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?