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Addiction Is Not A Choice: Dr. Gabor Maté’s Call for A Compassionate & Holistic Approach To Healing

By October 25, 2015January 19th, 202423 Comments
Episode #188



What if everything you presuppose about addiction is wrong?

Enter Gabor Maté.

World renowned lecturer, physician and bestselling author, today’s guest is a highly distinguished, in demand and at times controversial authority with a wealth of expertise on a range of topics that span addiction, stress and childhood development.

With over twelve years of first hand experience working up close and personal on Vancouver’s skid row with patients severely challenged by hard core drug addictions, mental illness and HIV, Dr. Maté has cultivated a powerful yet eminently commonsensical perspective on this devastating affliction that contravenes conventional medical dogma. A perspective that begins with a single edict:

Addiction is not a choice.

Moreover, addiction has little to do with illicit substances. It’s just not about drugs. Or gambling, or shopping, or porn or whatever behavior happens to, in the words of Dr. Maté, incinerate the lives of millions.

Instead, addiction is about the emotional pain behind the behavior. And healing is about confronting the past and untangling the circumstances that drive the individual to self-medicate in maddening defiance of all reason and logic.

The difference between passion and addiction is that between a divine spark and a flame that incinerates.


Based on cutting edge science, case studies and a wealth of personal experience, Dr. Maté concludes that addiction is a predisposition programmed in early years — an infestation that lurks miles beyond choice. A disease rooted neither in genetics nor free will but rather in environmental factors that hard wire brain neurochemistry during formative childhood development. Accordingly, those that suffer should not be shamed or criminalized, but instead treated in the same way we approach anyone suffering from cancer or an autoimmune disease — not with blame but rather with compassion, sympathy and medical intervention.

As an author, Dr. Maté has written extensively on the subjects of addiction, early childhood development & trauma, attention deficit disorder, and the relationship between stress and disease. His most recent award-winning book, In the Realm of Hungry Ghosts: Close Encounters with Addiction* (a #1 bestseller in Canada) mixes personal stories with science to present a radical re-envisioning of addiction not as a discrete phenomenon confined to an unfortunate or weak-willed few, but as a continuum that runs throughout (and perhaps underpins) our society at large; not a medical “condition” distinct from the lives it affects, but rather the result of a complex interplay among personal history, emotional, and neurological development, brain chemistry, and the drugs (and behaviors) of addiction.

Hope breathes in compassion and self-understanding.


In other words, it’s complicated. There is no miracle cure. There is no quick fix. But hope breathes in compassion and self-understanding — the first key to promoting healing and wellness,

Dr. Maté’s work — and this book in particular — have been absolutely revelatory in helping me better understand myself, my personal history with addiction, and my ever evolving quest for greater well being. He changed my life. And I truly believe his message holds the power to improve the lives of anyone personally or tangentially impacted by addiction. And let’s face it — in this day and age that includes almost everyone.

It was a unique honor to hold space with this compelling, paradigm breaking man. A conversation that begins with a survey of his life and labors but then subtly shifts — the verbal fulcrum slowly sliding until his focused insight was quite unsuspectedly yet keenly turned on me. The interviewer as patient; my own private session writ large.

Topics covered include:

  • the misplaced criminalization of addiction
  • the denial of trauma in addiction
  • addiction as a social issue
  • the shame & stigma that drives addiction
  • chemical effects & psychological defenses
  • early adaptations & sources of pathology/dysfunction
  • the impact of childhood experiences on behavior
  • commitment to the process & the inevitable payoff
  • self-knowledge vs. experiential knowledge
  • acknowledgment of suffering
  • the true nature of the human condition

Question: How can you treat those who suffer from addiction with more compassion?

I look forward to hearing all about it in the comments section below.

I love this conversation and hope it leaves you rethinking assumptions about human behavior and perhaps even your own behavioral compulsions.

Peace + Plants,

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Connect With Dr. Maté: Website | Twitter | Facebook

Notable People Discussed in today’s podcast:

Books You Really Should Read:

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Production & sound design by Dean Menta. Music by Tyler Piatt. Additional production by Chris Swan. Graphic art by Shawn Patterson.

*Disclosure: Books and products denoted with an asterisk are hyperlinked to an affiliate program. We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to and affiliated sites.


  • Tommy F says:

    Wow! Just clicked on the Amazon banner ad and purchased Dr. Mate`s latest book. Talk about someone who’s able to cut to the heart of our unconscious addictions. This is exactly the reason why I enjoy listening to this podcast.. exposure to people I would have never known of, but am now completely tuned-in to. Very brave of you Rich, stepping up and quickly taking your guard down, when he invited you to expose your insecurities and talk through them on the podcast. You could really feel the focused intensity of energy as you stepped into that precarious space of facing your insecurities without being able to grab for a safety net. You just jumped right into a risky vortex of vulnerability and came out strong through the other end of it.

    It really is about surrender over resignation. Surrendering to who we are in truth.. and resisting the temptative pull of resignation to our addictions. Moderation is our temptress. “Just a little bit won’t hurt…” Just one more drink, one more smoke, one more purchase, one more judgment, one more… We live in a hungry ghost society, where more is never enough, resulting in the suffering of constant scarcity. In opening up to sufficiency, we are whole, balanced, content and awake.

    Great show notes! Definitely going beyond the earbuds on this one.


  • Brenda says:

    One of your most powerful podcasts Rich. Thank you for your courage to explore your childhood with Dr. Mate – it helped me look into mine as well and understand the effects of childhood trauma in a very intense way, rather than just intellectualizing things. I hope you’re able to have him back on the podcast again and I just downloaded one of his books.

  • David says:

    This interview rocks the house and centers the soul. It uses logic, clear and succinct dialog, unscripted dramatic personal introspection, and a positive life-affirming core to describe a part of the cause of and a part of the solution to addiction. It takes self-help psychobabble that normally makes my eyes gloss over and spiritual mumbo jumbo that usually makes my eyes roll over and integrates and transforms them into an accessible, understandable, and powerful truth. Although I don’t think the framework described represents the full picture of addiction, as is professed, that framework does seem to play a significant role and is a role that most people are unfamiliar with. This podcast seems like essential listening for parents and those whose lives are touched by addiction. Thanks RR for taking the time to travel travel to Canada to make this interview happen and for applying the interview skills you have honed to a topic that is important to many people.

  • Victoria says:

    One of the best recordings. Rich Roll, you hit the home run with this one. Going into this podcast, I did not know anything about Dr. Gabor Mate and his work. What an important conversation. Being a parent, the most touching and critical bit for me was the childhood part of the discussion. I almost cried when Dr. Mate spoke about the importance for a child to have their experience validated as it happened without any judgement from a parent and/or guardian. I command you for allowing the conversation unfold the way it did. I bet it took some deep breaths to be willing to explore your own childhood in this format. Thank you for this powerful dialogue with Dr. Mate.

  • Mandy says:


    I work as a family doctor in Vancouver. About 3 years ago I was at a medical conference in Vancouver and was unexpectedly blown away by the wisdom of 3 of the speakers. One was Dr Gabor Maté. I had never had a learning experience which taught so much compassion in my many years as a doctor and it has left a lasting impression personally and professionally. Rich, I was so excited when I heard you say you had interviewed Dr Maté, I so wanted to hear you speak with him. The conversation was awesome. Thank you for travelling all that way and allowing more people to hear this lovely human and his wisdom.
    (Next time you are in Vancouver, if you are able, give us a heads up as I would love to go for a run with you. I’m an ultrarunner too. I’ve been an avid listener for a couple of years and am so grateful you are out there)

  • Floyd Kay says:

    I’ve been listening for a long time and this is my favorite episode ever.

    I wish it had gone on for three hours. I loved hearing Dr. Mate speak. HIs wisdom and compassion are amazing. I need to remember to bring that attitude into my meetings.

  • Bridgette says:

    Wow, this was an amazing podcast!!! I have been looking for this info for some time. Thank you for your willingness to explore your own childhood connection. I can’t even tell you how freakin’ happy I am to find Dr. Gabor Mate, who confirms what I have suspected for some time about trauma and the effects on our brain, nervous system and hormonal system.

  • One of my favourite episodes, Dr Mate’s direct yet compassionate tone, understanding and use of language is compelling to listen to and the way you let your guard down to be dissected online was vulnerable and admirable Rich.

    Big fan from the UK with my own podcast now, who’s journey to the plant powered way has been inspired and supported by your podcasts and positivity.

    Keep doing what you’re doing, being the change, love the show!

  • Meghan says:

    This was a great podcast… I share Rich’s hesitation about the childhood “trauma” just like Rich my childhood was Plesantville… PERFECT… I can’t think of anything that would have caused my addiction to endurance exercise/ exercise in general….

  • Tom G says:

    This was an awesome podcast. It was incredibly informative. Listening to the discussion with Dr. Maté and hearing him lead Rich to the realization of the impact of his early life on where he is today started me thinking about my own journey. I gained incredible insights into my past as a result of this discussion. I just purchased Dr. Maté’s book and am looking forward to reading it.

  • S N says:

    How would one give such a brilliant explanation…to kids? Can kids listen to this podcast to understand their experiences? Thinking of some nieces ages 6 & 8.

  • Marly says:

    This was such a powerful episode. I definitely learned a lot about myself and didn’t understand that the terrible things my mother was going through when she was pregnant with me and the continuation of the stress she was under during the early years of my life could have such lasting, physiological and psychological effects. It was definitely very enlightening learning about Dr. Maté and hearing his views on addiction, etc. The only thing I was disappointed about was his response to your question about what he would do as Surgeon General. It seems like such an obvious thing — that there is most definitely a way to “legislate” compassion — which is to create more legislation to support women. Women are not only the majority of caretakers of our children, but women have less layers built up around the notion of being compassionate. Maybe it’s a lack of testosterone, or maybe it’s upbringing. Either way, creating more legislation that helps support young mothers or provides more resources for women could create a huge impact for children in our country, and based on Dr. Maté’s comment in the interview, would have long-term impact on addiction.

  • Mike says:

    This! Especially about being a parent and almost crying.

    I almost felt like I was conducting the interview. Very powerful stuff and food for thought.

    Great podcast, Rich! As per usual!!!

  • Patricia says:

    Wow. I am going to be listening to this one again. Dr. Maté’s redefinition of an addict at the end of the podcast brought tears to my eyes. Though the trauma connection is not entirely new, he really develops it in a much more comprehensive way. Even his book title took my breath away because it is so appropriate. As a scholar of Buddhism, I can’t believe that I never connected the idea of the preta realm (the realm of the hungry ghosts) to addiction. Powerful and helpful imagery for me. For the record, however, it is worth pointing out that Dr. Maté’s psychologized version of Buddhist cosmology, refashioning the six realms of samsara as nothing more than human mental states, is not the understanding that has existed for most of Buddhist history. Even today for most Buddhists in Asia and in the Asian diaspora (as opposed to Western converts to Buddhism), the realms of samsara (humans, animals, gods, demi-gods, hungry ghosts, and hells) actually exist in the physical world, and reincarnation is real. In fact, it is in part the idea that suffering does not end with death but continues into an infinite number of lives (and not just human) that makes attaining nirvana—release from samsara—so urgent in this life.

  • Lukas says:

    I think kids don’t need an explanation, but just as he said someone who is there for them, listening to them with compassion and love. I encourage you to be that person for your nieces.

  • Mary-Ellen Landry says:

    This podcast is playing again as I type. I was held so captive by Dr.Maté’s words and voice. Not ever having heard of him before now seems like I’ve been asleep at the wheel. I was awe struck in how Dr. Maté explains addicts and addiction, the compassion there is here, and how it fundamentally changed me in how I think of these lost souls. the conversation around our parents etc. also struck home- having a great childhood overall, I know have a better understanding of the gaps I feel towards my father and how he was and is still at 75 doing his best particularly knowing more as an adult of the lack in his life. So much more in this conversation to take away. Rich, you handled your vulnerability on air with poise as Dr. Maté explored things with you. Big home run with this podcast.

  • Brian says:

    The only problem with this padcast was that it was too short. If I have ever wanted a 3 hour Rich Roll podcast this was it. The depth of this topic was eonderful and Rich, your openess was wonderfull.
    Looking forward to a part II some day.

  • Faye says:

    Thanks for allowing Gabor to take moments of your life to explain his ideas about trauma. I share his views about the role of early childhood trauma setting up the perfect conditions for addictive behavior. There are some amazing NPR & TED talks out there about dopamine and addiction plus connecting these things to process addictions like love, sex, shopping etc etc This was a great podcast with lots in it that seemed helpful to me. Thanks to both of you!

  • Patricia says:

    Hungry Ghost

  • Jennifer Charpentier says:

    This with conversation with Dr. Mate is still sending shock waves through my system and I listened to it the day it was posted. It has shown me a different facet of my alcoholism, made me consider my childhood with a new perspective and view my own parenting actions with a different pair of glasses…I want more information but I am almost afraid to read any of Dr. Mate’s books. Mind has tilted. Thank you once again for bringing fresh revelation to what it can mean to live a sober, recovered life.

  • clay schermerhorn says:

    I almost quit listening to this within the first few minutes…something just wasn’t clicking. Fortunately I stuck with it and am so grateful as this was one episode that I needed to hear desperately . This was one of the deepest-connecting episodes for me yet…from dealing with some long-standing “issues”, my experiences as a child, and to my experiences with our children. Rich, thank you so much not only for these podcasts alone, but introducing us to these beautiful people week after week.

  • Annie says:

    I love your podcast Rich, in fact it is my favorite. But sorry to be so blunt, I really hated this episode. Not your fault, I just didn’t resonate with Gabor Mate. I feel he is so full of himself and wanted to shovel some “truth” down your throat about your childhood. The guy is not very humble and cannot have a response to everything yet he kept contradicting every single sentence you said. I am an addict myself and I admit he has interesting points of view on the topic… But wow it was a torture to listen until the end. I didn’t have to, I know, but I really wanted to get something out of this… Every single comment is positive but I just needed to get this out of my chest in case someone else felt like me. I promise to post when I have something positive to say in the future. 😉 Keep doing amazing work Rich. -Annie

  • Patrick says:

    Thank you so much for this podcast Rich! I listened to it a few weeks back but still think about it often. It really helped me identify the things from my childhood that still cause me pain. Your podcast continually reminds me that I should be more vulnerable and courageous.


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