Wasted reads like two books in one.
The first forms the substance, in both content and interest. A vividly written page-turner, it relates a sensitive human being's descent through the inferno of alcoholic despair, and his redemption, even as death stares him in the face.
The second attempts to present the science of substance dependence and addiction treatment in a brief 70 pages.
Narrated by Michael Pond, the first section tells a harrowing story that opens with the drunken escapades of an alcoholic middle-aged man and his alcoholic girlfriend as they carom from disaster to catastrophe, from delirious sex to vituperative hostility, from hospital to jail and back. "How did this get to be my life?" Pond wonders while behind bars. He is an exile from his family, having demoralized and alienated his wife and three young sons. He loses his thriving psychotherapy practice, adding the shame of financial and professional ruin to his résumé of failure.
It gets worse. Pond becomes a helpless boozer, selling his expensive laptop for the price of a few beers, begging from passersby, grateful to feed on soggy pastry scrounged from a garbage can. He lurches from one recovery home, so called, to another. He approaches the nadir when he stores a heavy rock in his clothing and contemplates heaving himself into the ocean.
The saving moment finds Pond in hospital deathly ill, litres of pus being drained from his chest. For the first time in ages he does not crave alcohol. There had been months of clarity and abstention before, but under pressure or to please others. Now he decides he must stay sober for himself, hitting upon the only true motivation that can overcome addiction.
Pond depicts his perilous journey with engagingly self-revealing honesty and a keen eye, ear and pen for description, dialogue, anecdote and humour. Even as our protagonist loathes himself fiercely, the reader roots for him, finding him likeable and inviting of compassion.
Compassion is an essential theme in Wasted. Many people tried to help, but their genuine good will was often vitiated by impatience, harshness and judgment – "the contempt toward substance users that permeates our culture," he writes. Pond experienced such contempt even in Alcoholics Anonymous, a reason, he believes, why the 12-Step approach never worked for him despite the companionship, selfless support and loving kindness individuals in the organization gave him.
AA and associated treatments have come under fire recently, most notably in Lance Dodes's The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. As Palmer and Pond point out, AA was never intended as a treatment but as a way of life for people seeking liberation from dependence. No one should be forced into it, or into any other modality of recovery.
If 12-Step programs do not help everyone – and, for all their value, they help only a minority – what does? In her summary of addiction treatment, Pond's life partner and co-writer Maureen Palmer rightly argues that there is no "one size fits all" answer to the challenge of substance dependence. Medications can be beneficial to some, various types of counseling for others, but no single approach guarantees success. Experiencing a relapse even after his vibrant self-rehabilitation and newfound love relationship, Pond finally settles on naltrexone, an injectable drug to suppress craving. As Palmer also shows, there exists far more ignorance than knowledge pertaining to addiction. Such ignorance afflicts the medical profession. Most physicians receive little, if any, training in the subject, despite the devastating toll addiction takes on physical and mental health, longevity, productivity and family life. The ones so trained are educated with a very limited perspective.
The flaw in this book is the science. The writers uncritically accept the narrow medical view that addiction is primarily a brain disease, largely an outcome of genetic predisposition. Pond submits to a brain scan and is relieved to see that impulse regulation circuits in his cerebrum are impaired – this, to him, proves his earlier assertion that "I was born an alcoholic." He is unaware, as are the specialists he consults, that the human brain is a social organ influenced in its physiological development by the emotional environment: requiring what a seminal paper from the Harvard Center On The Developing Child termed "the mutual responsiveness of adult-child interactions."
The deficient dopamine incentive/reward pathways that all addicts share – be they substance users, gamblers, or compulsive shoppers – are depleted by trauma or stress in childhood and even by stress on the mother during pregnancy. As the authors do note, prolonged substance use will further damage the neurological pathways driving addiction. Thus the brain scan abnormalities of the adult reflect life experience; they are not the primary cause of addiction.
The human mind is not identical with the brain: in actuality, mental events shape the brain as much as brain formulates mind. The source of addiction is in the synergism of wounded mind and impaired brain.
Pond's father was a chronic alcoholic, oppressive, volatile and capricious. As an adolescent, Pond watched his father have drunken sex in their home with a strange woman while his mother was in hospital. "Hatred flares up from my gut, sears my brain," Pond recalls. Yet neither Pond (as psychotherapist) nor Pond (as alcoholic) perceives that it is the pain of childhood that, like all addicts, he has been compulsively re-enacting and running from all his life. The same pain also miswired his troubled brain circuits.
He inherited his addiction through the trauma inflicted on him and his siblings. Although predisposing genes may be involved, we must not confuse predisposition with predetermination; genes can be turned on or off by the environment. Even children born with predisposing genes have a greatly attenuated risk of addiction if brought up in emotionally nurturing homes. Large-scale population studies have identified childhood adversity as the most significant determinant of later dependence, as illustrated by the tragic and ongoing multigenerational harm residential schools perpetrated on our First Nations citizens.
Among the many deficiencies of the treatment industry, most grievous of all is the failure to recognize, address and heal the primal suffering at the very core of each addicted mind and soul. That the authors of this gripping and helpful work are also blind to the impact of trauma is an opportunity wasted.
Gabor Maté worked as an addiction physician in Vancouver's Downtown Eastside and is the author of In The Realm of Hungry Ghosts: Close Encounters With Addiction.