AMY GOODMAN: The Obama administration's budget proposal for the Office of National Drug Control Policy sets aside nearly twice the amount of funding for law enforcement and criminalization than for treatment and prevention of drug addiction. Out of a total of $15.5 billion, some $10 billion are used for enforcement. National Drug Control Policy Gil Kerlikowske praised the numbers as reflecting a "balanced and comprehensive drug strategy."
Well, just last year, the newly appointed drug czar and former Seattle police chief had called for an end to the so-called "war on drugs," raising hopes among advocates of harm-reduction approaches to curbing drug use. In an interview with the Wall Street Journal last May, Kerlikowske said, "People see a war as a war on them. We're not at war with people in this country."
Well, I'm joined right now here in the Democracy Now! studio by a doctor who has spent the last twelve years working with one of the densest populations of drug addicts in the world. Dr. Gabor Maté is the staff physician at the Portland Hotel, a residence and harm reduction facility in Vancouver, Canada's Downtown Eastside. Dr. Maté also treats addicts at the only safe-injection site in North America, a center that's come under fire from Canada's Conservative government led by Stephen Harper.
Dr. Gabor Maté is the bestselling author of four books. His latest, just out in the United States, is called In the Realm of Hungry Ghosts: Close Encounters with Addiction.
Obama's failure to deliver "change we can believe in" on the drug war front is more than just another routine disappointment, given what a spectacular failure the "war on drugs" has been. But by now it should be perfectly clear that only social and political movements will bring about actual change we can believe in, as opposed to the logo-ized kind. And a crucial component of movement-building is information-sharing. So below, there's a few high-points of this interview, and what Dr. Maté is up to.
But first, a sidelight. The story of how Vancouver came to have a safe injection site is a very interesting one, and it's woven into the CBC tv series, Da Vinci's Inquest, which ran from 1998 to 2005 in Canada, and now runs in syndication in various places in the US. It's a damn good show. The main character is based on Larry W. Campbell,, the former Chief Coronor, and former Mayor of Vancouver, British Columbia, who was chiefly responsible for establishing the safe injection site. The series also had a recurring character, a young female addict, whom I was repeatedly reminded of while listening to the segment on Democracy Now. And now, back to reality:
First is the basics about the existence and functioning of the safe-injection site as a harm-reduction strategy:
AMY GOODMAN: Now, what do you mean, the only safe-injection site, the only legal injection site in North America? People inject heroin there?
DR. GABOR MATÉ: People are allowed to bring their drugs there. We don't provide them with their drugs. I think we should, but we don't. But they bring it in, and without fear of being arrested, they're allowed to inject, under supervision. And the staff, without being fear arrested, are allowed to help them inject in a safe way, give them clean needles, sterile swabs, and resuscitate them if they overdose. So, everywhere else in Canada or in the States, of course, these activities would all be illegal.
AMY GOODMAN: Why are they allowed to do this?
DR. GABOR MATÉ: Well, it was conceived in a moment of political openness, because so many people pass on infections, like HIV and hepatitis C, to one another through injection use, sharing needles. They infect themselves with bacteria from their skin by using dirty water. So it's a harm reduction measure that, in many studies, have been shown to reduce the burden of disease and also the economic costs attendant to addiction to society.
AMY GOODMAN: And do you find that addicts can actually heal themselves or perhaps be able to get off heroin more easily by injecting there?
DR. GABOR MATÉ: Well, the facility is not designed to treat addiction, per se; it's designed to reduce the harm from it. It's a harm reduction measure. What we do find, though, is that we have a detox facility on the second floor, which is where I've been working, and people come from the injection facility to detox, because they've been into- brought into contact with compassionate caregivers perhaps for the first time in their lives. These people all had very tough lives. And so, for them to even contemplate receiving help takes a lot of trust.
Reflecting back on hearing this segment, it's remarkable to hear someone talking so calmly and sensibly about drugs, when the norm is to be at least mildly hysterical. IMHO, it's the undertone of hysteria, more than anything else, that keeps the drug war going. Once you start talking about it without hysteria, it's impossible to ignore how crazy the whole thing is. Why wouldn't you want to help addicts be as healthy as possible? How could it possibly make things better to have more sick people in the world? Like I said, crazy.
But something more, as well, which is revealed in the next interchange, discussing the nature of hardcore addicts, who are almost uniformly the product of childhood abuse:
AMY GOODMAN: Talk about the people you treat.
DR. GABOR MATÉ: Well, the hardcore drug addicts that I treat, but according to all studies in the States, as well, are, without exception, people who have had extraordinarily difficult lives. And the commonality is childhood abuse. In other words, these people all enter life under extremely adverse circumstances. Not only did they not get what they need for healthy development, they actually got negative circumstances of neglect. I don't have a single female patient in the Downtown Eastside who wasn't sexually abused, for example, as were many of the men, or abused, neglected and abandoned serially, over and over again.
And that's what sets up the brain biology of addiction. In other words, the addiction is related both psychologically, in terms of emotional pain relief, and neurobiological development to early adversity.
There was a bit of an aha! moment when I heard this. Not so much about the addicts-it's not that surprising when you think about it-but about why people can't think straight about addicts and addiction. It's simple, really: addicts are walking reminders of our own intense vulnerability. The childhood abuse that marked them for addiction could have happened to any of us. And we don't want to think about that-or worse yet, experience that vulnerability subliminally, terrified by it without knowing why-not for a single second. That's why it's so hard for most people to even think about addiction for a moment or two without starting to go a little crazy themselves. It sucks into the fantasy of childhood horror that addicts actually experienced first hand-and we don't even know that it's happening... we just feel it, and it to go away-immediately.
Next, the title of the book is explained-and with it, a bridge is formed:
AMY GOODMAN: What does the title of your book mean, In the Realm of Hungry Ghosts?
DR. GABOR MATÉ: Well, it's a Buddhist phrase. In the Buddhists' psychology, there are a number of realms that human beings cycle through, all of us. One is the human realm, which is our ordinary selves. The hell realm is that of unbearable rage, fear, you know, these emotions that are difficult to handle. The animal realm is our instincts and our id and our passions.
Now, the hungry ghost realm, the creatures in it are depicted as people with large empty bellies, small mouths and scrawny thin necks. They can never get enough satisfaction. They can never fill their bellies. They're always hungry, always empty, always seeking it from the outside. That speaks to a part of us that I have and everybody in our society has, where we want satisfaction from the outside, where we're empty, where we want to be soothed by something in the short term, but we can never feel that or fulfill that insatiety from the outside. The addicts are in that realm all the time. Most of us are in that realm some of the time. And my point really is, is that there's no clear distinction between the identified addict and the rest of us. There's just a continuum in which we all may be found. They're on it, because they've suffered a lot more than most of us.
I really believe this is the key to getting sane about drug addiction-realizing that all of us have that experience of helpless, needy emptiness, to some degree, on a continuum. And that makes perfect sense as well. What makes us so sensitive to the fear and loathing that addiction triggers (whether we recognize it or not) is the fact that we, too, all of us, share something in common with the hard core addict, at the same time that we want to deny it more than anything in the world.
Now, of course, even if we're sane about it, drug addiction is a serious problem. But it's made far more serious by our profoundly counter-productive ways of dealing with it. If drugs weren't illegal, and therefore much more expensive than the cost of production warrants, there would be relatively little property crime associated with drug addiction. And organized crime as a whole would be significantly weakened. So getting sane about drug addiction would reap serious rewards right away-but it would still leave serious problems as well.
And to tackle those, we need further understanding:
AMY GOODMAN: Can you talk about the biology of addiction?
DR. GABOR MATÉ: For sure. You see, if you look at the brain circuits involved in addiction-and that's true whether it's a shopping addiction like mine or an addiction to opiates like the heroin addict-we're looking for endorphins in our brains. Endorphins are the brain's feel good, reward, pleasure and pain relief chemicals. They also happen to be the love chemicals that connect us to the universe and to one another.
Now, that circuitry in addicts doesn't function very well, as the circuitry of incentive and motivation, which involves the chemical dopamine, also doesn't function very well. Stimulant drugs like cocaine and crystal meth, nicotine and caffeine, all elevate dopamine levels in the brain, as does sexual acting out, as does extreme sports, as does workaholism and so on.
Now, the issue is, why do these circuits not work so well in some people, because the drugs in themselves are not surprisingly addictive. And what I mean by that is, is that most people who try most drugs never become addicted to them. And so, there has to be susceptibility there. And the susceptible people are the ones with these impaired brain circuits, and the impairment is caused by early adversity, rather than by genetics.
That's a key point there: "[M]ost people who try most drugs never become addicted to them." It's the exact opposite of the whole "refer madness" fantasy, which, when you get right down to it, is the underlying subtext of entire drug war. This fear-driven fantasy is utterly divorced from any sort of realist approach to problem solving. Realism brings us back to science and understanding things in a way that naturally opens up the possibility of fixing what is broken.
AMY GOODMAN: What do you mean, "early adversity"?
DR. GABOR MATÉ: Well, the human brain, unlike any other mammal, for the most part develops under the influence of the environment. And that's because, from the evolutionary point of view, we developed these large heads, large fore-brains, and to walk on two legs we have a narrow pelvis. That means-large head, narrow pelvis-we have to be born prematurely. Otherwise, we would never get born. The head already is the biggest part of the body. Now, the horse can run on the first day of life. Human beings aren't that developed for two years. That means much of our brain development, that in other animals occurs safely in the uterus, for us has to occur out there in the environment. And which circuits develop and which don't depend very much on environmental input. When people are mistreated, stressed or abused, their brains don't develop the way they ought to. It's that simple. And unfortunately, my profession, the medical profession, puts all the emphasis on genetics rather than on the environment, which, of course, is a simple explanation. It also takes everybody off the hook.
This is the last main underlying point: Identifying an experiential cause--as opposed to an immutable pre-determined one--makes the problem solvable. And since the addict is largely helpless, it's our problem to solve it for them--at least up to the point where they have the capacity to begin developing independent agency. Time enough, once they've escaped hard-core addiction, for them to turn around and help others. This is a prime example of how liberalism--a belief in human agency and capacity to remake the world, fundamentally differs from conservativism's belief in fixed natures, fixed hierarchies, fixed boundaries. When you think about it through this particular lens, it suddenly becomes clear that--quite contrary to what it claims, conservatism is away of evading responsibility:
AMY GOODMAN: What do you mean, it takes people off the hook?
DR. GABOR MATÉ: Well, if people's behaviors and dysfunctions are regulated, controlled and determined by genes, we don't have to look at child welfare policies, we don't have to look at the kind of support that we give to pregnant women, we don't have to look at the kind of non-support that we give to families, so that, you know, most children in North America now have to be away from their parents from an early age on because of economic considerations. And especially in the States, because of the welfare laws, women are forced to go find low-paying jobs far away from home, often single women, and not see their kids for most of the day. Under those conditions, kids' brains don't develop the way they need to.
And so, if it's all caused by genetics, we don't have to look at those social policies; we don't have to look at our politics that disadvantage certain minority groups, so cause them more stress, cause them more pain, in other words, more predisposition for addictions; we don't have to look at economic inequalities. If it's all genes, it's all-we're all innocent, and society doesn't have to take a hard look at its own attitudes and policies.
And once you do accept responsibility, you start to discover that, yes, you can solve problems that formally misconceived as insoluble:
AMY GOODMAN: Can you talk about this whole approach of criminalization versus harm reduction, how you think addicts should be treated, and how they are, in the United States and Canada?
DR. GABOR MATÉ: Well, the first point to get there is that if people who become severe addicts, as shown by all the studies, were for the most part abused children, then we realize that the war on drugs is actually waged against people that were abused from the moment they were born, or from an early age on. In other words, we're punishing people for having been abused. That's the first point.
The second point is, is that the research clearly shows that the biggest driver of addictive relapse and addictive behavior is actually stress. In North America right now, because of the economic crisis, a lot of people are eating junk food, because junk foods release endorphins and dopamine in the brain. So that stress drives addiction.
Now imagine a situation where we're trying to figure out how to help addicts. Would we come up with a system that stresses them to the max? Who would design a system that ostracizes, marginalizes, impoverishes and ensures the disease of the addict, and hope, through that system, to rehabilitate large numbers? It can't be done. In other words, the so-called "war on drugs," which, as the new drug czar points out, is a war on people, actually entrenches addiction deeply. Furthermore, it institutionalizes people in facilities where the care is very-there's no care. We call it a "correctional" system, but it doesn't correct anything. It's a punitive system. So people suffer more, and then they come out, and of course they're more entrenched in their addiction than they were when they went in.
And by the way, according to many studies, the easiest place to get drugs is in prisons-and in schools, by the way. These are the two areas where you can get drugs in North America: the schools and the prisons. So that it makes no sense from any point of view. It serves some people, perhaps, with entrenched interests, but it does not serve the addict, nor does it serve society.
And I could tell you something else about that. A patient of mine with a $50 cocaine habit a day, which is not excessive, how does he raise money to be able to afford those drugs? By shoplifting. To reach $50 a day, he has to shoplift $500 worth of goods. Who pays for that? The social cost is way beyond the cost of law enforcement.
Indeed. Sanity pays. It pays dividends to us all. But first we must face our own shadows. |
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