I just started reading this, and I'll take you through it with me as I did with The Heart of Addiction. Again, I'm reading in small chunks to digest it more thoroughly.
The author uses an unusual organizational style. Each chapter's point is summarized by delving into one real-life story.
The opening stories are those of some truly unhappy people, the "junkies" who live on the streets or in government housing. Their lives often began, and then continued, with some truly horrific abuse. This isn't "my mother belittled me." This is "my mother shut me in the dryer for hours at a time."
No one with an ounce of compassion would deny that these stories are horrible. Mate's gift, such as it is, is in linking those wounded people to the addicts they currently are. It's easy to understand their unbearable inner state, their endless, bottomless, need for something to dull the pain and make them happy.
These people aren't the so-called functional addicts, and so probably aren't the ones who buy and read these books. I expect he'll get to that later. Amazon reviews indicated that Mate was able to make the leap needed to tie these more dramatic tales in with the more common compulsions hidden among the functional addicts.
It's quickly apparent that he rejects the falsified "disease" hypothesis. Indeed, "rejects" isn't quite the right word since he never brings it up -- it's quite cheering, really, to see that a dumb idea which has been mucking things up since the late 70's is finally going into the dustbin of history. People are seeing less and less need to pretend that behavior can be a disease. We'll gradually revise the taxonomy to be more accurate, and some day addictions won't be treated differently from other compulsions (and none of them will be "diseases").
Anyway, back to the book.
Aside from talking about early experiences which left addicts as vulnerable people, he talks about the role drugs play in their lives. They may, for example, make isolation bearable or make it easier to overcome. For one woman, drugs were the only thing she shared with her mother.
It's sad reading.