Dr Gabor Maté is a leading addiction medicine, healthcare, educator in treating addiction. His trauma informed approach in the treatment and healing of addiction is profoundly transformative.

“In the final analysis, it’s not the activity or object itself that defines an addiction but our relationship to whatever is the external focus of our attention or behaviour. Just as it’s possible to drink alcohol without being addicted to it, so one can engage in any activity without addiction.

On the other hand, no matter how valuable or worthy an activity may be, one can relate to it in an addicted way. Let’s recall here our definition of addiction: any repeated behaviour, substance-related or not, in which a person feels compelled to persist, regardless of its negative impact on his life and the lives of others.”

The distinguishing features of any addiction are: compulsion, preoccupation, impaired control, persistence, relapse and craving. Although the form and focus of addictions may vary, the same set of dynamics is at the root of them all.

Dr. Aviel Goodman writes, “All addictive disorders, whatever types of behaviors that characterize them, share the underlying psychobiological process, which I call the addictive process.”

It’s just as Dr. Goodman suggests: addictions are not a collection of distinct disorders but the manifestations of an underlying process that can be expressed in many ways. The addictive process—I will refer to it as the addiction process—governs all addictions and involves the same neurological and psychological malfunctions. The differences are only a matter of degree. There is plenty of evidence for such a unitary view.

Substance addictions are often linked to one another, and chronic substance users are highly likely to have more than one drug habit: for example, the majority of cocaine addicts also have, or have had, active alcohol addiction.

In turn, about 70 per cent of alcoholics are heavy smokers, compared with only 10 per cent of the general population.3 I don’t believe I’ve ever seen an injection drug user at the Portland Clinic who wasn’t also addicted to nicotine.

Often nicotine was their “entry drug,” the first mood-altering chemical they’d become hooked on as adolescents. In research surveys more than half of opiate addicts have been found to be alcoholics, as have the vast majority of cocaine and amphetamine addicts, and many cannabis addicts as well.

Dr Gabor Maté . “In the Realm of Hungry Ghosts: Close Encounters with Addiction.” Knopf Canada. Kindle Edition.