Q & A with Dr. Mate

On October 18, 2012, the Wellington Guelph Drug Strategy and partners held the Changing Futures Prevention Summit, a day uniting community members with national and international experts to discuss evidence-based approaches and practices to substance misuse prevention and mental health promotion with children and youth.Following the Summit, Dr. Gabor Maté offered to personally respond to additional question from our community to address the technical issues experienced on that day.Here are the questions and Dr. Maté’s answers:
 
WGDS:
In the Realm of Hungry Ghosts references several pieces of research regarding the impacts of exposure to prenatal stress, and recommends that one of the most effective prevention strategies should be instituted in primary care offices (family physician, obstetrician, midwives).
As we are working on developing a Community Prevention Plan in Guelph Wellington, do you have any advice or strategies to engage the primary care field in first acknowledging and understanding this role, and secondly, in taking action on a collective level to work preventatively with mothers who are expecting?
 
Dr. Mate: 
Prenatal visits should include not only a physical examination and testing, but also a conversational inventory about potential stressors in the expectant mother’s life: relationship issues, financial worries, etc.
Expectant women could be taught stress reduction techniques, including meditation, musical rest.
Risk factors such as a history of childhood abuse or trauma in the mom’s life could be identified and counselling offered. 
 
After your extensive research and work in the field of addictions, what do you see as the single most important thing a community should collectively work on to prevent or reduce the impacts of substance misuse?
 
Prevention: identifying families at risk, compassionately supporting young parents with risk factors.
Reducing impact: this is too broad a question to answer in a few words. The best advice I can give on this is in my book, In The Realm of Hungry Ghosts: patient, non-judgmental treatment; harm reduction modalities; public education to reduce stigma; understanding and treatment concurrent mental health issues; expecting relapses and taking them in stride, without punishing attitudes.
 
Recognizing that there are many variables that influence the development of addictions, you share very research-informed perspectives on the influences of trauma, early childhood stress exposure and an absence of attachment as being key contributing factors.
How are addictions explained in the context of “healthy,” “functional” families, where we might see one sibling strongly affected, where no other family members seeming to struggle with addictive issues?
 
What are often seen as “healthy and functional” families may harbour stresses and pressures and multi-generational dynamics that can be difficult for some children. No two children have the same family life or same experience of the parents. Parents respond differently to each child and, one child may be more sensitive than another.  The more sensitive the child, the more they are affected by stress—even by the same stress.
Also, one child may have had more protective relationships in their lives than another child in the same family.
Finally, addiction is only one way of coping—another child might compensate to the same stressors by being “extra good,” for example. They, too, will pay a price later, but it will look different in each case.
 
Similar to the question above, please help to explain the following situation:
Two young people experiment with crystal meth.  One goes on to use occasionally over the course of the year, only when influenced by peers.  The other is almost instantly gripped by addiction to the drug, and engages in chronic use for several years following.
 
One kid may have ADHD and find the stimulant a way of calming or focusing or motivating themselves, the other may not.  One kid may have been traumatized and finds some escape in the drug experience, the other may not need that. 
 
What advice do you have for those working with the more vulnerable populations in our community – to inspire hope, compassionately support their clients in their recovery processes and at the same time, ensure their own self care?
 
The way to compassionately support others is to deal with our own stuff, so that we don’t project our judgments and self-rejection on to them. To be mindful and aware of ourselves, and to be kind to ourselves.
As to self-care, I would urge people interested in this subject to read my book, When the Body Says No. We have to be able to say no; otherwise our “yes” becomes meaningless. We have to have compassion for others without making their problems our own.
 
Is there any particular treatment approach or modality that you have found to be “most effective” when working with individuals struggling with addictions?
 
There are many modalities. The key, always, is compassion: understanding that addiction is nobody’s choice, that addiction is not the fundamental problem, but a person’s attempt to SOLVE a problem: that of pain and suffering, based on emotional loss or trauma.
So we don’t judge people and we don’t just focus on their behaviours, but on their internal experience of themselves. We ask, what problem is the addiction attempting to soothe in your life, and how else might we approach that problem.
 
What are the potential impacts of attachment, trauma and separation on infants who are removed from their biological mothers at birth and adopted?  Has this been researched to demonstrate any heightened addiction issues in the adoptee?
 
Adopted children are at greater risk for suicide, depression, addiction etc because:
A. They experienced stress in utero, since – by definition – any woman planning to give up a baby is stressed (a single mom, a poor mom, a teenage mom, an abused mom) and,
B. There is an implicit, emotional memory of abandonment owing to the separation from the birth mother. 
I discuss this in In the Realm of Hungy Ghosts and in Scattered Minds.
 
Do you have any perspectives on Drug Treatment Courts and their efficacy?
 
Drug Treatment Courts can be, and have been, very effective for a selected population. They cannot function as THE answer to the issue of addiction, but they can be most helpful for some. Suggest you check out, for example, the Edmonton experience:
http://www.edtcrc.ca/pages/home/default.aspx
 
Many individuals with addiction issues have also been the victims of sexual abuse- seemingly to a much greater degree than any other form of abuse.  Acknowledging the harms/trauma of all abuse, is there a reason for the over-representation of sexual abuse specifically?
 
Sexual abuse is the ultimate abuse, in that a person’s humanity is completely disregarded and trampled on. In the mind of the abuser and, finally, in her or his own mind, the young child suffering sexual abuse ceases to exist as a separate human being and becomes, instead, nothing but an object, a tool for someone else’s momentary gratification.
It’s the ultimate objectification where the person’s own feelings, preferences, body sensations are completely disregarded. And, they are made to feel responsible for their own suffering, destroying any sense of self worth.