Addiction Management Blog

Archive for the ‘Book Reviews’ Category

Theater as a force of creativity, inspiration, and healing

Monday, July 15th, 2013

I am big believer in balancing our efforts to intervene on the pathological side of the equation of life issues, with efforts to enhance individual strengths, talents, and creative life energy. When we solely focus on problems, like addiction, depression, and trauma, we often – quite surprisingly and opposite to what you may think – get more of the same. The reason has to do with how systems operate in life, and the fact that there is a big difference between interventions aimed at reducing and stopping addictive behavior, and taking action to creatively bring something cool into the world that gives your life meaning and purpose.

One of my favorite books on this topic is The path of least resistance: Learning to become the creative force in your own life by Robert Fritz. He says: “There is a profound difference between problem solving and creating. Problem solving is taking action to have something go away – the problem.  Creating is taking action to have something come into being – the creation.” He goes on in the book to explain how the actions are very different, and why spending time creating cool things may in fact lead to better outcomes than focusing on getting addiction to go away. Now I say all of this because I believe one of the most creative, inspiring and healing forces in life can be found in theater. Yes, you heard me correctly, theater!

Whether you watch theater, decide to get into acting, or engage in set design, lighting or some other aspect of the production, being involved in theater is a way for the soul to nourish creative desires. While I am fortunate to have the opportunity to experience amazing theater multiple times a year in New York City, I can honestly say that theater in my home town of Portland, Oregon rivals the best of what I have seen on Broadway. Some of the most amazing productions come from Portland Center Stage that recently put together the following video in honor of theater and all that it can provide us. Enjoy!

Ah-hah moments to move beyond addiction

Saturday, May 11th, 2013

Not long after my wife and I were married, we decided to proactively increase our chances of staying together by enrolling in one of Dr. John Gottman’s weekend couples workshops in Seattle. At the time I was deeply immersed in my graduate studies in counseling and was excited to spend some time with the world-famous marriage guru. What I had not realized was that 1000 other people would be crammed into the Seattle Center taking the workshop as well, so my chances of a little one-on-one time were not so good. Fortunately, he circulated around while we all were doing exercises and I told my wife that if he ever came within 200 yards we should wave our hands wildly and grab his attention.

The moment came and sure enough my plan worked. He sat down and we began talking about some martial issue that escapes me now. During our conversation I began challenging him a bit about how people really change behavior, at which point he brought up focusing. Because I had told him I was nearing completion of my graduate program he assumed I would know all about focusing, but my deer-in-the-headlights response gave me away. I had to admit that never in any of my classes had the word focusing ever been mentioned. I was clueless and a bit embarrassed. He said it was the key to behavior change and I needed to know about it.

focusing_book_2007_medCoincidentally, the relative I mentioned a couple of blog posts ago who had given me a bunch of psychology books, had included the book  Focusing! Written in the 1970s by Eugene Gendlin, the book is based on about two decades of research analyzing what happens in therapy sessions that explain good outcomes. What Gendlin found is that it has little to do with the therapist or the specific type of therapy one gets, and far more to do with what happens inside the client. In essence, he discovered that positive outcomes occur when clients have “ah-hah” moments during sessions that awaken them to deeper truths about themselves and life. These moments occur when we (and clients) go inside and connect with what he calls a felt sense – a pre-verbal inner knowledge or awareness that comes from paying attention to an integrated and holistic aspect of our being that we can access at any time. If this sounds a little new-agey it really is not, it is just hard to describe something that cannot be easily put into words.

Have you ever lost your keys and banged your head against a wall trying to remember where you left them? No matter how hard you try nothing seems to work. So you go on to something else and then, in the middle of folding laundry, it hits you. You remember exactly where you left them! That moment of remembering is what Gendlin would call a felt-sense, an ah-hah moment that awakened you to an answer that previously was outside your awareness. While focusing can help you find your keys, it really has the power to change your life.

Focusing is the name Gendlin uses to describe the six-step process he developed for helping people – both and in out of therapy – have felt-sense experiences to solve a multitude of life problems, including addiction! If you have never heard about it, I really encourage you to check out the focusing website and read one of the many books written on the topic. What started as a little research project in Chicago in the 1950s has evolved into one of the greatest tools we have for overcoming addiction.

New book out today! Craving: Why we can’t seem to get enough

Tuesday, April 30th, 2013

cravingI am excited to announce that a new book is out today from my colleague, Dr. Omar Manejwala. He is the former Medical Director of Hazelden (one of the oldest and most respected treatment organizations in the world), and current Chief Medical Officer of Catasys, an innovative health management company focused on treating substance abuse problems. I was fortunate to receive an advanced copy of his new book, Craving: Why we can’t seem to get enough, so I have had the past month to review it thoroughly. If you struggle with addiction, or care about someone who does, then I strongly encourage you to get this book!  Why?

First, craving is a universal experience we all share and it also happens to be at the heart of addiction. In healthy doses, it is part of what makes us human. But when cravings become so intense that they lead to out-of-control behaviors, then they are not such a good thing. In fact, they cause significant pain and suffering. For those who have never experienced addiction, imagine holding your breath and then starting to think about air. How long before your desire to breath becomes an intense craving for air? How long until the craving for air becomes almost unbearable? You may think this example has little to do with addiction, but the regions of the brain that control your breathing, heartrate and other survival functions happen to be the same areas of the brain that get hijacked by addiction. By reading Dr. Manejwala’s new book, you will be treated to a very lucid and beneficial explanation of the science of craving. If you are afraid of brain science, have no fear, he makes it very accessible!

2013_0409_omar_manejwala_600x300Second, once you understand cravings more clearly, you will be in a far better position to do something about them. Perhaps what I like most about this book is that he provides an approach to deal with cravings that links back to the science of what we know about them. For example, part of the experience of craving is biological. Cravings are not just obsessive thoughts in your head, but are deeply rooted in physical and chemical changes that take place in the brain and body. Think back to our example about holding your breath. Is your need for air all in your head? Of course not. While we don’t require alcohol or drugs to survive like air, cravings have a similar intensity and feel because of what takes place physically in the body. So interventions focused on addressing the physical aspects of craving are critical. And at the same time, part of what makes cravings so painful is that once they start, they feel like they will never end until acted upon.

The best news of this book is that cravings can be overcome! Dr. Manejwala outlines a wonderful tool box of interventions that address both the physical aspects of craving, but also the painful obsessions that precede addictive behavior. You will learn about the benefits of self-help meetings, meditation, exercise, and being accountable to others. There are also some tools that you likely have not heard about, which is a testament to the comprehensive and holistic approach taken throughout the book.

Third, I really appreciate his view that “Courage is, in fact, the most essential quality of recovery, because without courage, none of the other needed practices are possible.” I couldn’t agree more! Dealing with addiction and all its complicating and co-occurring problems is not for the faint of heart. Those who engage in the process of overcoming addiction and are willing to face their most intense cravings, are among the best examples in our society of courage.

While I have a lot more to say about this book, Dr. Manejwala and I plan to discuss it over a video chat in the next week or so. Stay tuned for the broadcast and in the meantime, checkout the latest on the book on facebook and order your copy today.

Addiction and the Perennial Philosophy

Saturday, April 13th, 2013

perennial_philosophy_coverWe have known for a long time that among the most powerful ways to overcome addiction is through spiritual interventions. The essence of such approaches is that addiction is a problem of the ego, of our lower self, of the body. By harnessing the powers and energy from our higher self, from the part of us that is unchangeable and connected to the source (God, Buddha,  Allah, Atman …your choice), we can overcome most anything in life. This philosophy is at the heart of twelve-step programs, but it really goes far beyond recovery. In fact, it is about our ultimate work on this earth – awakening to our true nature.

I will admit I have been slow to all of this. I was not raised religious and the rare times I made it to church were with friends on holidays primarily for the food. Even more, I was raised in a family that valued science, and awakening to our true nature was not something that fit well into randomized clinical trials. So it took many years of wandering before I stumbled upon the Perennial Philosophy, something that made a lot of sense to me.

Perhaps you too have heard about it, or maybe not. Although I am sure there is a more elegant way to describe it,  I understand it like this. If you ventured back in history and gathered up all the wisdom on how to live life from all the great mystics and enlightened beings from all the world’s religions and spiritual traditions, and then boiled down their essential message, they would all speak universal truths, which is the Perennial Philosophy. It is the commonality in all religions, it’s what links them all together no matter how different they may appear on the surface. For me, this is very much like the scientific method. We have a bunch of researchers, who over time, using a variety of techniques, study a phenomena from various perspectives and all arrive at the same conclusion, informing reality as we know it!  Of course science is not perfect because it is conducted by people who can make mistakes, but history has shown that it is pretty darn good at helping us understand the world.

UntetheredSoulMech-#1.inddSo for me, the Perennial Philosophy bridges the gap between science and spirit, and has been a game-changer in life. If awakening to our true nature is our primary purpose on this earth, then it sure simplifies a lot of things! My to-do list is now much, much smaller. And so many things that I believed to be critical to a good life, things that I had to have, now seem not so important. Less really is more! What exactly is the Perennial Philosophy? There are two ways you can discover the answer. You can use your lower self, your ego, and read all about it. A good place to start is Aldous Huxley’s well-known The Perennial Philosophy. Or you can read about it in many of Ken Wilbur’s books, or get a nice summary on Wikipedia. But in all honesty, this method is a bit like reading all about a cool place you want to visit. It will give you some background, the lay of the land, but in the end it is not the cool place, is it? To really experience and understand the cool place you read about, you have to visit the cool place!

If you really want to understand the Perennial Philosophy you have to experience it through your higher self, through contemplative practice. There is no other way. Meditation, in all its forms, is the primary vehicle for developing a contemplative life, although there are other ways. With practice, you will discover the self behind the self. The part of you that has always been there, that does not change with your thoughts and feelings, and is capable of pure awareness. If this all sounds a bit warm and fuzzy, check out the bestselling book The Untethered Soul. I will admit, it has been a very slow journey for me. Perhaps the most important thing I have learned thus far – if you never take trip, if you never go inside and really see what is there – you are missing out on something very cool, beyond cool, actually.

Whose Will: A new book about addiction, courage, and hope

Tuesday, August 28th, 2012

I had the recent pleasure of speaking with Willie Harris, the author of Whose Will: Ordinary Person, Extraordinary Life, a riveting account of his personal struggle with addiction and path back to a spiritual and connected life.

Like most, the roots of Willie’s problems with alcohol and drugs began early in life, in a family awash in addiction, violence and trauma. His alcoholic father abused his mother, nearly killing her twice, and perpetuated his own traumas on Willie by passing down  the unfinished business of the previous generation. But even amidst the hell of family life, Willie told me, I personally had a spiritual connection that I cannot explain.  At ten years old, he would lay on the top bunk of his bed and talk to God. His mother thought something was wrong with him, and would often ask, who are you talking to?

But the connection did not insulate him from experiencing an early life of pain, misery and self-destruction. By 18, his world was spiraling out of control. The inability to appropriately process emotions, including rage, hurt and fear, set the stage for the perfect storm. Drinking, drugs and partying eventually landed him on the streets, where the brutal reality of his life eventually became the source of his awakening.

Although treatment played a role in turning Willie’s life around, it was the 12-step program that allowed him to take an honesty inventory of his life and begin to take responsibility for the role he played in his own undoing. The program also helped him understand the answer to the question  – why do I do these things to myself? He had a mental obsession with substances that was different than other people. He said, it overrides normal thinking. Once he understood he could not put substances into his body without serious repercussions, the path out of hell became much clearer.

He credits the 4th step of AA – Made a searching and fearless moral inventory of ourselves – as being a significant turning point in his life. By looking at me, I was able to forgive other people. I was able to go back and make amends, and every time I did I got better.

Today, Willie leads a simple, but spiritually grounded life. He is a successful businessman, happily married with two wonderful children, dedicated to his church, and to spreading the word that it is more than possible to overcome addiction. I was most impressed with his motivation and efforts to develop programs for teens, that can be taught in schools, to proactively help challenged kids better process and cope with painful emotions. I could not agree more that it is a tremendous need. It was an honor to speak with Willie and learn more about his story. I very much encourage you to get his book (www.whosewill.com) and be inspired.

Siddhartha’s path out of addiction

Saturday, June 30th, 2012

I’m not sure how I missed reading Hermann Hesse’s Siddhartha (Hilda Rosner translation) in high school, but I did. It’s one of those enchanting books I wish I would have read earlier! If you are unfamiliar with the story, I encourage you to read it and soak in its many wonderful messages about life. I have no intention of recapping the story here, but instead want to use parts of the story to illustrate one path out of addiction.

Siddhartha is a man on a mission, on a journey to the center of Self, to a place where Self is merged into unity, or the All. On his way to enlightenment he has many interesting adventures, including a period of time where he hangs out with the beautiful Mistress, Kamala. “She played with him, conquered him, rejoiced at her mastery, until he was overcome and lay exhausted at her side.” She enticed him into the world of the ordinary, a life of attachment. “The world had caught him; pleasure, covetousness, idleness, and finally also that vice that he had always despised and scorned as the most foolish – acquisitiveness. Property, possessions and riches had also finally trapped him. They were no longer a game and a toy; they had become a chain and a burden.

I find it interesting that as Siddhartha descends deeper into his attachments, Hesse beautifully describes addiction. “He played the game as a result of a heartfelt need. He derived a passionate pleasure through gambling away and squandering of wretched money….He won thousands, he threw thousands away, lost money, lost jewels, lost a country house, won again, lost again. He loved the anxiety, that terrible and oppressive anxiety which he experienced during the game of dice, during the suspense of high stakes. He loved this feeling and continually sought to renew it, to increase it, to stimulate it, for in the feeling alone did he experience some kind of happiness, some kind of excitement, some heightened living in the midst of his satiated, tepid, insipid existence.

And like so many who suffer from addiction and relapse to numb the pain and despair of an insipid existence, Siddhartha too experiences the consequences of his actions. “And whenever he awakened from this hateful spell, when he saw his face reflected in the mirror on the wall of his bedroom, grown older and uglier, whenever shame and nausea overtook him, he fled again, fled to a new game of chance, fled in confusion to passion, to wine, and from there back again to the urge for acquiring and hoarding wealth. He wore himself out in this senseless cycle, became old and sick.

For those who struggle with addiction, and their family and friends forced to endure a life on the edge, there is an insightful lesson in the story of Siddhartha.

I have had to experience so much stupidity, so many vices, so much error, so much nausea, disillusionment and sorrow, just in order to become a child again and begin anew. But it was right that it should be so; my eyes and heart acclaim it. I had to experience despair, I had to sink to the greatest mental depths, to thoughts of suicide, in order to experience grace, to hear Om again, to sleep deeply again and to awaken refreshed again. I had to become a fool again in order to find Atman in myself. I had to sin in order to live again.

For someone who reaches enlightenment, it’s strange imagining Siddhartha sitting by a river thinking about suicide. But he does. And in the pain of the moment, “he understood it and realized that the inward voice had been right, that no teacher could have brought him salvation. That was why he had to go into the world, to lose himself in power, women and money; that was why he had to be a merchant, a dice player, a drinker and a man of property, until the priest and Samana in him were dead. That was why he had to undergo those horrible years, suffer nausea, learn the lesson of the madness of an empty, futile life till the end, till he reached bitter despair, so that Siddhartha the pleasure-monger and Siddhartha the man of property could die. He had died and a new Siddhartha had awakened from his sleep. He also would grow old and die. Siddhartha was transitory, all forms were transitory, but today he was young, he was a child – the new Siddhartha – and he was happy.”

So often when addiction is the problem we believe heading off to treatment is the answer. No doubt treatment can be helpful and at times life-saving. But this story is a powerful lesson in how change, even the most challenging of changes, are possible when we access what is already inside us. Atman. The All. “To much knowledge had hindered him; too many holy verses, too many sacrificial rites, too much mortification of the flesh, too  much doing and striving.” Too much treatment, too many self-help meetings, too much reliance on evidence-based practices and medications. Too much action. Sometimes, the path of no-action, the path of contemplation – of sitting, listening, and just being is the path out of addiction.

 

Race to Nowhere

Monday, April 11th, 2011

Last week I watched the independent film Race to Nowhere that has won numerous awards for its strong messages about our broken educational system. Through interviews with students, parents, teachers, and others, the movie illustrates the dark side of being a kid in school. The race to nowhere for students is paved with an over-scheduling of activities, too much homework, too little sleep, and increased stress that is resulting in health problems, drug abuse, eating disorders, and suicide. What is even more troubling, is that for all the effort kids are putting into their school work and extracurricular activities, many are being churned out of our educational system lacking some of the most important qualities of a good education, including:  the ability to reflect deeply on topics, handle difficult emotions in the face of stress, and successfully engage in a wide range of healthy relationships. The film points the finger at numerous perpetrators, but in the end, fails to hit home that no one individual person or group is to blame, but rather it is the entire educational system that we must examine more carefully if we are to find the truth behind the worrisome outcomes.

When I think about the fact that over 80 percent of those who end up struggling with addiction begin their behaviors prior to the age of 15, this film frightens me even more. When did school become so competitive and stressful? Much of the over-scheduling of extra-curricular activities and hours of homework is in response to the demands, both perceived and real, associated with getting accepting into a college or university. What is sad is that the stress and pressure begin long before high school. My wife and I spent a couple of years tearing our hair out (the little I have left) trying to identify and enroll our son in the best possible elementary school. I put more time and effort into researching options, attending open houses, completing enrollment packets that included writing lengthy essays, than I ever did applying to graduate school! The process was absolutely crazy, and I know we were not alone. And now I know it was just the beginning.

Race to Nowhere illustrates painfully many of the current antecedents to addiction, and why we absolutely must reexamine our understanding of what education means and how we are going about educating our children. Failure to do so will only lead to a new generation of addicts.

 

“Calm Energy” as an antidote to addiction

Monday, October 18th, 2010

I have mentioned Dr. Robert Thayer before on this site, but have not dedicated a blog entry to his ideas until now. When I first read his book, Calm Energy: How People Regulate Mood with Food and Exercise, I was immediately impressed by the implications of his  work for those struggling with addiction. In a nutshell, he provides a very strong case that many of our moods and unhealthy eating habits have in common two biopsychological dimensions that he calls energy and tension. In an earlier book (The Origin of Everyday Moods, 1996) he describes how the dimensions can be used to create the illustration below.

The above four states represent different expressions of our energy and level of stress. Calm Energy is the quadrant where we find our best moods. We have energy and no tension. It is similar to the states people call flow or being in the zone. It is a place we want to be, where our attention is focused, we are productive, and we feel good about life. It is not a place where addiction is found, and in fact, is really the antidote to cravings and addictive appetites. The opposite of Calm Energy is Tense Tiredness. This unfortunately is the place many of us find ourselves these days, in large part due to the speed of life, decreases in sleep, and increases in stress. It is a place of low energy, bad moods, anxiety and depression. It is also the state where addiction thrives. When we feel tense and tired there is a natural tendency to want move away from this state, and addictive behaviors are among the most powerful, reliable, quick, and easy ways to disconnect from Tense Tiredness. I say disconnect because engaging in addictions does not really provide an antidote to this state. Instead, it may in the short run give us more energy, and change our mood, but only temporarily. When the addictive behavior ceases, chances are good that what follows will be more tension and lack of energy, perpetuating the relapse cycle.

I like to think about Calm Tiredness as a lazy Sunday afternoon. In general, it is a pleasant state, but often not as productive or positive as Calm Energy. Nothing wrong with it, and in fact we need down time to recharge our batteries. The final state, Tense Energy, is a state where we are quite productive and busy, often due to deadlines and being rushed for time. Many Type A personalities fit this state, as well as those who like to live on the edge and seek out thrills.

In my own life I find the model incredibly useful in helping me understand my own eating, exercise, sleep, and mood patterns. One of the best things you can do for yourself is take a day (or two) and track your level of energy and tension by the hour. Rate each on a scale of 1 to 10 and then plot the results on a graph. It is revealing to see just how significantly these states change in the course of an average day. The graph also helps to identify intervention points for: (a) preventing relapse, (b) developing optimal times for exercise, and (c) determining whether we are getting enough sleep. In addition, the graph can help you understand how time of day subtly influences how we think about life problems.

In sum, addiction most often shows up when we are tense and tired, but can also occur in the other states as well. Among the most significant points Dr. Thayer makes in his book is that the single best way to cultivate a life of calm energy is by developing a regular habit of exercise. Perhaps that is why the National Institute of Drug Abuse has already invested over 4 million in research into the connections between addiction and exercise.

Uncovering the pervasive roots of addiction: Part 2

Monday, July 12th, 2010

“Addiction in the modern world can be best understood as a compulsive lifestyle that people adopt as a desperate substitute when they are dislocated from the myriad intimate ties between people and groups – from the family to the spiritual community – that are essential for every person in every type of society.”

Bruce K. Alexander, The Globalisation of Addiction: A Study in Poverty of the Spirit

In the previous post I discussed how adverse childhood experiences (ACEs) to a large extent play an important role in the development of addictions. Given that over 80 percent of those who develop addictions begin adaptive behaviors to cope with ACEs prior to the age of 15, we as a society need to place a greater emphasis on identifying at-risk kids and intervening as early as possible. But there is another insidious root to addiction that I believe goes beyond individual ACEs and plays an even greater role in the development of addiction – free market society.

Bruce K. Alexander spent decades as a distinguished addiction researcher in Canada before becoming so frustrated by a lack of progress in helping those who struggle, that he completly changed careers and decided to focus on teaching history instead. Despite doing everything he could to avoid topics around drugs and addiction, the more he studied history, the more he discovered insights that began to change his entire perspective on the nature of addiction.

In general, when we think about addiction, we think about it as an individual problem. Individuals are exposed to a host of risk factors, including ACEs, peer group influences, and the availability of objects of addiction in communities. The more risk factors an individual is exposed to, the more likely the chances are that he or she will develop an addiction. Conventional wisdom also suggests that the antidote to addiction is intervention and treatment. But when Dr. Alexander began studying history, he discovered cultures and societies where common objects of addiction were present (drugs, alcohol, sex, food), yet addictive behavior was minimal or nonexistent. ”Addiction can be rare in a society for many centuries, but can become nearly universal when circumstances change – for example, when a cohesive tribal culture is crushed or an advanced civilisation collapses (Alexander, 2008).” Throughout history, the primary factor responsible for the societal change leading to pervasive addiction is the introduction of free market society. Why?

When a society introduces free markets, exchange of goods and services optimally are not encumbered by family ties, cultural traditions, religious values, or anything else that may impede free play of the laws of supply and demand. In other words, free markets create an “every man (or woman) for yourself” dynamic that puts me in competition with everyone else for jobs, insurance, a house, goods, services and Lady Ga Ga tickets. One consequence of this system is that people become dislocated, or disconnected from one another because of the time and energy necessary to keep up with the Jones. Free markets are incredibly profficient at knowing how to keep people focused on stuff over experiences. Flashy ads, mass media, and the latest gizmo from Steve Jobs keeps us always wanting more. In the pursuit of the American dream, what many get instead is isolation, fear, and dislocation, which ultimately leads to compulsive lifestyles where people develop addictive relationships to stuff and get further and further disconnected from nurturing human relationships.

Dr. Alexander’s Dislocation Theory of Addiction is well documented in a paper titled The Roots of Addiction in Free Market Society (highly recommended reading) and a more extensive read: The Globalisation of Addiction: A Study in Poverty of the Spirit. His work is extremely important in helping us all understand many of our current societal ills beyond addiction, including: divorce, single parenthood, children in poverty, obesity, unemployment, and excessive time in front of the TV. Until we as a society place relationships and experiences over materialism, consumption and stuff, Thoreau’s observation that ”the mass of men lead lives of quiet desperation” will ring ever more true.

What is the solution to mass dislocation? I believe part of the answer lies in making some tough societal changes including ending the senseless war on drugs (a big topic for another time). But for the individual struggling right now with addiction, the answer is much more about restructuring life in a way that emphasizes relationships over stuff. To do this, one must have the developmental  capacities necessary to know how to initiate, develop, and maintain healthy human relationships.

Living Hero Podcasts: Dr. Gabor Mate Interview

Sunday, May 30th, 2010

I recently learned about the website Living Hero that produces podcasts of “living luminaries and mavericks” hosted by Jari Chevalier. Her most recent interview was with Dr. Gabor Mate, a Canadian physician with a broad range of life experience (and wisdom) on topics including: mind-body medicine, stress and trauma, ADD, and addiction. I first heard about Dr. Mate when a close therapist friend told me about his book, In the Realm of Hungry Ghosts: Close Encounters with Addiction. Shortly thereafter, another friend said he had been to Portland and spoke at a college campus. Then…the podcast interview. Call me slow, but eventually I do pay attention when the universe is attempting to tell me something – like pay attention to this guy!

After listening to the insightful interview by Jari (please go listen now), it is clear that much of what Dr. Mate believes is very much in line with the information on this website and blog. He advocates understanding addiction as a coping response to underlying pathologies, namely adverse childhood experiences. These early events impact brain development, as well as other developmental capacities, resulting in the need for relationships with objects that help regulate stress and emotion cycles. Although much of the discussion focused on addiction as a coping response (feel better), I believe Dr. Mate would also agree that addictive behavior is perpetuated because it feels good – the brain likes it!

I remember a case involving very successful business owner who decided to have lunch with her girlfriends at a local diner that just happened to also have newly installed video poker machines. Having no history of gambling behavior, she thought nothing of putting a buck in the machine to see what would happen. Minutes later she experienced a “big win” – a $600 dopamine rush. So…the following week she told her girlfriends they should meet again for lunch at her lucky restaurant. She put another dollar in the machine and amazingly she won the jackpot again, another $600 big win. That was all it took for her brain chemistry to rearrange some important neurons that led to an out-of-control gambling addiction. Her husband brought her to the clinic because she was unable to stop playing video poker, was blowing thousands of dollars per day, and neglecting her business and family. Although she did love how winning made her feel, in the end, her relationship with video poker machines was just another substitute for the human intimacy she so longed for, but struggled to obtain.

Addiction is a very complex problem with no easy answers. What I like most about Dr. Mate’s approach to healing is that it is humane, sensible, and incorporates harm reduction strategies. More information about his work can be found on his website. But if you can’t wait to read his book, then listen to the podcast byJari, it is well worth your time.