In the Brahmajala Sutta, the spiritual master Gautama—known to us as the Buddha—says that many pleasures are addictive. Any repeated behavior has the characteristic of addiction, if the addicted person cannot resist. Dr. Aviel Goodman considers all addictive disorders as sharing the same characteristics of what he calls “the addictive process” (224). Craving and shame are common factors in all forms of addiction. They commonly lead to deception, which can lead to guilt and self-loathing on the part of the addict who lies.

Maté examines pathological gambling as an example of this concept of pleasure as addiction. Studies suggest that chronic gamblers have low serotonin and high dopamine levels. The feeling of pleasure—largely due to the anticipation of winning—prior to gambling, activates the reward circuits of the brain, which are the same circuits playing a pivotal role in drug addiction.

Compulsive overeaters and shoppers experience the same fluctuations. Their dopamine levels rise and they find themselves propelled into the addictive behavior as the thinking parts of the brain go away.

While working on In the Realm of Hungry Ghosts, Maté asked his son Daniel for edits. After helping him, Daniel wrote him a letter. In the letter, he describes Maté’s CD addiction as confusing and pathetic, and states that that he did not understand it as a child.