One of the six realms on the Buddhist Wheel of Life is the Hungry Ghost Realm, its inhabitants “creatures with scrawny necks, small mouths, emaciated limbs and large, bloated, empty bellies,” writes Dr. Gabor Maté in his excellent new book, In the Realm of Hungry Ghosts.

“This is the domain of addiction.” A ravaged German-Canadian man is one day quoting the final lines of Goethe’s Faust, the next delivering a drug-fuelled anti-Semitic diatribe; a woman, very pregnant and intent on keeping her baby, is found beaten up on the sidewalk and screaming for drug money: these are among the hungry ghosts Maté encounters in his job as resident doctor at the Portland Hotel on Vancouver’s Downtown Eastside.

One of the book’s strengths is Maté’s detailed and compassionate characterization of the afflicted addicts he treats, but this is not just a memoir. Rather, using his own experience as well as the most advanced recent research, he attempts to delineate the closely interrelated psychological, social, and neurological dimensions of addiction. He describes the ways in which it affects the chemicals and brain centres responsible for rewards and decision making, but he is also careful to point out that those neurological elements are related to the emotional life of the addict. “When the brain is diseased,” Maté writes, “the functions that become pathological are the person’s emotional life, thought processes, and behaviour.”

In the end, for Maté addiction is neither the result of the seductive power of heroin or cocaine or alcohol nor the expression of an identifiable genetic predisposition, but the consequence of childhood trauma, social and cultural dislocation, and a sense of spiritual emptiness and lack of meaning. If addiction involves destructive behaviours pursued irrespective of the consequences, triggered by the need to fill a chronic inner emptiness, then the long road to recovery requires what Buddhists call “mindfulness”: a calm, unjudging, compassionate attentiveness to what is happening within.