on hungry ghosts

1. Hungry ghosts

If you don’t stop it never gets better. I know you think that if you keep clinging until your hands are bloody you can change the conditions of the game. It doesn’t work like that. The game is rigged and you keep losing.

This is for you if you’ve ever paced around your apartment at an hour you should be asleep, propelled by the frantic need to do something again and again. Waiting for a text then waiting for the next text. Eating an entire pack of Oreos, then moving onto the pizza you ordered on Doordash at 1 AM. Buying and buying and buying. Carefully monitoring the level of alcohol left your glass, worried it’ll run out, worried that something will get between you and your fix. 

In this essay I heavily reference Gabor Mate’s book In the Realm of Hungry Ghosts. I highly recommend the book. In it, Mate touches on his experiences working as a physician for the unhoused in the Downtown Eastside, many of whom were addicts, as well as his own history of addiction.

So, what is a hungry ghost? Buddhism defines it as a person with an endless void inside them, driven by primal desire constantly but never able to satiate it. People who are prone to addiction tend to be hungry ghosts. As someone who has occasional hungry ghost qualities, I’ve spent a lot of time thinking about the distinction between liking something and liking it too much. I don’t think my experiences are anything special: addictive behavior is normalized in the world we live in.

Of course, there’s a distinction between substance addiction and behavioral addiction: as Maria Konnikova puts it, “A substance affects a person physically in a way that a behavior simply cannot: no matter how severe your trichotillomania, you’re not introducing something new to your bloodstream.” But there are also many similarities:

As Potenza and his colleague Robert Leeman point out in a recent review of the last two decades of research, there are many commonalities between those two categories of addiction. Both behavioral and substance addictions are characterized by an inability to control how often or how intensely you engage in an activity, even when you feel the negative consequences. Both come with urges and cravings: you feel a sudden and debilitating need to place a bet or to take a hit in the middle of a meal. Both are marked by an inability to stop.

I’m currently in Las Vegas. You could say the premise of the Strip is that it’s a place where desires can be satisfied endlessly. But being here reminds me of how desire itself can be endless. How you can want and want and want with no end to it. You can ruin your health and still not be done. You can rob a bank and still not be done.

Mate: “Misplaced attachment to what cannot satiate the soul is not an error exclusive to addicts, but the common condition of mankind.”

*I am not a medical professional and I’m not trying to give medical advice. Addictive behavior varies in severity, and if your health or life is in serious danger please seek help. This is also not meant go give a complete picture of addiction: Mate’s book delves further into issues like opioid addiction and the socioeconomic factors that contribute to it and I encourage you to read it.

2. What is addiction?

Mate believes that addictions are essentially all the same—they vary in destructiveness (opiod addiction vs online shopping addiction has very different effects on your health), but the core mechanism never changes. People often suffer from multiple addictions (alcohol and gambling, for example.)

Our current understanding of addiction is that addictive substances hijack brain reward circuitry. The substance that you’re addicted to—drugs or alcohol or food—causes a pleasurable dopamine surge. Over time, as usage increases, the circuits adapt and your dopamine levels drop. Addicts tend to have fewer dopamine receptors as well as lower levels of serotonin, the brain chemical that helps regulate your mood. Mate:

PET imaging studies in addictive eaters have, predictably, implicated the brain dopamine system. As with drug addicts, obese people have diminished dopamine receptors; in one study, the more obese the subjects were, the fewer dopamine receptors they had. Recall that reduced numbers of dopamine receptors can be both a consequence of chronic drug use and a risk factor for addiction.

Changes also occur to the extended amygdala and prefrontal cortex:

The extended amygdala controls our responses to stress. If dopamine bursts in the reward circuitry in the basal ganglia are like a carrot that lures the brain toward rewards, bursts of stress neurotransmitters in the extended amygdala are like a painful stick that pushes the brain to escape unpleasant situations. Together, they control the spontaneous drives to seek pleasure and avoid pain and compel a person to action. In substance use disorders, however, the balance between these drives shifts over time. Increasingly, people feel emotional or physical distress whenever they are not taking the substance. This distress, known as withdrawal, can become hard to bear, motivating users to escape it at all costs.

In short: the more you use, the more you need. Everything reminds you of the thing you’re addicted to. You feel terrible when you try to quit.

If you’re not sure whether you’re addicted:

1. Does your relationship with the thing feel compulsive?

   From Susan Burton’s memoir about anorexia and bulimia:

   It was not just like an addiction, it was an addiction. Every waking moment was about either giving in to it or resolving not to but the succumbing anyway … it was a compulsion I was locked inside. It was physiological dips I had to address with sugar. It was feeling flat and immobile without food. It was feeling I could not lift a limb. It was feeling like thought could not even move through my brain without an assist. But it was also eating in an involuntary way that had nothing to do with energy.

   There’s liking something, there’s really loving it, and then there’s thinking about it all the time, feeling like you need it—reverting to a fugue state where your actions are no longer completely your own. There’s thinking about it and then there’s obsessive preoccupation. There’s knowing when to stop and there’s waking up the next morning knowing you careened to a place beyond control.

2. Does it make you feel good after the fact?

   When you’re done, do you feel happy and satiated, or do you feel ashamed?

3. Does it make you more present, or more absent?

   Addiction makes you absent, makes you self-absorbed. You’re so fixated on your internal world that you lose the ability to pay attention to those around you. Mate on how his relationship with his wife suffers when he’s in the grip of addiction:

   “My relationship with Rae loses vitality. Because my internal world is dominated by obsession, I have little to say and what I do say rings hollow in my own ears. Because my attention is pulled inward, the interest I offer her becomes dutiful, rather than genuine. When I’m in one of my addictive cycles”

4. Is it actively hurting your life?

   Healthy relationships and habits should improve your life. At the very least they shouldn’t do any damage. If something is actively hurting you (your friendships, your work performance, your ability to focus, your health), it’s a sign that your relationship with it is unhealthy.

The official DSM 5 criteria for substance use disorders can be found here.

3. Addictive personalities

According to Mate, the traits that most often underlie the addiction process are:

1. Poor self-regulation

2. Lack of basic differentiation

3. Lack of a healthy sense of self

4. A sense of deficient emptiness

5. Impaired impulse control

In Appetites, Caroline Knapp mentions that in AA meetings you often hear “people say that, by, definition, an addict is someone who seeks physical solutions to emotional or spiritual problems.” Similarly, Mate writes that people are “susceptible to the addiction process if they have a constant need to fill their minds or bodies with external sources of comfort, whether physical or emotional. That need expresses a failure of self-regulation—an inability to maintain a reasonably stable internal emotional atmosphere.”

I think of people with addictive personalities as people who get too much of what they want but not enough of what they need. Many creative people have addictive personalities: there’s a kind of extreme sensitivity that’s required when you’re making something, and that sensitivity often leads a poor inability to self-differentiate. You’re reactive and immersed, but when you’re removed from the thing you’re immersed in you don’t know who you are. So you turn to immersion, to addiction, as a way of escaping your own uncertainty. The feeling addiction creates—obsessive, all-consuming—becomes a way to escape all the other things you would rather not feel. Like uncertainty or anxiety or boredom. But you need to be able to coexist with those emotions in order to not be a hungry ghost.

Of course, some addicts are extremely high-functioning. Caroline Knapp, in her memoir about alcoholism, describes how she went to Brown and worked a high-pressure job while spending 20 years as an alcoholic; Leslie Jamison, in The Recovering, went through the Iowa Writer’s Workshop and wrote prolifically while she drank every night. Mate himself describes how he was addicted to CDs and to working obsessively while he received praise as a doctor. The damage you’re causing isn’t always visible to the external world because you’re working overtime to hide it.

In the book Mate describes how Dr. Michael Kerr distinguishes between two types of differentiation: functional differentiation and basic differentiation. “Functional differentiation refers to a person’s ability to function based on external factors. The less basic differentiation a person has attained, the more prone he is to rely on relationships to maintain his emotional balance.” Maybe you have friends who seem to be stable in a relationship, but exhibit concerning behavior as soon as they’re single again. These are people who have functional differentiation but not basic differentiation—when they have a boyfriend/girlfriend/spouse around to support them they do fine, but when they’re all alone they have no stable sense of self. When the relationship is going poorly, they start turning to sex or alcohol or shopping to comfort them.

“Addiction is the lazy man’s path to transcendence,” Mate writes. In a later chapter: “A state of spiritual poverty, we will be seduced by whatever it is that can make us insensate to our dread.” We all know people who are always looking for God in the bottle, the line of coke, the arms of another person. It’s no coincidence that a fair number of these people end up literally believing in God: they’re looking for that feeling of transportation, something greater than themselves. People who have addictive personalities are more likely to have experienced childhood trauma and struggle with self-love. Unfortunately, when you don’t love yourself you tend to look for love in places that lead to more self-loathing.

4. Stopping

Behavior modification

In the book Mate recommends a Four-Step Method that was developed at UCLA by Dr. Jeffrey Schwartz and his colleagues to treat OCD. He points out (and I agree) that OCD and addiction have much in common—both are impulse-control disorders, both involve acting out a pattern that feels almost involuntary.

He writes that “The Four-Step program is based on the perspective that makes the best sense of disorders like OCD and addiction: that they are rooted in malfunctioning brain circuits and in implicit stories and reliefs that do not match reality.”

The steps:

1. Re-label

In Step 1 you label the addictive thought or urge exactly for what it is, not mistaking it for reality. I may feel, for example, that I must leave off whatever I’m doing right now and go to the classical music store. The feeling takes on the quality of a need, of an imperative that must immediately be satisfied. Another person will say that she needs to have a chocolate bar immediately or needs to do this or that, depending on the object of the addiction.”

2. Re-attribute

“In Re-attribute you learn to place the blame squarely on your brain. This is my brain sending me a false message. This step is designed to assign the re-labelled addictive urge to its proper source. In Step 1 you recognized that the compulsion to engage in the addictive behavior does not express a real need or anything that “must” happen; it’s only a belief. In Step 2 you state very clearly where that urge originated: in neurological circuits that were programmed into your brain long ago, when you were a child. It represents a dopamine or endorphin “hunger” on the part of brain systems that, early in your life, lacked the necessary conditions for their full development. It also represents emotional needs that went unsatisfied.

3. Re-focus

In the Re-focus step you buy yourself time. Although the compulsion to open the bag of cookies or turn on the TV or drive to the store or the casino is powerful, its shelf life is not permanent. Being a mind-phantom, it will pass, and you have to give it time to pass. The key principle here, as Dr. Schwartz points out, is this: “It’s not how you feel that counts; it’s what you do.”

4. Re-value

This step should really be called De-value. Its purpose is to help you drive into your own thick skull just what has been the real impact of the addictive urge in your life: disaster. You know this already, and that is why you are engaged in these four steps. It’s because of the negative impact that you’ve taken yourself by the scruff of the neck and delayed acting on the impulse while you’ve re-labelled and re-attributed it and while you have re-focused on some healthier activity. In this Re-value step you will remind yourself why you’ve gone to all this trouble. The more clearly you see how things are, the more liberated you will be.

Alcoholics Anonymous famously uses the 12-step program. I’m sure everyone has heard of the Serenity Prayer: “To accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” It’s hard to tell what the success rate of programs like AA is. Some people claim it’s as low as 5%, but:

Addiction specialists cite success rates slightly higher, between 8% and 12%.

A New York Times article stated that AA claims that up to 75% of its members stay abstinent.

Alcoholics Anonymous’ Big Book touts about a 50% success rate, stating that another 25% remain sober after some relapses.

A study conducted by AA in 2014 showed that 27% of the more than 6,000 members who participated in the study were sober for less than a year. In addition, 24% of the participants were sober 1-5 years while 13% were sober 5-10 years. Fourteen percent of the participants were sober 10-20 years, and 22% were sober for 20 or more years.

In addition to 12-Step Programs, there are also several forms of therapy, including but not limited to Cognitive Behavioral Therapy (CBT), Dialectal Behavioral Therapy (DBT), and Rational Emotive Behavior Therapy (REBT).

Drugs

Behavior modification aside, there are substance-based treatments for addictive behavior which vary based on the addiction. Examples include Vyvanse for binge-eating and Naloxone for opiod addiction.

Psychedelics are highly promising as addiction treatment. Jon Kostakopoulos tried everything—inpatient and outpatient programs—to cure his alcoholism for years. A few years ago he participated in a psilocybin clinical study at NYU, and never touched alcohol again. He’s now working on a psychedelic non-profit.

Johns Hopkins researcher Matthew Johnson led a small open-label study to see whether psilocybin helped people quit smoking. From Scientific American:

At the six-month mark, 80 percent of smokers in the pilot study (12 out of 15) had abstained from cigarettes for at least a week, as verified by Breathalyzer and urine analysis—a vast improvement over other smoking cessation therapies, whose efficacy rates are typically less than 35 percent. In a follow-up paper, Johnson and his colleagues reported that 67 percent of participants were still abstinent 12 months after their quit date, and 60 percent of them had not smoked after 16 months or more. Additionally, more than 85 percent of the subjects rated their psilocybin trip as one of the five most meaningful and spiritually significant experiences of their lives. The team is currently more than halfway through a larger, five-year study of 80 people randomized to receive either psilocybin or a nicotine patch at the new Johns Hopkins center.

According to Johnson, “Evidence suggests that there are psychological mechanisms of action at play. For example, people endorse that after the psilocybin sessions, it was easier for them to make decisions that were in their long-term best interest, and they were less likely to make decisions based on short-term, hedonistic desires.”

5. Moving forwards

I like the term hungry ghost because when I’m craving something I often feel like I’m being haunted, and it’s helpful to remember that *I’m the one doing the haunting.* I’m the one looking everywhere else for something only I can give myself.

From Heather Havrilesky’s Dear Polly column:

When you feel love for him and think that you could probably accept almost anything just to have him back, that’s you trying to love and accept yourself fully, for the first time.”

You can never get enough of what you don’t need. But what you want always points towards what you need, just not in the way you think it does. You feel empty and you feel bored; you think you need more external stimulation to stop feeling that way. But if you rely on something external to feel better you'll never be able to regulate your own emotions without it.

Remind yourself: I am looking for reassurance that can’t be given. I am looking to fill an emptiness that I have to learn to accept.

You already have what you need. But you’ll never find it if you spend your entire life looking for it everywhere it’s not.