Dr. Gabor Maté Part 2 of 3 Trauma & recovery across the lifespan: insight into addictions

[Music] so as mentioned I've worked for 12 years in Vancouver's Downtown Eastside with a population that's known in North America is the most concentrated densely populated area of addiction anywhere within a few square block radius we have thousands of drug users the open-air drug market in the streets the needles the injections in the back alleys and so on people still even now people find shocking towards it there so I worked there for 12 years including for two years I was mentioned at the supervised injection site now if if one success is a physician is to be measured by the longevity of his patients then you might say that I was quite a failure in my last 12 years as a doctor because my patients died young they died of HIV and it's complications of course especially since the drug use made their HIV treatment very sometimes quite intermittent they died a suicide of overdoses of complications of injection borne diseases absences of their brain spinal cords heart valves and so on so the second chapter of my book in a realm fire goes opens at a funeral home I won't read you much on the chapter except this is of a patient who was 35 her name is Shannon and she having stayed six months at a rehab home or several months at least something snaps she came back to the Downtown Eastside and within a couple of months was found dead of an overdose and after the funeral we meet in a parking lot I look at the small cluster of human beings gathered at the funeral of a comrade who met her death in her mid-30s how powerful the addiction I think that not all the physical disease and pain and style cortical torment can shake loose its lethal hold on their souls nothing sways them from their habit not illness not the sacrifice of our love and relationship not the loss of our earthly goods not the crushing of their dignity not the fear of dying the drive is that relentless how to understand the death grip of drug addiction what keeps penny injecting after the spinal separation that nearly made her paraplegic why can't Beverly give up shooting cocaine despite the HIV the recurring abscesses I've had to drain on her body and the joint infections that repeatedly put her in hospital what could have drawn Shannon back to the Downtown Eastside and her suicidal habit and her six months get away parish shrug off the deterrence of HIV and hepatitis a crippling born infection and the chronic burning piercing pain of exposed nerve endings going to an unhealing ulcer on her leg now the societal answer to that question as to what addiction is all about is basically that it's in it's a problem of choice people just choose to do drugs they choose to do drugs because they're ignorant because they're ethically flawed morally deficient or stupid but it's a choice to make if you think that something is a conscious thought choice that somebody makes then how you gonna stop them are you gonna stop them by deterring them how you deterring them by means of Pinet punishments so the Canadian government is dedicated to the draconian punishments of drug addicts as you know they just introduced laws that make it much tougher and drug addicts now for growing six marijuana plants just as just as Uruguay is not bringing legislation to a lot of people to go on their own marijuana and to tax it and to market it so Canada is making it increasingly punitive to possess drugs and if apparently according to new legislation if you're a party and you pass somebody a marijuana joint you can be accused of trafficking and the mandatory sentences for drug possession are going up and up and judges and prosecutors have less latitude now to plea-bargain on to or to exercise clemency the result of which that in a society that has less and less money for social services less than as money for culture less than less money to protect the environment we're spending billions of dollars on building more jails and keeping people in jail longer all because we think that addiction is a matter of choice now the other hypothesis when it comes to addictions is the more the disease model addictions this model would have it is the disease of the brain and as to when it comes to the causation of the disease what we're looking at is genetic causes so that alcoholism drug addiction and sore or nicotine addiction and so on these are largely determined by genes so this hypothesis would have it know that addiction is represent the disease of the brain is certainly valid you can show that on brain scans and all kinds of biochemical assays the addicted brain is a disease brain however the assumption that this is genetic and certainly that looking at it as a disease is more humane and and offers at least the imperative of treating people which the choice hypothesis does not but what the choice hypothesis and the genetic hypothesis do have in common is a powerful ideological comfort because if something is a matter of individual choice on the one hand or on the other hand it's because of some gene that they inherited then we don't have to look at social conditions we don't have to look at the social conditions that engender addictive behaviors we don't to look at how children are treated or not to look at what happens to pregnant women we don't have to look at what happened in this country to the Aboriginal population which is some of the world's highest rates of addiction this is despite the fact that there were substances in North America that potentially addictive before the coming of the Caucasians such as tobacco such as peyote such as psychedelic mushrooms such as other plants such as alcoholic spirits in some areas of North America but there was no history of addiction if these problems were purely genetic or matters of choice why was in their addiction before and yet now our First Nations population is dying at much higher rates than the rest of the population they're incarcerated much more in the downtown east side of Vancouver 30% of my clients were First Nations origin they only make up 20% in the Canadian population well if addiction is a choice or a genetic disease we don't have to look at any of that stuff so it's very very convenient which brings me to say about medicine that we think of medicine as a science and perhaps as an art yes it's both of those things but it's also an ideology and it's a way of looking at the world it's a way of understanding human beings and the ideology of modern medicine reflects the ideology of mainstream society and so that the the idea of separating people from their emotions from their bodies follows from the needs of a society that has to exploit people's physical labor without any care for their emotional states because in this society you can't care about people's emotional states because if you did you'd have to make very different economic decisions than you're making right now so you separate the two and similarly a society that celebrates individual enterprise and individual success at the expense of the others it's dog-eat-dog kind of mentality we can't be looking at people's social relationships and the necessary interconnection and the need for love so that that separation of mind-body and separation of environment psychosocial environment from the physiology of individuals is not a scientific perspective it's an ideological one it's an ideological that completely ignores the science that's the nature of ideology is that it doesn't let that the facts penetrate it doesn't let the facts penetrate because the facts would put threaten the order but only it it only admits those facts that doesn't threaten the ideology and those facts that would undermine or call into question the ideological perspectives are not they don't come into the equation at all they in the words of mr. Spock they just don't compute so there's a lot of realities in this world that in the minds of decision makers just don't compute now if we look at addictions more closely what do we see remember I talked about adaptations well when I was diagnosed with ADHD I was given dexedrine which elevated what does a dexedrine do by the way it elevates the level of dopamine in the brain dopamine making a sensual brain chemical particularly for incentive and motivation and I'll tell you more about dopamine in a little while what else elevates dopamine any stimulant does caffeine does crystal meth does cocaine does nicotine does and that means that if for some reason your brain is deficient of dopamine when you do caffeine nicotine cocaine or crystal meth you're gonna feel really good really alive really vital so that I know that in the Downtown Eastside probably thirty percent of my clients addicted to these stimulants actually ADHD in fact that we even tell you hey Doc you know I don't get it but most people when they do cocaine or crystal meth they get all hyper but me I calm down and I clean my room and what they're telling me on a gold platter is here's my diagnosis doc it's ADHD but they don't know that they're just self-medicating so addictions I'm submitting to you are in almost all cases self medications what else do people self medicate their self medicate depression if you've taken Prozac like I have for depression an SSRI serotonin selective serotonin uptake inhibitor elevates the level of this important brain chemical between the nerve cells elevates mood but you know what else blocks the uptake of serotonin cocaine does people use cocaine to self-medicate the depression people use alcohol to stuff medicate ADHD in one study 40% of male alcoholics were shaunt of ADHD it calms down the brain the hyperactive bein so does marijuana a lot of kids will tell you that I spoke part I can listen to the teacher better and they're they're telling truth because it caused on a vein now they can listen better what they'll remember is another story I'm not advocating cannabis as a treatment for ADHD but subjectively they do get some relief so in that sense it's a self medication people self medicate PTSD PTSD with what with the opiates the opiates are powerful modulators of the symptoms of PTSD now there was a study I've been maintaining this for years I mean I don't how to say this with a sigh entirely arrogant but everything I've been saying it needs to be proved by studies all the time it it happened this morning they looked at PTSD cases you know what predicted PTSD not the war and this is amongst veterans in Iraq and Afghanistan you know what predicted PTSD not what happened in the war we think that PTSD is because of what happened to war you know like roméo Dallaire the Canadian general has PTSD everybody thinks this PTSD happen because of what he witnessed in Rwanda now what predicts PTSD is trauma in childhood what what happens is that the and shot the Syndicates triggered by them what you what you experienced as an adult but if you're going to meet as a child you can go through this experience as an adult and not be traumatized at all so again we come back to what happened in your attachment relationships so people self medicate PTSD with the opiates people's medica self medicate anxiety of course with the drugs they medicate social social anxiety the guy who can't interact and feel confident socially without having a few drinks first or a shot of cocaine or crystal meth so on a very simple medical level on an aeromedical level medication addictions are stuff medications so just to tell people to give it up without looking at the underlying conditions is obviously unsatisfactory but looking deeper than that when I say the narrow medical level the American the medical versus pet is nothing wrong with the medical perspective in you know in what it says mostly what's wrong with the medical model what it doesn't say and the problem with physicians by the way I maintain it's not that they think they know everything they don't they're very humble they don't they it's not that they think they know everything but what they think they don't know is not worth knowing that's what the problem is so that we don't look at the larger picture so the mayor they're not a medical perspective on an addiction is quite accurate but it's it misses the point because there's so much more to it now if we look at addictions from a brain perspective or why is it that the drugs work in the human brain so opiates for example have been known to medical practice for thousands of years Chinese medicine Middle Eastern medicine they've been used for a long time used for pain relief they're the most powerful pain relievers that we have and anybody working with palliative care patient is very grateful for the presence of opiates like morphine and dilaudid and and so on in the decoding in the treatment of pain but opiates don't only soothe physical pain they also sue the emotional pain because it turns out that the same structure in the brain that experiences the suffering of physical pain also experiences the suffering of emotional pain if people undergoing brain scans and while they're doing while they're under the brain scan you subject them to an experience of emotional rejection the same part of the brain will light up as would light up if you've stuck them with a knife pain is pain and the language recognizes that because we talk about that painful comment or hurtful experience or stab in the heart what you said hurt me gave me a lot of pain it did because you experiencing the emotional pain in the same part of the brain is it expressed physical pain that's not strictly true it's the suffering is experiencing the same part of the brain and that part of the brain is richly endowed with opiate receptors so that the opiates are powerful pain relievers in fact if you look at the drugs of abuse they all are pain relievers alcohol as you know is a pain reliever before the days of anesthesia you've seen these cowboy movies you know the guy gets a bullet in the leg what do they do before they dig it out a shot of whiskey what's the expression that we use when somebody is drunk too much it's kind of a wry expression we say oh he's feeling no pain cocaine is a local anesthetic still used that way and then one the other all drugs are used to numb your feelings or to escape from emotional distress and that means by the way as my mantra says that the first question in addiction is not why the addiction but why the pain and if you understand why people have pain you cannot look at their genes you can't look at choices you have to look at their lives their actual life experiences go deeper and we ask why is it that these medication with his drugs even work well why is it why is it that you take an opiate that grew in Afghanistan and you take it here in Canada there is such a powerful impact on your brain and your body well of course the answer is is because we have receptors for the opiates not receptors as you know are chemical binding sites on the surfaces of our cells so each cell has tens of thousands of receptors for many different kind of messenger substances so they my head is a brain cell then there might be a receptor that looks like this you know thousands of these there might be thousands of these thousands of these you know all these different configurations of receptors and each kind of receptor a different chemical can bind now by the way turn bruce lipton a molecular biologist asked a brilliant question which I totally flogged when he asked me this as a medical doctor I totally flubbed it let me ask you this remember the picture in high school biology of the human cell there's this sort of square with the membrane around it and the cytoplasm the gelatinous material that fills up the space in the cell in the center there's the nucleus but what if I asked you what do you think is the brain of the cell or what would you say what would anybody say the nucleus okay and how many would agree that the nucleus is the bane of the cell just okay put your hand up if you agree who would say anything else any other opinions yeah they are delay of the membrane and why do you say that say that again you're totally right I I also said it was the nucleus but actually it's the membrane because there was the part of our body that our brains have their job of receiving messages from the amaya and telling the body what to do and then taking the messages from the body and the communicating to the environment that's done by the membrane not by the nucleus the nucleus is simply the gonads of the cell it contains the genetic material but it's the what happens is that messengers from the environment come they fit into the receptor and together the messenger and the receptor then create an interaction or a reaction in the membrane that then sends a message to the nucleus telling the nucleus what to do in other words the genes are turned on and off by the environment and that's why the idea that so many of the diseases are genetic is so false because genes are turned around by the environment so we have receptors for opiates but why do we have receptors for opiates why do with receptors for a product that comes from a plant in Asia we have receptors for them because what we don't actually we don't have receptors for opiates from a plant that comes from Asia we have receptors for opiates that our own body manufactures in other words our own body makes the very same substances or very similar similar enough that they look alike so that the receptors are fooled now why do we have an opiate system and by the way our opiates are called endorphins endorphins and dodging is morphine like substance now why do we have opiates receptors because they play an important function human life in fact they play three important functions many important functions actually but in the brain that three major functions are number one pain relief number two the experience of pleasure and reward so without opiates we have no sense of reward whenever you're happy joyful elated it's because you have endorphin flow opiate flow in your brain and number three they play a function they play a role without which life is not even possible and that role is in a word love attachment remember I talked about the importance of the attachment really without which life is impossible well it's the opiates that silient Lee make love possible whenever is an attach the tuned interaction between a baby and a parent they have both endorphins flowing in their brain that's why parents get addicted to their kids because they love that endorphin flow in infant mice when you knock out their opiate receptors and orphan receptors genetically these little mites will not vocalize this stress that will not cry for their mothers on separation what would that mean in the wild their demise obviously cause only the presence of the mother sustains the life of the infant in other words the opiate addiction takes hold in a brain circuit without which life is impossible you want to know why people save your heart than giving it up imagine in your life if if you had no sense of pain relief yet too much pain if there was little sense of reward and joy and furthermore not much of a sense of connection and of a sudden you had this chemical that would give you all these qualities how would you give it up what is this sufficient for somebody put a sign in the wall saying just say no just say no to love and connection and pain only one sex trade worker a 27 year-old woman told me the first time I did heroin she said it felt like a warm soft hug and others have told you the same thing so that's the opiates I've already mentioned the stimulants in another mouth experiment in a laboratory you take a pellet of food and you put it in the mouth of this little mouse who would chew it and swallow it and enjoy it but it's put the food down inches away from his nose he will not stir to eat it in fact will start to death he's quite capable of movement but you won't why because genetically they knocked out his dopamine receptors dopamine that chemical which is elevated by the stimulant drugs is their incentive motivation chemical dopamine flows whenever be excited about something motivated when we're curious vital vibrant feeling really alive when we're seeking food seeking a sexual partner exploring a novel object or a novel environment these are states of high dopamine flow without dopamine we're listless not motivated and [Music] apathetic so imagine then that somebody that gave you a substance died all of a sudden you feel totally alive and life is exciting how would somebody take that away from you by putting a sign on a wall saying just say no and really what you might have divined by now is the question that I'm asking is who is susceptible to addiction because what is clearly not true is that drugs are addictive doors are not addictive not by themselves if drugs are addictive by themselves we couldn't give morphine in large quantities to large numbers of people but if fact we do and they don't become addicts is alcohol addictive or clearly not most people who drink alcohol even repeatedly even in relatively large quantities don't become alcoholics they don't become addicts its food addictive clearly not human beings have been eating forever without being food addicts but to some people it is addictive it's a pack of cars or gambling addictive not to most people but some people become hooked on it so the question we have to ask is what makes some people susceptible the whole idea that that drugs are addictive is total nonsense most people who try could even crystal meth and crystal meth is a very powerful drug you know sex will elevate your dopamine levels by a hundred percent pretty good cocaine by 300% Christel met by 12 hundred percent one patient told me that crystal meth is like an orgasm without sex but even then most people who try crystal meth the vast majority of people who try crystal meth even repeatedly don't become addicted to it I'm not advocating that English should try it or use it all I'm saying is that it's not true that by itself you can cause addictions so clearly what you have to have is a susceptible individual and a potentially addictive behavior and by the way what is the potential use of behavior what is the potential of the behavior the answer is anything anything my definition of addiction simply says addiction is any behavior that you crave that gives you temporary relief or pleasure that is negative consequences and you can't give it up despite the negative consequences nothing about substances it's any behavior substance related or not that gives you temporary relief and treasure that you crave and that you engage in despite negative consequences you're not able to give it that's what an addiction is clearly you can be addicted to gambling to internet shopping to work to sex to sports to the acquisition of wealth to power and to substances as a matter of fact when you look at the brain circuits involved in addiction whether they have to do with any of these behaviors or with substances it's exactly the same brain circuits that are involved shopping addicts get the same dopamine hit that the cocaine addicts got except they get it through the shopping so the shopping addict is a chemical addict except the chemistry is internally generated to that particular behavior same at the gambler same with the sex addict same with the workaholic so that whether you're looking at biochemically or psychologically addiction is all fill the same role in people's lives it's just that in the case of the substance addict they have to get a substance and then the question is why and so this is where I'll stop for a moment and then I'll come to some of these answers but I just stop right now and see if there's any questions or comments on anything that I've said so far [Music]

Channel: CaseyHouse

Views: 104,750

Keywords: HIV, mental health, health care, addiction, Casey House, Dr. Gabor Mate

Id: D5zDdiOFnV4

Length: 28min 54sec (1734 seconds)

Published: Mon Mar 19 2018