Exchange Between Gabor Maté and Stanton Peele

Stanton Peele described an unpleasant encounter he had in Vancouver with Gabor Maté last November.  Gabor then wrote a series of 13 points. Stanton Peele asks some follow-up questions.

Gabor Maté wrote:

I’ve followed this multifaceted discussion with interest. To me it illustrates the limitations of any one particular view of addiction.

1. Has the disease model some validity?

Yes, as a physician I perceive that in significant ways it shows up as a chronic illness with physiological correlates in the brain and other tissues.

2. Is the disease model an accurate way of explaining addictions?

As many of these exchanges have pointed out, it is inadequate and some ways inaccurate.

3. Are brain abnormalities not identifiable in addicted people?

Sure they are. Do they explain the addiction?  No they do not. Do they reflect something important about the nature of addiction?  Yes they do. (See Marc Lewis’ wonderful Memoirs Of An Addicted Brain, or my In The Realm of Hungry Ghosts)

4. Is free choice not a feature of recovery?

Of course it must be.

5. Is free choice an adequate response to addiction?

Only for some. Not for many others.

6. Is harm reduction the answer to addiction?

It was never meant to be nor can it be. Is it useful and even a necessary approach for many people’s beginning on the path to recovery? Without doubt.

7. May genetic factors help to predispose to addictions?

They may in some cases. Do they explain most addictions? Not by a long shot.

8. Can we understand either the psychology or physiology of addictions without looking at childhood stresses and, in severe cases, trauma?

Not in my view.

9. Does everyone traumatized become addicted?

Not by a long shot. Was every addicted person significantly stressed or traumatized? Yes, whether they or their clinicians understand this or not.

10. Why do some traumatized people become addicted while others develop mental illness, cancer, or autoimmune disease?

I don’t know.

11. Is there a difference between craving/addiction and physiological dependence?

As Lance points out below, of course.

12. Are 12-Step programs THE answer?

As Lance points it in his recent book, by no means. I gladly blurbed his book, without agreeing with him fully.

13. Can 12-Steps programs be life saving and life enhancing?

I have met many for whom they have been.

We need to keep exploring these questions without convincing ourselves that we have arrived at the final answers. Hence, I’m grateful for this discussion.



Stanton Peele wrote:

Gabor – it’s good to have your voice in this discussion.

Let’s ignore all that has been said and get directly to the meat of the matter, shall we?

Tell us, do you believe, as you say, in the “essential” value of AA’s approach of powerlessness and moral inventories?

Or do you agree with my approach in my books and treatment of empowering people and lifting their sense of themselves?

This is a very important difference in the addiction field, don’t you think?

You say to read your words. But you both laud AA, and Lance’s book denouncing AA’s detrimental control of the field.

In your detailed list below, you say you don’t agree “fully” with Lance’s book.  WHAT don’t you agree with in it?

Can you also tell us if you think it is valuable to pursue non-abstinent remission/harm reduction from substance addiction?

You say “We need to keep exploring these questions” and that you’re “grateful for this discussion.”  So will you answer my questions?



Stanton Peele

Dr. Stanton Peele, recognized as one of the world's leading addiction experts, developed the Life Process Program after decades of research, writing, and treatment about and for people with addictions. Dr. Peele is the author of 14 books. His work has been published in leading professional journals and popular publications around the globe.


  • Liam Newsom says:

    Stanton, i agree its hard to know what exactly causes addiction. It seems to have to do with pain specifically. Im not explictly under the opinion that Gabor holds that it is based solely in childhood trauma. Its nuanced and hard to know and prove. I see where your coming from with saying that trauma work is self sabotaging but im under the opinion theres nuance to real trauma work. I think we all carry a degree of trauma within us to an extent, life itself is challenging and carry’s a degree of suffering. This is unavoidable, i like the idea of a “myth of normal”

    I think the real work is in acknowledging this, tracing things back and finding an understanding based in acceptance. I think simply being positive and not actually fucking listening to ourselves and our pain and our own damn experience is the real toxicity and doesn’t work. I know this cause its simply not true, positivity arrises when we no longer need to lie to ourselves about our real feelings and reality, when we can be with ourselves in compassion and feel angry, hurt, betrayed etc.. allowing these to be seen and experienced. The distinction is not getting lost in the thoughts and storys and allowing these feelings to play themselves out. Its uncomfortable but deeply healing. Allow them to pass and for real genuine authentic positivity and gratitude to arrise. Only from there we c an probe and ask questions and begin to understand our own experience and the actual “why” to our deepest feelings and reality.

    We need a balance of both approaches, I think Gabor gets this and this is what his practice is about. Its not about losing yourself in your story and your past. Its about coming out of comfortable bullshit denial, facing who you really are, shining the light of your awareness, truly loving the wholeness of yourself, paying attention and finding necessary change. People need real love not just positive thinking and delusional stories of positivity which deny there own direct experience. Its an integration of both the approaches. I dont think you can find positivity without addressing our negativity and inherent human roots down to hell.

  • Diane says:

    My addiction recovery community includes Mate’s work in our program and it’s incredibly helpful

  • Stanton says:

    Luke, I will try to outline my thoughts on the dangers of Gabor Maté’s trauma approach to addiction.

    The impact of Gabor’s trauma-based approach in the addiction field is negative, and strongly so. I say that first recognizing that serious negative life events (or more like ongoing negative conditions, which the ACEs actually are) are critical risk factors in young people’s development.

    Nonetheless, these things are true:

    1. No set of negative early childhood events, up to and including the most severe, definitively orients a person’s life towards addiction. A large majority of those in even the most severe ACE categories will not become addicted.
    2. Worst of all, Gabor locates the impact of these events in permanent brain changes. Aside from being fictive, this construction is harmful, as well as being untrue to the life courses of — once again a solid majority — of those with addictions, who will instead outgrow and overcome them.
    3. The solution to ACE-caused trauma and subsequent negative health and psychological conditions is to eliminate (as much as possible) the occurrence of these events. This is a social issue, and not a later-life therapy one.
    4. Indeed, the vast bulk of therapeutic literature (cf. Seligman’s positive psychology movement) shows that focusing on past negative life events prevents psychological and therapeutic progress. Rather, exceeding these experiences requires minimizing them in the person’s outlook, ongoing forward planning, and developing the life and emotional skills needed to do so.
    5. Gabor’s most crowd-pleasing move is to select someone from the audience who claims that they developed an addiction or other negative psychological condition without having undergone childhood trauma. Gabor then craftily questions the person to ferret out some supposedly secret trauma they underwent.

    This is not a therapeutic technique, but a circus show. Every sensible person should know this. Discovering (more likely inventing), then concentrating on, previously undetected childhood trauma (often very loosely defined) deters people from dealing with, and making progress in, their problematic life issues.
    The trauma approach is anti-therapeutic. In particular, the focus on past trauma depletes people’s confidence, energy, and belief in the possibility that they can overcome trauma and deal with immediate life and emotional problems.
    As a mind experiment, imagine answering a call from a person considering suicide. Who in their right mind would say, “Imagine the worst thing that has happened in your life, and keep that as your main focus going forward”?

  • LakeSkyAsh says:

    What happened to getting to the meat of the matter? And it looks like it was misinterpreted as to why Mate referenced Lewis’s book and Mate’s book..
    And Mate gives his reason for referencing Lance’s book, that the 12 steps aren’t the only way… For real Stanton, show some interpretive coherence in what Gabor is saying, and come up with a better reply, cause as far as it looks, you just asked more questions and didn’t get to the meat of any of it. All the while Gabor Mate’s explanation carried a clearer presentation of his points and simple delivery of his stance on things, while stanton’s delivery is vague and makes no attempt to clear things up.

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