A Q&A with Dr. Gabor Maté: The Essential Elements of Successful Teen TreatmentFeb 15, 2022
"Q: What treatment services do you believe are needed in teen rehabs for the question of trauma to be addressed effectively?
Dr. Maté: A program for teens that addresses teen addiction has to recognize that the addiction is the teenager’s desperate attempt to escape from unbearable emotional distress. At the same time, this behavior is a reckless cry by a teenager, a frantic way in which they are asking for help. It’s a scream for help.
If you only address the behavior, if you only treat the addiction in the teen, then you are ignoring the actual message. The actual message is, “I’m suffering, and I need help.” By focusing only on the behavior, the root cause behind the behavior is completely missed. Ultimately, the person is not being helped for the root cause of the suffering.
Connection is Key
First, a program that addresses these problems in teens, specifically teen addiction and trauma, has to understand that these teens tend to lack good connections with adults. They are in deep need of adult leadership. That lack of connection is part of what led them astray. In many cases, even if they were loved and supported, a certain emotional contact and connection was lost. Due to childhood trauma, teens often break away from healthy family systems. They adopt maladaptive ways to relieve the pain. It does not matter exactly what happened to cause these problems because it’s not about blame. It’s about helping the child.
Without adult leadership, no animal and no mammal grows to be a healthy adult. All mammals need the protection and nurturing, the modeling of and the contact with the adult. In a program for teen addiction and rehabilitation, adult leadership is essential. A goal of any teen program should be to create nurturing, emotionally safe, welcoming relationships with the teens so they can feel secure enough to rely on the adults for guidance. After a safe place is created, the next learning stage needs to be based on trust and respect.
The Family System
Second, the program needs to recognize that the manifestation of addiction in the teenager represents a problem in the entire family. As much as possible, the family needs to be involved in the healing process as well. Many parents do not realize that the child’s problem is a sign of a greater problem that is damaging the entire family system.
Third, the program needs to address the issue of trauma in the child or the teenager. I don’t like when teenagers are no longer considered to be children. This fails to recognize the course of modern human development and the time it takes to become a mature adult.
Trauma cannot be ignored. There are many ways to treat trauma, but it has to be recognized and addressed within the context of a teen rehabilitation program.
Healing the Mind, Body, and Spirit
Fourth, kids need good food and physical activity in order to heal. Good nutrition needs to be an essential part of teen rehab. Ideally, teens are very active. They have growing bodies and they have a lot of energy. That energy needs to be expressed. They need a lot of physical activity—not necessarily competitive sports, but they need to be outdoors. They need to connect with nature, and they need to connect with their own bodies.
Next, teenagers often lack the general social skills of being able to listen to and relate to and be heard by others. They need help, in the right context, to develop those skills. As part of this, they need to be encouraged to develop the capacity for self-reflection. They need to be able to look at their thoughts and their emotions, and be curious about them and reflect on them. By forming a healthy relationship with themselves, they’ll be able to form healthy relationships with others.
Those are the basic requirements for a teen treatment program that’s going to work. Although it’s not that different from what is needed by adults in an addiction treatment program, the main difference is that, with teens, the adult guidance needs not only to be skilled, but also very emotionally connected. Emotional connection is at the root of the healing process.
Q: You mentioned that families need to take part in a teen’s recovery when dealing with teens and substance abuse and addiction. Why is such participation required in order to achieve sustainable healing?
Dr. Maté: According to the latest research and my understanding, teen addiction tends to be a result of family system issues. I make that statement not just as a clinician, but as a parent who has experienced it firsthand in my family. Parents need to understand that I’m not criticizing anybody, because I’m in no position to criticize anybody. My own children have faced these issues, and I understand how I contributed to that process. I do not want to blame parents, because I know parents do their best and parents love their kids. It is not a question of whether we did our best or whether we love our children.
Q: Many rehabs today avoid using the label “addict” because of the negative stigma attached to addiction in our society. Does the language of addiction need to be changed in order to overcome this stigma of drug addiction?
Dr. Maté: Yes. The problem with words is that they become saddled with connotations that weren’t there when the word was originally coined. A perfect example is the word “neurotic.” Neurotic used to be just a medical definition for somebody with anxiety, but now it’s become pejorative: “Don’t be so neurotic.”
It’s the same with the word “addict.” Addiction used to have no negative meaning at all. It didn’t mean addiction in the way that we use it today. It had a totally different meaning. An addictus in Latin was somebody who failed to pay a debt to a lender or even to a friend, and therefore had to become a slave to them. Addiction comes from a word that means to assign someone or something to another person. Addictus meant you were assigned to the person that you owed as a slave to repay the debt.
The Consequences of Stigma
Up until modern times, to be addicted to something did not necessarily mean a pathological relationship with that thing. It also could mean that this was what you really loved to do and wanted to do. You could be addicted to agriculture, not in the sense of a modern-day addict, but in the sense that this is what you loved to do. This is what you are most focused on in your life. At the same time, of course, the root addictus also carries the connotation of slavery. From that point of view, it’s a perfectly good word because addiction is a kind of slavery. From my own personal experience, when I was addicted to my behaviors of addiction, I was a slave to them. I had no control over them. They controlled me. That’s the definition of slavery.
Nothing is inherently wrong with the word. The problem is the stigma attached to addiction, and the stigma doesn’t come from the word. The stigma comes from our lack of understanding of how somebody becomes a slave to a habit. A stigma comes from our lack of appreciation of the suffering that drives addiction.
Redefining Our Understanding
From my point of view, it’s not a question of playing with words. It’s a question of redefining our understanding of what addiction and more specifically, teen addiction, actually is. If it makes some people feel better to use a different word, I’m not going to argue with that. For me, however, it’s not a question of changing words. It’s a question of changing attitudes. The question is whether or not we are going to have compassion when confronted by the suffering and the trauma that lies behind the addiction."
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