How to Heal Addictions with Mindfulness–In the Realm of Hungry Ghosts (Post 3)

In The Realm of Hungry Ghosts Cover

Hi. Welcome back. Thanks for joining me as we read and discuss Gabor Mate’s book on addiction, “In the Realm of Hungry Ghosts.” Today, we’re going to explore Part II. In this section of his book, Mate explains how addiction creates biological and psychological feedback loops that are self-reinforcing.

First, however, let’s discuss what are the agreed upon hallmarks of addiction, both substance related and not. First, the standard view of addiction is any habitual pattern in which a person feels compelled to repeat despite its negative impact on himself or others. Therefore, addiction involves:

1. an obsessive preoccupation and compulsive engagement with a substance or activity

2. impaired self-control over the use of a substance, or engagement in a behavior

3. continued use of the substance or engagement in the behavior despite evidence of harm

4. a sense of dissatisfaction, irritability, or intense craving when not using the substance, or engaging in the behavior

Dr. Mark PirtleAs Mate writes, ‘these are the hallmarks of addiction, all addictions.’ Mate goes on to explain that addiction involves the same brain circuits, whether the addiction is chemical or behavioral. Therefore, addictions do alter brain physiology.

This is the feedback loop that I was alluding to, where the biology (brain circuits and chemicals) affect the psychology (thoughts and motivations). That explains why it’s so difficult to define addiction from one perspective, biological or psychological. We cannot place addiction in any one of those boxes; it’s more complex than just biology, or just psychology. A larger perspective is necessary to understand it. Without that larger understanding, treatment will necessarily be insufficient.

Mate goes on the write that at the ‘heart of addiction is a dependency, excessive dependency, an unhealthy dependency–unhealthy in the sense of unwhole, a dependency that disintegrates and destroys.” Such a dependency is akin to what I call “attentional fixation.”

In my next post, we’ll explore the factors that predispose a person to addiction. If you find these posts enlightening, please feel free to share them with your social networks.

Wishing you well,


How to Heal Addictions with Mindfulness–In the Realm of Hungry Ghosts (Post 2)

In The Realm of Hungry Ghosts Cover

Welcome back to our review of Gabor Mate’s Book In the Realm of Hungry Ghosts. I want to share a few bits from Chapter 3. Specifically, the premise that Dr. Mate puts forth that addiction is a “flight from distress.” He’s very explicit. “Far more than a quest for pleasure, chronic substance use is the addict’s attempts to escape distress.” What he’s saying is this, addicts are compelled to use substances and engage in behaviors in order to feel better. More often than not, in the background, there’s some painful circumstance or condition.  

AddictDepression, anxiety, PTSD, ADD and or any number of other chronic stress-related conditions push an addict to seek relief in their drug of choice or in medicating behaviors. Interestingly, Mate points out that the same brain circuits that feel physical pain are also active during experiences of emotional pain. ‘When people speak of feeling emotional pain, they are being quite accurate.’ Mate states very strongly that ‘hurt’ is at the center of all addictive behaviors.

In my next post we’ll explore the hallmarks of addiction.

For those readers who would like to go deeper, way deeper, check out the work of Eric Garland.

Feel free to comment and ask questions. If these posts are helpful to you, please share them with you social networks.

How to Heal Addictions with Mindfulness–In the Realm of Hungry Ghosts (Post 1)

In The Realm of Hungry Ghosts Cover

Hi everyone. Happy Monday. I’ve been reading a fantastic book that I want to share. Indeed, as I read it I’ll spend the next month or more blogging about it. I’ll highlight the salient points and hopefully, like a book club, interest others in reading it too. And then participate in our question and answer discussions.

Physician, Author and Public Speaker, Gabor Mate

If you’re not familiar with Gabor Mate, he’s a Canadian MD, author and speaker who has written extensively on addictions and other stress related conditions. Currently, I’m reading his #1 Canadian best seller, “In the Realm of Hungry Ghosts.” In it, he details the many stories of his Downtown Eastside Vancouver clinic, where he works as a physician.

Lest you think this book is solely about drug addicts and addictions, let me pop that bubble. Mate masterfully helps the reader understand the nature, scope, and destructive power of all craving, not just to drugs, but to otherwise accepted “addictions” like to work, power, possessions, and success.

Additionally, and importantly, Mate helps the reader understand the mind-body connection. Thoughts and emotions do change our brains, which then influence subsequent thoughts and emotions. After reading his book, you will understand the science behind the difficulty of changing one’s thoughts, feelings and behaviors. Afterwards, this scientific understanding may help engender compassion to arise, when you or someone you know struggles to change.InTheRealmOfHungryGhosts_cover

I’ll even do my best as well to get Dr. Mate to join us in our discussions, so you can ask him your questions directly. So let’s dive in and spend some time learning about the tendency for humans to fixate, and seek happiness where it cannot be found, in the realm of hungry ghosts.

 In Buddhist cosmology, the realm of hungry ghosts is occupied by beings who long for fulfillment and relief, but are never achieve it. Hungry ghosts are ostrich-like creatures with large bellies and long thin necks. Their mouths are so sensitive that they’re unable to eat or drink enough to satisfy their cravings. Additionally, whatever they do ingest, upsets their delicate constitution.

Hungry Ghost
Hungry Ghost

The hungry ghost realm therefore stands as a symbol for addictions of all kinds. Mate’s Downtown Eastside Vancouver patients live in this realm. Shortly into the book however, the reader comes to realize, that we all cycle through this realm at one time or another. The only difference between us and them is just a matter of degree.

Part 1 of the his book details the lives of patients caught in this unmerciful cyclic state. Readers also gain an deeper understanding of the motives, although sometimes irrational, that keep his addicts stuck. As many of you know, I’ve worked in rehab since 2007. I thought I’d heard and seen it all. The depth and scope of suffering of Mate’s patients surprised even me.

If you want to join in and read Mate’s book with me, get online or go to your local book seller today. I’ll be blogging about it Monday’s, Wednesday’s and Friday’s until I’m finished. There’s a lot this book can teach us about ourselves. I hope you join us.

Lastly, if you enjoyed this post and think it’s informative, please share it with your social networks on FB, Twitter, Linkedin, and others. I appreciate you helping me get the work out into the world. Thanks.

Mark Pirtle

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Hot Topic: Addiction and Celebrity Overdose

Philip Seymour Hoffman

I know I’m late to the party—writing this article nearly 2-months after the January overdose death of Philip Seymour Hoffman. Despite my tardiness, the issue of accidental death by overdose remains topical. For good reason, as a nation we are experiencing an epidemic of drug overdoses—New York alone experienced a 84% increase in heroin-related deaths from 2010 to 2012. If you’ve paid any attention, you’ve undoubtedly witnessed the barrage of headlines and new stories on this subject. Coverage has been wall to wall, from NPR to the New York Times. For good reason too, accidental death stirs up so much emotion. Sadness is the first and most natural reaction to such loss. But I’ve read articles where anger was clearly being directed at the drug user. On the surface, I get it. The author of such an article is likely mad because death by overdose is so avoidable and such a waste. ‘Why couldn’t the addict just made another choice?’ Clearly it must be more complicated than that.

Philip Seymour HoffmanSince all of us likely know someone who suffers from an addiction of some kind, such accidents compel us to find someone or something to blame. That makes sense to me too. It’s natural for us to want to understand the reasons behind these tragedies. When blame is cast, it seems to fall on either the “disease” of addiction, or the poor “choice” of the addict.

When someone blames the disease, as did Huffington Post blogger Akikur Mohammad, MD did in his March 14th article, addiction is equated with cancer and diabetes, which have no known cure. I know I’m swimming against the stream of generally accepted medical consensus here, but the word disease, when applied to addiction, makes me wince a little. Is smoking a disease? I know smoking causes disease, but is it a disease itself? Also, if addiction were a disease, then addicts would have no free will. Nothing is forcing anyone to use drugs. Sure, ample evidence proves addiction causes brain changes that dysregulate both thoughts and emotions, which fixates an addict’s attention on obtaining and using drugs, which then makes it difficult for the addict to curb cravings. This is all true. And this is precisely why Dr. Mohammed also rightly makes the case for compassion rather than condemnation of addicts. But clearly, there’s a difference between an addiction and say, Alzheimer’s disease. Addicts can and do learn new attentional and emotional self-regulation skills. They can and do recover. Despite the best medicines modern science can provide, one cannot practice one’s way out of Alzheimer’s. We also often hear that addiction is “progressive.” Yes, sure. But my response to that argument is that addiction is progressive the same way practicing the piano is progressive. The more a person engages in any activity, the more one’s brain changes in response to the activity. Call it what you like: neuroplasticity, or training effect, or Karma. People get good at what they practice. For these reasons, I think it’s best to view addiction as a conditioned flow of contextually dependent triggers, thoughts, and sensations. If this flow remains unconscious, the addict cannot interrupt it, and it will continue indefinitely. If the flow of triggers, thoughts, and sensations is interrupted with skillful awareness, it can and will change. In that sense, addiction is more like a verb than a noun. Addicts wanting to recover must first learn how to mindfully monitor triggers, thoughts, and sensations before they engage in healthier behaviors. Healing any addiction requires one to consciously break out of an attentional fixation, and then wake up to a broader perspective from which a better choice can be made.

When a writer blames the user, he or she making a similar mistake, which is to say oversimplifying a complex flow of interdependent actions. This is what New York Post reporter, Andrea Peyser did in her Feb 9th article. Peyser is relentlessly damming, but on target when she takes on a complacent recovery industry, but then mistakenly blames Hoffman for his accidental overdose when she concludes her article with this sentence: “He made his choice.” In one sense she’s right—Hoffman engaged in a premeditated act. He made a string of fateful decisions that night, which culminated in his accidental death. And if this were a legal proceeding, Hoffman’s many “choices”—from calling his dealer, to going to and taking money out of the ATM, to cooking the drugs, and finally to injecting them into his arm—would convey responsibility onto him. But in another sense, Peyser and others who blame the addict are missing a vitally important nuance. First, even though he’d been sober for 23 years, he’d never really understood the causes of and remedies of his addiction. His “recovery education” up to that point failed him. Subsequently, once caught in a conditioned flow of triggers, thoughts and sensations (what others call the disease) Hoffman was ill equipped to skillfully work through the urges. Attentionally fixated as he was that night, access to the full range of choices was not available to him. I can relate with Peyser and her dislike of a recovery system that’s surely broken. But we lack compassion when we blame Hoffman for not knowing what he didn’t know. Without the understanding or the skill to get “meta” on himself, Hoffman did not have the ability objectively watch the flow of triggers, thoughts and sensations. Without the ability to be mindful, he was stuck in a cyclic addictive compulsion. Therefore, his “choice” to use was not so much a conscious one, but rather the only one available to him at the time. Addiction is complicated, where paradoxically, two seemingly contradictory conditions are true at the same time: 1) addicts are not forced to act out; and 2) once in the grip of a conditioned flow of triggers, thoughts and sensations, compulsive acting out is the only thing that occurs to an addict[1].

For the reasons stated above, blaming the disease, or the addict for lack of moral strength, is not appropriate. In Buddhist psychology, the primary reason people suffer is because of ignorance. Meaning people just don’t know how to help themselves. All of us want to be happy and avoid suffering. That’s what Hoffman was trying to do the night he died. The reason he was compelled to use drugs is because he had used them before. He was seeking relief in a way he had received relief in the past. We all do this. We repeat the past is because we are conditioned by it, and that conditioning influences us in the present. For this reason alone, the problem of addiction will not go away. We are only days or weeks away from the next talented but troubled person crossing the line and inadvertently killing him or herself with drugs. My hope is that this article can wake us up to a new mindfulness-based recovery paradigm—one that does not over simplify a complex set of interdependent conditions. There is a middle way between the extremes of blaming the disease or blaming the addict. If readers are interested in an evidence-based recovery programming (online courses, 13-month guided program, workshops and 1:1 Skype sessions) that employs mindfulness practice to work with triggers, thoughts, and sensations please visit

[1] Field M., Cox WM. Attentional bias in addictive behaviors: a review of its development, causes, and consequences. Drug alcohol depend (2008) 97:1—20. DOI: 10.1016/j.drugalcdep.2008.03.030