence genes! Kids who are more violent are more likely to have a certain genetic variant But it turns out if these kids are brought up in families without violence or abuse, they're less likely to be violent then others So it takes a combination of abuse and that gene to create the violence Same with addiction The genes don't determine... In fact there's a whole science called 'Epigenetics' The influnces tha override genetics are far mroe important that what the genes say themselves So the genetic argument, and the choice argument, are simply cop outs from... that prevent us from looking at what actually happens nothing genetic about it There were addictive substances in north america prior to the coming of the caucasians Peyote, there was Tobacco, there were even Alcoholic spirits There was no addiction After that massive dislocation, the historical horror that befell the aboriginals in north america, that's when addiction becomes their response to all the pain. So when i go to Native communities now, the trauma now is entrenched in the generations It's passed on multi-generationally ..are destroyed when their lands are taken away, when their movement is restricted, and then on top of that when they experience generations of sexual abuse, in the Christian run residential homes... In Thunder Bay there was a woman there from a reserve nearby, she said that on her reservation there were 188 people, 133 are addicted. and it's simply a legacy of what happened to them and what continues to happen to them Again the assumption when it comes to addictions is that these people have to hit rock bottom, they have to be punished, and so on and then they'll see the light No they don't. What's rock bottom for sombody who lives in the downtown east side? with hiv, having lost everything? What's the rock bottom that they're gonna have to hit? People don't need rock bottom, they need the very opposite They have to have some confidence, some hope of victory Victory is when you're treated like a human being, when you can look upon yourself with some compassion when you realize that despite all thats happened to you, and despite all that you've done, you're still a worthwhile human being That's not the kind of victory our system gives people The politicians thrive from creating enemies out of the most abused sections of the population They thrive on creating fear of them When you marginalize in our society criminalize people, impoverish them, you are simply making sure that they're gonna stay addicted For the most part, the system is almost designed to keep people entrenched in misery We're busy building jails! We have to get our priorities straight, right? The british government cut programs for addicted youth in the north (sighs) but it's got money to support olympic athletes Now you tell me what our priorities are Look the use of psychoactive drugs has increased exponentially, in the last several decades, including with children In the states right now there are 3 million kids on stimulant medications for ADHD There are a half million kids on heavy duty anti-psychotics Not because they're psychotic, but because we don't know how to control their behavior because their environment has become so toxic for them that they simply are acting out all the time There's a so called 'biological psychiatry' these days Giving drugs to change people biology But the understanding that the human psychology, The interpersonal neurobiology that our.. that the neurobiology, the biology of our nervous system depends largely on our relationsips Thats completely ignored in medical practice That's the reality When you ask me how to change that I have no idea! I mean, I can talk till I'm blue in the face I'm not pessimistic about it in the long term I think at some point sanity will prevail but the short term outcome, is very dismal as far as I'm concerned When you look at the suicide rate The school drop out rate, the incarceration rate and our coutnry is spending 11 billion dollars in jails What's needed first of all is a massive shift of attitude We spend i don't know how many billions on supposedly bringing freedom, and justice, and education, to the Afghanis oh what a joke In other words it would take a massive reorientation of priorities, and a massive commitment to be a bit humble, and honest about what we're doing and what we've done We haven't even begun to address that My message is not to wait for the government to do any of that Cause it ain't going to happen anytime soon They're going to have to confront the abuse in their own communities you know.. without shame, without self blame, but they're gonna have to confront it Because without confronting the abuse question They're never gonna confront the addiction question either That's the first step If we had that shift of perspective I think the possibilities would be infinite Would be infinite Be infinite Infinite Infinite