Mohamad Shabib
Registered Psychotherapist (Qualifying) · September 16, 2026
In the Realm of Hungry Ghosts: Close Encounters with Addiction is Gabor Maté's attempt to explain why people keep returning to drugs and other habits that are hurting them. His answer is that addiction is a way of relieving pain, pain that can begin with stress and adversity early in life, and that it calls for compassion more than blame.
This guide is commentary, not a stand-in for the book, which you can borrow from a library or find at a bookstore.
The main message is that addiction makes more sense once you ask what it does for the person. Maté treats compulsive use as a way of calming fear and discomfort, and his page for the book frames addiction as a problem of human development rather than of character. His patients' stories are real, and we leave them to the book.
Yes. Gabor Maté is a retired medical doctor. After twenty years in family practice and palliative care, he spent twelve years in Vancouver's Downtown Eastside as staff physician for the Portland Hotel Society, a housing and harm-reduction non-profit, working with people living with addiction and mental illness. He was appointed a Member of the Order of Canada in 2018 (Governor General of Canada), and the book won the 2009 Hubert Evans Non-Fiction Prize.
A hungry ghost is a figure from Buddhist tradition, and Maté uses it as an image of craving that no amount of a substance or behaviour can fill. Hungry ghosts, or pretas, are pictured with swollen bellies and needle-thin throats, so their hunger is never satisfied (McNicholl, Tricycle, 2025).
Some early Buddhist texts portray pretas as departed family members helped by offerings from the living, with their state traced to stinginess in a past life. Some Buddhists read them as a picture of greed and others of addiction, the reading Maté's title draws on.
Maté's short answer is pain, especially pain that starts early, and he plays down genes. His main ideas, in our own words:
Neither, in Maté's framing: his book page rejects both labels, genetic disease and individual moral failing, and he treats addiction as a response to pain shaped by development and circumstance. Health Canada also rejects blame but frames addiction differently, as a treatable medical condition rather than a choice, with trauma, chronic stress, environment, mental health and genetics among contributing factors.
No. The evidence does not show that trauma is the root of every addiction, or that it explains addiction in any one person. Maté's own site says he is not claiming that everyone with an addiction was traumatized or abused as a child; he traces addiction to emotional loss, with trauma as one source.
Support comes from research on adverse childhood experiences (ACEs), such as abuse, neglect or household dysfunction. In a 2003 survey of more than eight thousand six hundred adults at a California primary care clinic, each category of adversity was linked to two to four times the likelihood of starting illicit drug use in early adolescence, and people with five or more reported drug use problems, addiction and injection drug use at seven to ten times the rate of those with none. Assuming the link is causal, the authors estimated that these experiences could account for one half to two thirds of serious drug use problems in that group (Dube et al., 2003, Pediatrics).
These findings have limits: adults recalled childhood years later, and a group pattern does not prove cause for any one person. Psychologist Nick Haslam calls the link between childhood adversity and problem drug use solid but far from a one-to-one rule. He notes that even severe hardship does not make the majority of people who go through it ill or impaired, and calls Maté's broader view, which puts trauma at the centre of ill health in general, one-sided (Haslam, The Conversation, 2023).
Not one that causes addiction on its own, but genes matter, and critics say Maté plays them down too far. Haslam calls Maté's statement that no single addiction gene has been or will be found false, unless an addiction gene has to cause addiction by itself, a test nothing else would pass either. The US National Institute on Drug Abuse (NIDA) says scientists estimate that genes, including environmental effects on how genes are expressed, account for forty to sixty per cent of a person's risk of addiction.
So a family history of addiction can raise your risk, but NIDA says no single factor determines whether someone becomes addicted.
Critics argue that a humane message comes with claims about causes that outrun the evidence. In a 2011 Psychology Today blog post, Stanton Peele, PhD, and Alan Cudmore called Maté's account of childhood trauma altering brain chemistry speculative and a poor fit with the data. They said it overlooks people who recover naturally, including without formal treatment, and, while praising his humane medical work, argued that his model distracts from harm reduction's wider goals. A later addendum by Peele adds that treating trauma's effects as permanent is untrue and unhelpful.
None of this cancels the book's case for compassion, and if your own use began as a way to cope with something painful, that connection still deserves attention.
Maté argues that the war on drugs deepens addiction by adding stress and pushing people further to the margins, as he told Democracy Now! in 2010. At the Portland Hotel Society, he helped develop harm reduction initiatives, which aim to reduce the damage from drug use without requiring a person to stop first. TEO Counselling takes no position on drug policy here; the overdose steps below follow Health Canada's guidance.
The book may suit you if you want to understand why someone you love keeps using despite the cost, or whether your own habits fit Maté's pattern. It also argues against a fear people can be embarrassed to say out loud: that needing something this badly means you are weak.
Consider reading it with a professional's support if:
It is worth considering if you want a compassionate account of addiction from a physician who worked in the Downtown Eastside, with two cautions. Treat its claims about trauma, genes and the brain as one clinician's thesis, not settled science. And use it to understand addiction, not as a recovery plan: a book cannot assess risk or notice when things are getting worse.
Maté's central question, what use gives a person as well as what it costs, is one counsellors can explore in addictions recovery counselling, alongside practical steps agreed together.
Mohamad Shabib, MACP, CCC, is a Registered Psychotherapist (Qualifying) with the College of Registered Psychotherapists of Ontario (CRPO). He is trained in Motivational Interviewing, a collaborative way of exploring your own reasons for change, and in CBT (cognitive behavioural therapy) for Addictions. He holds a graduate diploma in addiction treatment and prevention, leads TEO's work on compulsive porn use, and works with clients in British Columbia, Ontario, Alberta, Saskatchewan, Manitoba, and Newfoundland and Labrador, in English or Arabic.
Rola Shbib, Registered Social Worker, RSW (Ontario) #866715, supports clients with addictions, substance use and grief, in English, in the same six provinces.
Where trauma keeps use going, Mohamad is also trained in CBT for Trauma (Levels 1 and 2) and has Advanced EMDR training through an EMDRIA-approved programme. Focusing on trauma is a shared decision, not a requirement. If faith, or family expectations about alcohol and drugs, shape how you feel about use, you can bring that into sessions too; see spiritually integrated therapy.
TEO Counselling is an online practice with no prescribing, diagnosis, medical monitoring, detox or supervised consumption services, and it does not offer Compassionate Inquiry, Maté's own therapeutic method.
Individual sessions are $150 per 60 minutes, and no referral is needed. The first step is a free 15-minute consultation by video or a scheduled phone call, booked online.
This guide is commentary on In the Realm of Hungry Ghosts. It is not a substitute for reading the book, and it is not a substitute for professional help. To talk through your own use or a family member's, book a free consultation, or text (519) 760-5211 with a question first. This text line is not a crisis service.
Gabor Maté argues that addiction is an attempt to relieve pain, pain that can begin with stress and adversity early in life, and that it calls for compassion rather than shame, moral judgement or punishment. He places street drug use on the same spectrum as compulsions that pass as respectable, such as overwork or shopping.
Yes. Gabor Maté is a retired physician who trained at the University of British Columbia. His own biography describes twenty years of family practice and palliative care, followed by more than a decade of work in Vancouver's Downtown Eastside with people living with addiction and mental illness. Secondary sources add that he was the staff physician for the Portland Hotel Society, a housing and harm-reduction non-profit there, for twelve years. He was appointed a Member of the Order of Canada in 2018.
The title borrows the hungry ghost, or preta, from Buddhist tradition: a being pictured with a swollen belly and a needle-thin throat whose hunger is never satisfied. Maté uses it as an image of craving that no amount of a substance or behaviour can fill. Some Buddhists read hungry ghosts as a metaphor for greed and others as a metaphor for addiction, while some early Buddhist texts portray them as departed family members helped by offerings from the living.
No. Research on adverse childhood experiences shows a strong link between childhood adversity and later drug problems, but it is an association across groups, not proof of cause for any one person, and Maté's own site says he is not claiming that everyone with an addiction was traumatized or abused. The US National Institute on Drug Abuse says scientists estimate that genes, including the effects of environment on how genes are expressed, account for between forty and sixty per cent of a person's risk of addiction, and that no single factor determines whether someone becomes addicted.
Critics say his claims about the causes of addiction go further than the evidence. Psychologist Nick Haslam argues that Maté's broader view, which puts trauma at the centre of ill health, is one-sided, and calls false his statement that no single addiction gene has been or will be found. Stanton Peele and Alan Cudmore called his account of trauma altering brain chemistry speculative and a poor fit with the data, said it overlooks natural recovery, and argued that it distracts from harm reduction's wider goals, while praising his humane medical work.
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