Notes from the ASAM Review Course in Addiction Medicine

[MY COMMENTS ARE BRACKETED IN BLUE] and I have colored red important concepts about which I have written articles on this web site as well as discussed in Hypoics Handbook. Much of what is discussed herein is exactly what Hypoism is. In terms of etiology, these two neurobiologists still wrongly use the term "environment and chronic drug use" even though they have no data on environmental etiology. Other than this, what they say is Hypoism. What they don't comment on is that Hypoism has implications on recovery about which they are not aware because this is not part of their expertise. Gardner's comments about the ineffectiveness of current therapies is at least an honest assessment unlike NIDA's official line on that. You should know that I talked to Gardner about Hypoism many years ago and sent him my book over a year ago. Since then he has come closer to Hypoism, especially his comments about the key role of the limbic "thinking" and decision-making in addictions and lack of conscious control, though he doesn't acknowledge Hypoic's Handbook, concepts he wasn't writing about before talking to me. How I get them to acknowledge Hypoism in all its facets is beyond me.

I do believe it is dishonest for them not to recognize Hypoic's Handbook, the book that has already described the complete paradigm they are just beginning to discover.

The Power of SPAM:

Carlton Erickson, PhD - of the University of Texas College of Pharmacy, Austin, TX - observed that until relatively recently the field of addiction treatment and prevention drifted aimlessly due to insufficient research evidence. There also has been much misinformation about just how addicting drugs work in the brain. [I've been saying this for over 8 years and they are just saying it today after denying it all this time.]

Persisting negative attitudes have harmed the quality of patient care and have hindered funding for prevention, education, and research in addiction. Erickson portrayed these negative influences as "SPAM" - Stigma, Prejudice, And Misunderstanding. Among other damaging outcomes, SPAM leads to unfairness toward certain treatment options, belittling of patients, and lack of insurance coverage. [I've been saying this for years. This is exactly what has happened to me. read: http://www.nvo.com/hypoism/thedoctordrugwarwrongandwastefulp1/]

He said that the picture is rapidly changing thanks to scientific research indicating that the brain's pleasure/reward pathway - consisting of cells and structures deep within the brain is affected by all addictions. However, addiction does not automatically occur with a particular drug; rather, individual factors of genetics, environment, and chronic drug use play key roles in susceptible persons. [The etiology is their primary conceptual problem and is clarified in Hypoic's Handbook. They are not allowed to agree with it, however, because it is politically incorrect for them within their culture of power, the NIDA. SPAM will never be corrected until Hypoism is in place because it clarifies the "conscious choice dilemma" of the hijacked brain hypothesis.]

Pirating Pleasure:

Eliot Gardner, PhD - Senior Research Scientist at NIDA's Intramural Research Program, Washington, DC - observed how one might consider the addictive power of certain drugs as an accident of nature. [refer to my article: http://www.nvo.com/hypoism/thehypoismaddictionhypothesis/] He has written, for example, that the poppy and coca plants quite unintentionally produce chemicals (morphine and cocaine) capable of "pirating" the pleasure pathways of the brain. Alcohol, a byproduct of natural fermentation, acts similarly, as does practically every other addicting substance. [Refer to my article: http://www.nvo.com/hypoism/aimingatanunderstandingofaddictions/]

The brain's pleasure/reward pathway is necessary for survival since it motivates important activities such as food seeking and eating, mating, and parenting. Unfortunately, those same parts of the brain that are stimulated by natural pleasures and rewards are also stimulated by addicting substances.

Both Gardner and Erickson stressed that a key characteristic of drug addiction is impaired control over the compulsion to use drugs and the inability to stay away from them if the person tries to stop. This is probably caused by abnormal functioning of pleasure/reward structures. [Not the conscious part of the brain, the cortex. Refer to my article: http://www.nvo.com/hypoism/hypoisminanutshell/]

The important point here is that, since these sites of addicting drug action are located well inside the brain, and not in the cerebral cortex - which is the outermost, thinking part of the brain - addictions are not primarily under conscious control.

That is, addictive behaviors are not simply problems of weak willpower, poor judgment, or corrupt morals. Furthermore, a person cannot simply think hislher way out of addiction. [They don't think their way into or out of addictions - a key addition to this statement.]

Brain Chemistry Disease:

According to Erickson, addiction is essentially a brain chemistry disease and addicting drugs seem to "fix" chemical disturbances in the brain, at least briefly. Gardner observed that different addictive drugs enter the brain's pleasure/reward centers at different sites and affect the brain in different ways. The various effects of addicting drugs are due to the way in which a given drug can disrupt [I would use the word ALTER not disrupt] brain functioning.

Gardner further proposed that vulnerability to drug addiction may be caused by unusually low levels of certain natural chemicals in the pleasure/reward system. [HYPOISM] People with such chemical imbalances get a greater "kick" from certain addicting drugs than persons with normal brain chemistry. In fact, those drugs actually may produce unpleasant feelings in "normal" persons, motivating them to avoid the drugs. [Thus the concept of CHOICE is irrelevant to "normal" people and unrelated to hypoics because there is no "conscious" choice about using addictors. The inability to conceive of this sentence is the reason addictionology has made no progress in understanding addictions in spite of their knowledge of the basic neurobiology. They understand the cellular and receptor issues but not the issue concerning what mechanism in the brain is effected by that neurobiology. Moreover, non-hypoics can't identify with hypoic use of addicting drugs.]

Erickson similarly suggested that when an addictive substance stimulates certain brain centers, it may satisfy an unfulfilled chemical need in the brains of susceptible persons. It's as if their brains respond to the drug, "Welcome. You're just exactly what I've been waiting for!" [Exactly what Hypoism says.]

Getting Straight:

Stress and depression can trigger relapse to drug-taking, Gardner explained. Environmental cues - people, places, things - also play crucial roles.

With chronic use of certain drugs, like opioids, the depression, anxiety, and restlessness that follow drug use become unbearable. Under these circumstances, Gardner has written, the addicted person no longer uses drugs to get a "rush" or "high," but simply to get back to feeling what they consider as better or "normal" (to "get straight" in street parlance).

Erickson suggested that a goal of addiction treatment is to improve function in the proper brain areas. [This is a mistake that Erickson needs clarifying because he hasn't thought through the claim. Attempts to improve functioning of the hypoic brain WITH DRUGS is what causes addictions in hypoics. In actuality, acknowledgment and acceptance of neurotransmitter deficiencies is what is needed for real recovery, not change. Recovery from the disease instead of from the addictions is missed by current addiction "experts" because they are ignorant of the disease that causes all addictions, Hypoism. Recovery from Hypoism via the steps set out in Hypoic's Handbook, steps that are derived from the actual neurobiology of the disease is being ignored because of this ignorance. All addicts suffer from not knowing about it, but no one in the field will tell them about it!] The success of methadone maintenance is evidence that many people need and benefit from pharmacologic therapy for a prolonged period to overcome abnormal brain chemistry. [This, of course, is a major error in Erickson's thinking because he is ignorant of drug-free recovery and its many advantages over chronic addiction to Methadone. I strongly confront him on this bias.]

He also has written that the emotional, interactive, sometimes stressful process of recovery via behavioral therapy programs and/or 12-step groups also may be associated with at least temporary positive changes in brain chemistry. And such changes may eventually engender a decreased need for the addictive substance.

Physical Dependence:

Gardner emphasized that the brain pathways producing desired effects of addictive drugs are entirely separate from those causing physical dependency (and subsequent drug withdrawal or abstinence syndrome). Some drugs, such as cocaine, are very addicting, yet they produce no physical dependence.

Furthermore, research has clearly demonstrated that drug taking behavior cannot be explained simply in terms of the ability of addicting drugs to ease or overcome the withdrawal discomfort as drug effects wear off. That is, the need to constantly avoid unpleasant withdrawal effects does not account for continued drug addiction.

Withdrawal can be basically understood as a physiological "rebound" effect [Neurophysiological Adaptation], Gardner explained. If chronic drug administration and/or intoxication causes one bodily effect, withdrawal from the drug will typically cause an opposite reaction.

For example, opioids may produce constipation, whereas opioid withdrawal produces diarrhea. Withdrawal from sleep medications (sedative-hypnotics) often produces insomnia.

Of course, unpleasant withdrawal effects can be quickly ended by more drug-taking. However, the importance of physical dependence and the need to overcome withdrawal effects in drug addiction should not be overstated, Gardner cautioned. Explanations of continued drug taking merely based on tolerance, physical dependence, and/or avoidance of withdrawal symptoms do not paint the whole picture.

Role of Thinking:

A major unresolved question is how input from the thinking, outer portion of the brain might come into play in addiction and recovery. As noted above, Gardner and Erickson suggested that during active addiction more primitive brain centers in the pleasure/reward pathway dominate and drug-taking becomes involuntary or, at the least, not entirely under conscious control.

In this regard, Gardner has acknowledged early 19th century descriptions of drug addictions as being impulse control disorders: "Voluntary control is profoundly impaired. The patient is compelled to perform acts which are dictated neither by his reason nor his emotions acts of which his conscience disapproves of, but over which he no longer has willful control. [What he leaves out is that initial use of the addictors is likewise involuntary - a concept current addictionology is biased against but that genetics of addictions compels.]

The notion of addiction being related to OCD might open new doors for therapeutic strategies. [I have had OCD on my list of addictions for 10 years. They are just getting around to considering this.]

Along similar lines, Erickson wondered whether addictions might be appropriately considered obsessive-compulsive disorders (OCD). That is, those afflicted think about the substance or behavior all the time (obsession) and end up repeatedly taking the drug or behaving uncontrollably (compulsion). [DUH]

For example, David observed that OCD occurs 2 to 3 times more often in alcoholics and other drug dependent persons than in the general population. The notion of addiction being related to OCD might open new doors for therapeutic strategies of interest to psychologists and counselors. [What they don't yet see is that the disorder is Hypoism, a brain mechanism, and the individual addictions are but the symptoms, not diseases in themselves.]

Overcoming Hurdles:

A series of seemingly insurmountable hurdles appear to be erected in the path of drug-dependent persons wishing to recover and stay abstinent. What is the solution?

Gardner has written that there are surprisingly few clearly effective and FDA-approved medicines for treating drug addiction, including methadone and LAAM maintenance for opioid addiction (with buprenorphine awaiting approval); naltrexone and disulfiram for alcoholism; and nicotine substitution therapy and bupropion for tobacco dependence. Strategies solely based on talk therapy, group therapy, behavior modification, and economic incentives have had limited success. [As you would expect because they don't deal with the correct and actual brain mechanism that causes addictions. How will they find the correct therapies without getting the etiology correct? They won't. Thus, the need for Hypoism, the complete and correct paradigm.]

The many presentations at the ASAM Course made it clear that better solutions will be found through continuing scientific research. [And, only if they open their closed minds to Hypoism, the addiction paradigm that already has clarified everything about addictions from etiology to recovery.]