PsychEd Episode 56: Understanding Trauma and Addictions with Dr. Gabor Maté

PsychEd: educational psychiatry podcast

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers trauma and addictions with Dr. Gabor Maté, a retired physician who, after 20 years of family practice and palliative care experience, worked for over a decade in Vancouver’s Downtown East Side with patients challenged by drug addiction and mental illness. The bestselling author of five books published in thirty languages, including the award-winning In the Realm of Hungry Ghosts: Close Encounters with Addiction, Dr. Maté is an internationally renowned speaker highly sought after for his expertise on addiction, trauma, childhood development, and the relationship of stress and illness. For his groundbreaking medical work and writing he has been awarded the Order of Canada, his country’s highest civilian distinction, and the Civic Merit Award from his hometown, Vancouver. His fifth book, The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture was released on September 13, 2022.

The learning objectives for this episode are as follows:

By the end of this episode, you should be able to…

1. Understand the connection between trauma and the development of addictions and other mental illnesses

2. Critically reflect on current diagnostic and treatment paradigms

3. Apply principles of trauma-informed care to psychiatric assessment and the provision of mental health services

Guest: Dr Gabor Maté

Hosts: Sena Gok, Rhys Linthorst, Angad Singh, Nikhita Singhal, and Alex Raben

Audio editing by: Sena Gok

Show notes by: Nikhita Singhal

Interview Content:

• Introduction - 0:00

• Learning objectives - 01:43

• Defining trauma - 02:14

• Current dominant views of addiction - 07:27

• Defining addiction - 11:05

• Relationship between trauma and addiction - 16:15

• Neurobiology of addiction - 17:20

• Brain development - 25:48

• Genetic susceptibility - 36:10

• Trauma-informed approach to treatment - 39:45

• Importance of therapeutic relationships - 44:10

• Societal barriers - 48:15

• Harm reduction - 54:32

• Closing comments - 01:00:14

Resources:

• Books:

• In the Realm of Hungry Ghosts (Gabor Maté)

• The Myth of Normal (Gabor Maté)

• The Body Keeps The Score (Bessel van der Kolk)

• The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions (Jaak Pansepp, Lucy Biven)

• Dr Gabor Maté’s website: https://www.drgabormate.com

• Adverse Childhood Experiences (ACEs) study: https://doi.org/10.1016/s0749-3797(98)00017-8

• More information on ACEs from Harvard University’s Center on the Developing Child: What Are ACEs? And How Do They Relate to Toxic Stress?

• Compassionate Inquiry (psychotherapeutic approach developed by Dr Gabor Maté)

References:

• Brown, T., Berman, S., McDaniel, K., Radford, C., Mehta, P., Potter, J., & Hirsh, D. A. (2021). Trauma-Informed Medical Education (TIME): Advancing Curricular Content and Educational Context. Academic medicine: journal of the Association of American Medical Colleges, 96(5), 661–667. https://doi.org/10.1097/ACM.0000000000003587

• Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/

• Colon-Rivera Hector, A., Aoun, E. & Vaezazizi, L. M. (2023). Addiction Psychiatric Medicine: A Comprehensive Board Review. Elsevier.

• Dugosh, K.L. & Cacciola J. (2022). Clinical assessment of substance use disorders. In J. A. Melin (Ed.), UpToDate. Retrieved from https://www.uptodate.com/contents/clinical-assessment-of-substance-use-disorders

• Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8

• Fundamentals of Addiction: Screening. CAMH. Retrieved from https://www.camh.ca/en/professionals/treating-conditions-and-disorders/fundamentals-of-addiction/f-of-addiction---screening

• Michaels, T. I., Stone, E., Singal, S., Novakovic, V., Barkin, R. L., & Barkin, S. (2021). Brain reward circuitry: The overlapping neurobiology of trauma and substance use disorders. World journal of psychiatry, 11(6), 222–231. https://doi.org/10.5498/wjp.v11.i6.222

• Olsen Y. (2022). What Is Addiction? History, Terminology, and Core Concepts. The medical clinics of North America, 106(1), 1–12. https://doi.org/10.1016/j.mcna.2021.08.001

• Panksepp J. (2011). The basic emotional circuits of mammalian brains: do animals have affective lives? Neuroscience and biobehavioral reviews, 35(9), 1791–1804. https://doi.org/10.1016/j.neubiorev.2011.08.003

• Powers, A., Petri, J. M., Sleep, C., Mekawi, Y., Lathan, E. C., Shebuski, K., Bradley, B., & Fani, N. (2022). Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample. Journal of anxiety disorders, 88, 102558. https://doi.org/10.1016/j.janxdis.2022.102558

• Shonkoff, J. P., Richter, L., van der Gaag, J., & Bhutta, Z. A. (2012). An integrated scientific framework for child survival and early childhood development. Pediatrics, 129(2), e460–e472. https://doi.org/10.1542/peds.2011-0366

• Volkow, N. D., & Li, T. K. (2004). Drug addiction: the neurobiology of behaviour gone awry. Nature reviews. Neuroscience, 5(12), 963–970. https://doi.org/10.1038/nrn1539

CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association.

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