One of the things I have become increasingly interested in through my Professional Addiction Studies at McMaster University is what happens when we stop looking only at the substance someone is using and begin looking at the person who is using it. This is one reason the work of Canadian physician and author Dr. Gabor Maté has stood out to me. Maté is widely read and discussed in the field of addiction, and his work has also been a recurring part of my studies through McMaster’s Professional Addiction Studies program. Having encountered his ideas throughout my coursework, I wanted to look more closely at the way he asks us to think about trauma, addiction and the person behind the behaviour. When someone continues drinking even though alcohol is creating problems in their life, returns to cannabis after deciding they want to stop, or continues using another substance despite understanding the consequences, it is easy to focus entirely on the behaviour. We ask why they keep doing it, why they cannot simply stop, or why someone would continue something they know is hurting them. Maté asks us to look underneath those questions. His work on addiction places considerable emphasis on childhood adversity, emotional pain, stress and the ways people adapt to their experiences, rather than viewing addiction only as a problem involving the substance itself (Maté, 2012). For me, this does not minimize the consequences of addiction or remove personal responsibility. It gives us more information about what we are trying to understand. I often think of it this way: you can’t just fan the smoke. At some point, you have to put out the fire. If we focus only on the behaviour without becoming curious about what has been feeding it underneath, we may be seeing only part of the picture.
BEFORE IT BECAME A PROBLEM, IT MAY HAVE BEEN A SOLUTION
One of the strongest ideas I have taken from studying Maté is the importance of asking what an addictive behaviour may have been doing for the person before it became something they desperately wanted to change. Maté’s writing places addiction within a much larger story involving stress, emotional pain, childhood experience and the biological systems involved in attachment, motivation, reward and self-regulation (Maté, 2012). Alcohol might initially make social situations easier for someone who feels anxious or self-conscious. Cannabis might become associated with quieting an anxious mind at night. Another substance might provide energy, confidence, pleasure, connection or temporary distance from emotional pain. Before we look only at what the substance eventually took away, I think it is worth asking what it originally gave. This is one of the reasons I have become increasingly uncomfortable with explanations of addiction that begin and end with the idea that someone should make a better choice. A person can understand that something is harming them and still struggle tremendously to change it. If a behaviour has repeatedly provided relief, protection, pleasure or escape, giving up the substance may also mean giving up something the person has come to rely upon. Eventually, the role the substance plays in a person’s life can change. Something that initially seemed to help may begin creating problems of its own. What once provided relief may eventually contribute to distress, and what once felt freeing may begin to feel increasingly restrictive. What matters then is recognizing when the solution has stopped solving the original problem and has started creating new ones.
MATÉ’S BROADER UNDERSTANDING OF TRAUMA
One area of Maté’s work that interested me most during my studies was his discussion of trauma because he asks us to think about it more broadly than simply identifying what trauma is.There is the trauma most of us immediately recognize, including abuse, violence, abandonment and other experiences that should never have happened. Maté also discusses what is often called developmental trauma, where the issue is not necessarily a terrible event but the absence of important experiences and emotional needs that should have been present (Traumatology Institute, 2016). This was one of those ideas that made me stop and think.A person may look back and sincerely say, “Nothing terrible happened to me. I had a good childhood,” and that may be true. At the same time, other questions are worth considering. Did they generally feel emotionally safe? Was comfort available when they were distressed? Were they able to express sadness, fear or anger? Did they feel seen and understood? Was there consistent affection and emotional connection? This is not about blaming parents. A parent can deeply love a child while also dealing with depression, grief, financial pressure, trauma, illness, relationship difficulties or countless other circumstances that affect emotional availability. No parent provides a perfect childhood, and an imperfect childhood does not automatically lead to addiction. What stayed with me from Maté’s discussion is that understanding what shaped a person sometimes means looking not only at what happened, but also at what they needed and perhaps did not consistently receive.
TRAUMA, ADAPTATION AND DISCONNECTION
Another important part of Maté’s thinking involves disconnection. His broader work also describes disconnection from the self as one way people can adapt to suffering (Traumatology Institute, 2016). Many examples show how a child can begin disconnecting from parts of themselves while also adapting to what is happening to them. A young child does not consciously decide that vulnerability is unsafe or that some people should suppress certain emotions. Patterns can develop through experience. If expressing anger repeatedly creates conflict, someone may learn to push anger down. If showing vulnerability results in rejection or hurt, they may become reluctant to show it. If emotional needs repeatedly go unanswered, they may gradually learn not to expect those needs to be met. Adaptation and disconnection go hand in hand. Adaptation can be like a superpower when we are children. It helps us adjust, protect ourselves, and survive. The problem is that what once protected us in childhood and what started as a type of superpower can become our kryptonite in adulthood. When we bring addiction into that conversation, another question appears. If alcohol, cannabis or another substance later provides relief, confidence, connection, numbness or temporary escape, what role has that substance begun to play in the person’s life? I sometimes think about this by asking: if this behaviour had a job, what has it been trying to do? There will not be one answer that applies to everyone, which is exactly why I do not think there is one simple explanation for addiction.
CHILDHOOD EXPERIENCE, STRESS AND THE DEVELOPING BRAIN
Another important part of Maté’s thinking involves disconnection. His broader work also describes disconnection from the self as one way people can adapt to suffering (Traumatology Institute, 2016). Many examples show how a child can begin disconnecting from parts of themselves while also adapting to what is happening to them. A young child does not consciously decide that vulnerability is unsafe or that some people should suppress certain emotions. Patterns can develop through experience. If expressing anger repeatedly creates conflict, someone may learn to push anger down. If showing vulnerability results in rejection or hurt, they may become reluctant to show it. If emotional needs repeatedly go unanswered, they may gradually learn not to expect those needs to be met. Adaptation and disconnection go hand in hand. Adaptation can be like a superpower when we are children. It helps us adjust, protect ourselves, and survive. The problem is that what once protected us in childhood and what started as a type of superpower can become our kryptonite in adulthood. When we bring addiction into that conversation, another question appears. If alcohol, cannabis or another substance later provides relief, confidence, connection, numbness or temporary escape, what role has that substance begun to play in the person’s life? I sometimes think about this by asking: if this behaviour had a job, what has it been trying to do? There will not be one answer that applies to everyone, which is exactly why I do not think there is one simple explanation for addiction.
WHEN RELIEF BECOMES IMPORTANT
Another part of Maté’s work that resonates with me is the attention he gives to pain and relief. When we focus only on the substance, we may miss what using it changes for the person. For someone living with anxiety, alcohol might temporarily reduce tension. For someone whose mind will not quiet at night, cannabis might become associated with sleep. For someone who feels socially inadequate, a substance might provide temporary confidence or connection. For someone carrying emotional pain, intoxication might provide a temporary break from having to feel it. The examples will differ from person to person, but the underlying question remains useful: what changes for this person when they use? This also connects with what we know about learning and reinforcement. Behaviours that produce rewarding experiences or remove unpleasant ones are more likely to be repeated. Over time, emotional states, environments, people and routines can become connected with substance use and the expectation of relief. For someone who has lived with distress for years, relief itself can become an incredibly powerful reward. This helps explain why knowing the consequences does not automatically make an urge disappear. If alcohol has become someone’s answer to anxiety, taking away the alcohol still leaves the anxiety. If cannabis has become part of how someone sleeps, removing cannabis still leaves the question of how they will manage sleep. If substance use has provided belonging or connection, stopping the substance does not automatically replace the connection.
FOLLOWING A FAMILIAR FEELING
Another part of Maté’s teaching that caught my attention was his curiosity about feelings and where they may have appeared before. Sometimes something happens in the present, and a person suddenly feels insignificant, rejected, powerless, unsafe or small. The current situation is real, but the intensity or familiarity of the feeling can make it worth asking whether that emotional experience has a history. When have I felt something similar before? How far back does that feeling seem to go? What comes to mind when I allow myself to stay curious about it rather than immediately trying to explain it away? I found this part of Maté’s thought process fascinating because it reminds us that the current situation is not always the entire story. Sometimes a present experience touches an emotional pattern that has existed for much longer. That does not mean every uncomfortable feeling has a hidden traumatic origin, and it does not mean searching for memories or constructing an explanation that is not there. It means allowing curiosity to replace the assumption that the present moment exists entirely on its own.
FEELINGS, BELIEFS AND THE BODY
Maté’s discussion also made me think more carefully about the difference between an emotion and a belief about ourselves.Someone might say, “I feel unworthy,” but unworthiness is not an emotion in the same sense as fear, sadness or anger. It is a belief about oneself, although powerful emotions and physical sensations may accompany that belief. Anxiety might involve a racing heart, tightness in the chest, sweating, muscle tension, changes in breathing or sensations in the stomach. Sometimes those physical responses are noticeable before someone has consciously identified what they are thinking or feeling. Rather than deciding what those sensations mean, it can be helpful to become curious about them. What am I noticing in my body? What emotion seems to accompany it? Does this experience feel familiar? This does not mean that every bodily sensation represents trauma. It means our emotional lives aren’t experienced through thoughts alone, and sometimes paying attention to thoughts, feelings, and physical responses together gives us a fuller picture.
UNDERSTANDING DOES NOT MEAN EXCUSING
One concern that sometimes arises when addiction is discussed through trauma, adversity and emotional pain is that understanding the reasons behind a behaviour somehow removes accountability. I do not see those things as opposites. A person can recognize that alcohol helped them cope during a difficult period while also acknowledging that drinking is hurting them now. Someone can understand why cannabis became important while also recognizing that it is now creating problems. We can have compassion for why a pattern developed while still taking responsibility for what happens next. Understanding the purpose of a behaviour does not excuse its consequences. It gives us a meaningful place to start when we consider why changing it may be difficult. Instead of spending all our energy asking what is wrong with me, we can begin by asking what happened to me, what has the behaviour has been providing, and what is needed now.
WHAT STUDYING MATÉ HAS ADDED TO MY UNDERSTANDING OF ADDICTION
Perhaps the part of Maté’s work that has stayed with me most is the reminder that there is always a person behind the behaviour. A story exists before addiction. There were experiences, relationships, strengths, vulnerabilities and ways of coping before the substance became something the person wanted to change. The more I study addiction, the less interested I become in finding one explanation for why it develops. There is no single road into addiction because there is no single explanation for why it develops. Biology, genetics, psychology, early experience, stress, relationships, learning, environment, culture, social connection and the properties of the substance itself can all be part of the picture. Maté’s work doesn’t need to explain every part of addiction to contribute meaningfully to that conversation. What I find particularly valuable is the developmental and human perspective he brings. His work continually brings us back to the person and asks us to consider what happened before the behaviour we now see (Maté, 2012).
THE PART THAT GIVES ME HOPE
Whenever we discuss childhood adversity and the developing brain, we need to be careful not to leave people believing that their future was decided before they were old enough to have any say in it. Early experiences matter, but they are not the only experiences we will ever have. People keep learning and adapting throughout life. Long-standing patterns do not disappear simply because we understand where they came from, and change is rarely as simple as deciding to think differently. However, we can learn and practise different responses; relationships can offer new experiences, and people can develop other ways to find connection, comfort, and relief. Our history matters, and understanding it may help make sense of patterns that once seemed confusing, but our history does not have to become our identity or dictate every response we have for the rest of our lives. Maté’s work does not provide a single explanation for addiction, nor should it. What it does particularly well is remind us not to lose sight of the human being while we are trying to understand the behaviour. And I end here with a comment I made earlier about the difference between fanning the smoke and putting out the fire. Maté’s work reminds us that when we look beyond the behaviour, we begin to understand that trauma and addiction are rarely about one thing. By looking more deeply at what is driving the addiction and addressing the pain and experiences beneath it, we have an opportunity to put out the fire where it needs to be put out, rather than continuing to fan the smoke.
ABOUT THE AUTHOR
Shannon Shade, RCH, is a Registered & Accredited Clinical Hypnotherapist and Behavioural Change Specialist based in Calgary, Alberta. Her practice focuses on trauma, addiction and the patterns that often develop around stress, emotional pain and coping. She is currently completing Professional Addiction Studies through McMaster University and has additional education in trauma-informed care, harm reduction, peer support and addiction-related practice. Shannon works with adults in Calgary and online.
REFERENCES
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Maté, G. (2012). Addiction: Childhood trauma, stress and the biology of addiction. Journal of Restorative Medicine, 1(1), 56–63. https://doi.org/10.14200/jrm.2012.1.1005
Traumatology Institute. (2016, February 17). Dr. Gabor Mate on growth, trauma & addiction [Video] YouTube.