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Addiction in Terminal City and beyond...

Preamble:
--I was tempted to give 5-star ratings to 3 psychology books in a row�� I jumped on this 480-pager after Hari’s:
i) Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions, and
ii) Chasing the Scream: The First and Last Days of the War on Drugs, where the city I live in (Vancouver, Canada) is featured (“Terminal City��) for (1) grassroots activism for addiction harm reduction and (2) addiction research by author Dr. Gabor Maté (esp. addiction and childhood trauma) and Bruce K. Alexander (“Rat Park�� studies).

Highlights:

1) Dislocation and childhood trauma:
--I've summarized the focus on social roots of addiction (as opposed to chemical) in reviewing Hari's Lost Connections: Uncovering the Real Causes of Depression - and the Unexpected Solutions. For those who find Hari's journalist writing style a bit sensationalist at times, useful supplements: "Heroin on Prescription", "Neuro-Realism", "The Least Surrogate Outcome", "The Stigma Gene", "Brain-Imaging Studies Report More Positive Findings Than Their Numbers Can Support. This Is Fishy" in physician/evidence-based medicine prof Goldacre's I Think You'll Find It's a Bit More Complicated Than That.
--Maté opens the empathic door with his experiences as a doctor treating addiction in Vancouver’s infamous Downtown East-side (DTES), adding the visceral details of personal cases to the framework of addiction’s social roots: dislocation (esp. from meaning) and childhood trauma (pain). Addiction thus functions as relief (self-medication) much more than as vapid pleasure.
--Hints of connecting an individual’s drug addiction with society's economic-growth industries gets the political-economy nod from me; lowly drug addicts are punished for serving as a mirror to society’s own addictions (endless profit-seeking growth beyond planetary boundaries/balance, which requires demand to keep up; this excess consumerism is manufactured by the colossal advertising industry, whose product is dissatisfaction and consumerist addiction). Synthesizing the roots/alternatives to addiction and applying this to our society’s addiction to economic growth in the age of ecological crises seems prescient.
-Gone Tomorrow: The Hidden Life of Garbage
-Captains Of Consciousness: Advertising And The Social Roots Of The Consumer Culture
-A Consumers' Republic: The Politics of Mass Consumption in Postwar America
-Channels Of Desire: Mass Images and the Shaping of American Consciousness
--Maté highlights how medicine is predominantly focused on reactive disease-classifications rather than proactive public health promotion (in this case, healthy psychology esp. childhood development). Despite some technical challenges (ex. difficulty in studying positive development factors like parental attunement), medical institutions are conservative power structures lacking broader synthesis. We can add that medicine (like many social services) is increasingly marketized into profit-seeking businesses (rather than social needs); prioritizing social needs have always had many contradictions with the capitalist economy (i.e. not socialism). Note: ironically, it is Big Media’s sensationalism that obscures Big Pharma’s structural depravities with crude anti-vax/AIDS denial distractions:
-Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients
-Bad Science: Quacks, Hacks, and Big Pharma Flacks
--To really get to the roots of addiction requires socially prioritizing the phase from prenatal to early childhood, providing universal economic/nursing/psychological/community support, rather than today’s fend-for-yourself individualism, economic stresses (both parents working, precarious jobs, household debt, housing costs from financial speculation) and accompanying abandonment... There are much more short-term profits in stressing the vulnerable and creating addiction!
--For those abandoned succumbing to addiction: without social prioritization building an “island of relief��, addiction prevention erodes into addiction management (i.e. chronic disease), where harm reduction is the only viable bandage. Thus, we have Vancouver, with:
(i) Grassroots activism winning some of the most progressive harm reduction policies to provide humane treatment for addiction as a chronic disease (i.e. safe maintenance via safe injection sites, detox, etc.), while
(ii) Rampant capitalism (financial speculation ballooning housing prices, high inequality with precarious-yet-essential service jobs, Darwinian individualism and voracious advertising of consumerism) creating ever-more addicts and relapses. If you cannot build alternative communities, where else can you turn to?
--I'd be interested comparing this with, say, modern China’s efforts against the legacy of colonial Opium Wars: communist China’s approach seems to be reversed, with (i) conservative anti-drug repression, while (ii) focusing on social needs and building alternatives, from pre-revolution’s 30’s life-expectancy + Century of Humiliation to mass literacy/public health/land reforms/infrastructure/anti-poverty policies (on this, see a comparison with post-colonial India: Capitalism: A Ghost Story)
--I will add that bad-ass Michael Parenti (political economy: Blackshirts and Reds: Rational Fascism and the Overthrow of Communism) seemed to voice support (at the end of a lecture) for prohibition of hard drugs in the context of this actually not being enforced (because the CIA was involved in the drug trade and FBI COINTELPRO used this to derail urban black/Latino activism). I assume what Parenti meant was proper regulation, not prohibition which is, after all, US’s policy and results in criminalization, thus black market criminal violence and lethal dosing; the CIA/FBI activities are extralegal (always tricky when your government is an empire). See: Chasing the Scream: The First and Last Days of the War on Drugs

2) Genetics vs. Environment:
--“Psychology�� was one of the earliest nonfiction topics I explored, starting with Steven Pinker’s How the Mind Works. Little did I realize I was falling into the logic-bros trap of New Atheist/Western Enlightenment theology, as I then descended down Pinker’s The Blank Slate: The Modern Denial of Human Nature and especially The Better Angels of Our Nature: Why Violence Has Declined, Sam Harris�� The Moral Landscape: How Science Can Determine Human Values (and many more, dear god, pun intended).
--Thankfully, I am blessed to come from an immigrant family; even though I was completely ignorant of world history and geopolitics at the time, something still did not pass the smell test. Today, I have yet to fully unpack how much of their abysmal analysis of history/geopolitics lies in methodological practices/ideological assumptions that also affect their “science��; I’ve wasted enough of my life on them the first time to relapse. Thankfully, this was all pre-Jordan Peterson (which I eventually reviewed: 12 Rules for Life: An Antidote to Chaos); what’s with all these hacks emerging from “psychology��?
--I do remember being impressed with Pinker’s descriptions of twin studies, which I am happy to now see Maté critique. These studies buttress the medical focus on genetics over environment:
(i) Adoption studies are supposed to isolate genetics (since for non-adoption, children and parents share both genetics and environment). However, given Maté's focus on prenatal development, many environmental factors are already introduced pre-adoption (mother’s stress, separation).
(ii) Identical vs. fraternal twins studies are supposed to isolate genetics, but Maté highlights the environmental factors missed in comparing with fraternal twins where fraternal differences (physical, temperament) trigger different environmental responses.
…overall, Maté’s focus on epigenetics (how environment shapes gene expression) and the “synaptic pruning�� during infancy is compelling, as is the critique that conservative ideologies conveniently focus on genetics to avoid inequalities in the environment.

In the period following birth, the human brain, unlike that of the chimpanzee, continues to grow at the same rate as in the womb. There are times in the first year of life when, every second, multiple millions of nerve connections, or synapses, are established. Three-quarters of our brain growth takes place outside the womb, most of it in the early years. By three years of age, the brain has reached 90 percent of adult size, whereas the body is only 18 percent of adult size. This explosion in growth outside the womb gives us a far higher potential for learning and adaptability than is granted to other mammals. […]

Greater reward demands greater risk. Outside the relatively safe environment of the womb, our brains-in-progress are highly vulnerable to potentially adverse circumstances.

--Now, a general critique of this book seems to be Maté’s section on his own behavioral addition, where critics seem to focus on the whimsical surface behavior (purchasing classical music) and not on the consequences (neglecting parental and doctor responsibilities).
--I’m still processing Maté’s steps to sobriety; his bits on Buddhism reminds me how much I prefer someone like Maté mentioning this as opposed to a useful idiot like Sam Harris (Waking Up: A Guide to Spirituality Without Religion).