The whole business with addictions centers around this system
AIMING AT AN UNDERSTANDING OF ADDICTIONS
Here's your quote for the day: "Most human misery comes from either the misinterpretation
of reality or from the misunderstanding of reality."---Umanoff
Misery from misinterpretation and misunderstanding of addiction
is included. The human brain works in such a way as to make this
misery practically inevitable. Hopefully, my understanding of
the brain and addiction as outlined below can help others to allay
[CRITICAL CONCEPTS, CONCEPTS YOU MUST UNDERSTAND TO COMPREHEND
THIS ARTICLE, ARE IN RED OR BLUE.
If you don't understand these statements, please let me know and
I will help you with them.]
The whole business with addictions starts with and centers around
the system diagrammed below. It begins here, with the reward cascade,
and grows in concentric circles, each larger, each heading towards
the ultimate behavior, addiction or no addiction. All explanations
of and treatments for addiction must take this system and its
workings into account. Moreover, the disease we envision and utilize
to explain the cause of addictions, must take into account the
entire system, not merely the reward system or just the behavior.
Here are the circles. The FOKS is defined in: http://www.nvo.com/hypoism/whatshypoismwhatsanaddiction/
The Behavior System
(In the case of addictions, the addiction is the behavior)
As you can see from this diagram, there are many physiological
steps between the reward cascade neurobiology and the ultimate
behavior, addiction. One cannot simply explain addictive behaviors
by the mere outlining of the physiology of the reward system.
Likewise, one is in deep trouble in dealing with addictions if
one expects interventions solely at the level of the reward system
to "cure" addictive behaviors. Similarly, because of
these many steps, we wouldn't expect a single gene to be responsible
for addictions. There are many places in this system where genetic
alterations can cause addictions, and, thus, we would expect many
possibilities of where altered genes programming for functional
changes in this system would be capable of causing addictions.
How do we know this is the system where the pathophysiology of
addiction resides? Look at the prototypical experimental addiction
paradigm, the animal who has had a fine electrode placed in
certain positions of the brain under MRI or surgical guidance.
This animal will perform practically any task endlessly to receive
small electrical shocks into only these parts of the brain. The
animal will prefer these tiny shocks over sex, food, and water,
and put up with painful aversive stimuli even to the point of
death. Practically any animal will respond with addiction this
way in the presence of the electrode. When the brains of these
animals are dissected, it is found that this behavior can be elicited
only along a specific neural tract in the mesolimbic region of
the brain, the so-called pleasure center, reward system or reward
cascade: from VTA to Acc (DA) and the ICSS in the diagram below.
of the brain-reward circuitry of the mammalian (laboratory rat)
brain, with sites at which various abusable substances appear
to act to enhance brain-reward and thus to induce drug-taking
behavior and possibly drug-craving, ICSS, descending, myelinated,
moderately-fast-conducting component of the brain-reward circuitry
that is preferentially activated by electrical intracranial self-stimulation;
DA, subcomponent of the ascending mesolimbic dopaminergic system
that appears preferentially activated by abusable substances;
Raphe, brain stem serotonergic raphe nuclei; LC, locus coeruleus;
VTA, ventral tegmental area; Acc, nucleus accumbens; VP, ventral
pallidum; ABN, anterior bed nuclei of the medial forebrain bundle;
AMYG, amygdala; FCX, frontal cortex; 5HT, serotonergic
(5-Hydroxytryptomine) fibers, which originate in the anterior
raphe nuclei and project to both the cell body region (ventral
tegmental area) and terminal projection field (nucleus accumbens)
of the DA reward neurons; NE, noradrenergic fibers, which originate
in the locus coeruleus and synapse into the general vicinity of
the ventral mesencephalic DA cell fields of the ventral tegmental
area; GABA, GABAergic inhibitory fiber systems synapsing upon
the locus coeruleus noradrenergic fibers, the ventral tegmental
area, and the nucleus accumbens, as well as the GABAergic outflow
from the nucleus accumbens; Opioid, endogenous opioid peptide
neural systems synapsing into both the ventral tegmental DA cell
fields and the nucleus accumbens DA terminal projection loci;
ENK, enkephalinergic outflow from the nucleus accumbens; DYN,
dynorphinergic outflow from the nucleus accumbens; GLU, glutamatergic
neural systems originating in frontal cortex and synapsing in
both the ventral tegmental area and the nucleus accumbens.
For perspective, it needs to be known
that the reward system as pictured above in a mouse, first developed
several hundreds of millions of years ago in reptiles, our evolutionary
predecessors, to reward instinctive
In fact, earth worm's brains contain
a neurotransmitter chemical, octopamine, very similar to dopamine,
which was probably used for the same rewarding purposes in even
these more primitive organisms. Thus, the concept of neurotransmitter
reward of instinctive behavior is very very old one evolutionarily.
Today we have fifty or more neurotransmitters acting in or on
or around this system, but the end result is still the same, release
of dopamine in the nucleus accumbens. As you will discover on reading
further, the human reward system has evolved over these hundreds
of millions of years to reinforce and evaluate instinctive behaviors
of all animals from primitive reptiles up the evolutionary ladder.
Every instinct is neurobiologically hard-wired
and is wired to the reward system.
All addictive chemicals, drugs, act on the same receptors designed
for these neurotransmitter that have evolved to regulate and modulate
decision-making and survival behavior. I discuss this more completely
in another article at: http://www.nvo.com/hypoism/thehypoismaddictionhypothesis/
To complete the evolutionary perspective I briefly introduce below
the basics of the modern human brain set up:
At a basic evolutionary level, the brain is organized in three
parts (the tripartite brain): 1) The reptilian brain brainstem
(BODY): controls automatic life support and basic motor functions,
and the basic instincts of territorial acquisition and defense,
dominance striving, agonistic threat displays, and mating. 2)
The limbic (early mammalian) system (HEART or SOUL): assigns
emotional context (emotional evaluation) to real situations and
memory for decision-making purposes, and allows for and programs
mammalian instincts. 3) The cortex (HEAD): does the rational
thinking, analyzing, coordinating, calculating, and the associating
of real and imaginary information, assigning meaning as well as
use of language, speech and complex motor function. The key to
the anatomy diagram below: Reptilian is black, Limbic (early mammalian)
is shaded, and Cortex (late mammalian) is white. Words in parentheses
are mine. For comparison, I place the circle diagram next to the
tripart brain diagram of MacLean.
On the left is MacLean's Tripartite Brain
(from MacLean, P. D. (1973)
A Triune Concept of the
Brain and Behavior,
University of Toronto Press, Toronto)
The structural parts of the reptilian brain are NUCLEUS
ACCUMBENS, basal ganglia, olfactory tubercle, and
the corpus striatum.
The limbic parts of the brain are cingulate cortex, fornix, HIPPOCAMPUS,
, amygdala, prefrontal cortex, hypothalamus, and parts of the
thalamus, and the pituitary gland delineated in the picture of
the brain cut sideways below. You can see from this comparison
just how ancient are the unconscious parts of the brain that affect
To continue, the same kind of behavioral
response can be elicited from these animals when, instead of electric
shocks, certain drugs are placed in these same brain areas and
never in others via micropipettes. All known addicting chemicals
have been shown to interact somewhere along this neurological
along this neurological system, somewhere along the length of
the system, but not all at the same place (as seen in the diagram).
All addictive chemicals, though, do ultimately cause release of
dopamine at the nucleus accumbens as an end result. This release
of dopamine is the conscious experience of pleasure, the felt
reward or high, to use the vernacular. (Similarly, all
instincts cause stimulation and activation of this system.)
There may be other brain
drug effects when these same drugs are ingested systemically,
but it is the dopamine release at the nucleus accumbens that is
the ultimate neurobiological change, recognized consciously in
a person as a change in feeling, that accompanies addiction in
those who eventually become addicted. This is exactly the same
phenomenon as occurs in animals with electrical stimulation of
the reward cascade, although not as intense, not to the same degree.
Simultaneously, many unconscious neurobiological processes are
occurring that also ensure addiction in those susceptible to addiction
and its perpetuation (neurophysiological adaptation). The reward
system is, however, the proximate end point resulting in addiction.
Unlike with electrical stimulation, not all animals get addicted
to drugs when administered systemically. Some pure bred strains
of animals do get addicted this way, though, some to one chemical
and others to other chemicals. Many of these strains do so "voluntarily,"
as a sign of preference, genetically determined. This is quite
similar to our experiences with humans. Some humans get addicted
and others, exposed to the same drugs and behaviors, don't get
addicted. Some of those who do get addicted, get addicted to
one chemical and others to other chemicals, and still others to
behaviors, not chemicals. The key issue, though, is that all addiction,
chemical or behavioral, occur via the reward pathway.
There are two other issues related to this system and the overall
organization and function of the brain that must be included here
to fill the void of misunderstanding of addictions. 1) Modularity
of the brain, and 2) Delusion of control.
1. Brain modularity: If one gazes at the human body, or any animal
or plant body for that matter, it becomes immediately apparent
that organisms are made up of many machines working in conjunction
to produce a functional whole. This is true at the macroscopic
level as well as at the microscopic and submicroscopic level.
If you aren't aware of this, please take a course in biology.
Most people would agree to this when it comes to the body, but
balk when confronted with this reality when it comes to the brain.
We currently misconceive our brains as vague black boxes out of
which mysteriously come thoughts, feelings, decisions, and behaviors.
Much to our lament and chagrin, however, is the fact that neurology
and neurobiology have progressed to the point that even the brain
is known to be a collection of machines, modules, that have evolved
to perform specific functions to produce a functional whole. As
in all known diseases of the body, when portions of these modules
are either genetically altered or altered by outside forces such
as microorganisms, trauma, toxic chemicals, or environmental physical
forces, these machines can break in a variety of ways and instead
of performing their "healthy" functions, produce outcomes
that are damaging to the organism. Diseases don't arise out of
vacuums. All of nature, human and otherwise, works this way. Lack
of this understanding, or more realistically, this misunderstanding,
frequently to the point of superstitious belief, has forever been
responsible for human misery. I want to
state emphatically here that there is a brain module whose job
it is to make decisions, The Decision-Making Apparatus, in which
the reward system has a central role. Disorders
of this module produce diseases we currently view in a perverted
light. One of these diseases is Hypoism whose symptoms are addictions.
To understand addictions we must understand
the functional module out of which they arise, its "normal"
function, and ultimately, how alterations in its machinery cause
the disease from which addictions arise. This material is fully
discussed in my book, Hypoic's Handbook.
2. Delusion of control: When brain machines are working "normally"
we have the illusion that we are in control of our brain and its
functions. In fact, we are not. "Normal" brains don't
require control. This truth is accepted in bodily machines, but
not in brain machines. The only time we recognize we (our consciousness)
are not in control is when a disease strikes. A peculiar dichotomy
in evaluation of these events usually arises at this point. If
we can pin point an outside cause for the malady such as a bacterium,
poison, or gene, we accept being out of control especially if
this outside cause is perceived as overpowering our will. We didn't
choose to get sick, so we are personally not responsible for the
illness. We can accept that. When this occurs to our brain for
some recognizable and diagnosable reason, we also accept it. But,
when we expect ourselves or others to be in control of our/their
brains and the brain begins to act in ways that we don't like
and we have no recognizable cause for this, we blame ourselves
or the person who is out of control. The fact is, when the brain
is functioning "normally" we think (misinterpret) that
we're in control of it when we aren't, and similarly, when it
is functioning "abnormally" in certain people we think
they are willfully and consciously misbehaving, "out of control."
The entire concept of "control" is a delusion. No one
is in control. Currently, addiction fits into this kind of misinterpretation
of reality due to ignorance and lack of understanding of the biology
of addictions. Addicts are no more in control
of their disease, Hypoism, and addictions than are nonaddicts
in control of their not being addicts.
Until this misconception is clear and related to the
neurobiology of the disease causing addictions which I hypothesize
is Hypoism, but may well be something else, we will maintain the
human misery we currently call addiction. Let me be perfectly clear, however, whatever
the disease turns out to be, it will and must involve some machine
or module in the brain that is functionally broken for one valid
reason or another. In addictions,
it is clear that the module is broken because of genetic reasons,
due to low activity genetic alleles in place of normal activity
involving immorality, willful misbehavior, lack of religion or
role models, poor upbringing, pseudopsychological psychobabble,
spiritual or metaphysical maladies.
Many questions concerning the role this
system plays in producing addictions have to be answered by any
paradigm claiming to explain human addictions which are to drugs
(chemical addictors - exogenous neurotransmitter substitutes)
and behaviors (instinct stimulated endogenous neurotransmitter
These questions are:
- What is the brain module that is genetically broken that causes
- How does the reward system fit into and participate in the
normal and abnormal function of this module?
- What is an addiction?
- What is an addictor?
- What is the difference between electric stimuli and addictors
which explains why every animal or person experiencing addictors
as opposed to direct electrical stimulation doesn't get addicted?
- What is the biological difference between different addictors?
- What is the difference between the people (and animals) who
get addicted and those who do not, never, even on experiencing
the same addictors? Or, asked in a different way, why can most
people use addictors without ever getting addicted while others
do get addicted?
- What role does genetics, the predominant etiological factor
in addictions, have in this system and in the differences between
addicts and non-addicts?
- Why do different people get addicted to different specific
addictors rather than to all of them, and moreover, not the same
one(s), even in the same families?
- How do behavioral addictors relate to chemical addictors,
and why are they both similarly addicting and their addictions
identical to one another?
- How well does the paradigm fit the science and empiricisms
of addictions, all addictions.
- How do current and even future attempts to control this system
as a way to "treat" addictions (fail to) deal with the
underlying entity that cause addictions?
- How do we aim valid scientific experimentation toward delineating
the cause of addictions.
There probably are many other questions needed to be answered
by any paradigm devised to deal with addictions, but those above
are a good start to altering our misconception of addictions.
If you believe in a particular paradigm of addictions, ask yourself
in all honesty, "Does my paradigm answer these questions?"
NO CURRENT ADDICTION PARADIGM ANSWERS THEM. Despite this, they are used willy nilly because people believe them. This must be changed.
Hypoism answers them all. Hypoism is amenable to experimental
validation. Hypoism results in healthy and realistic recovery
For more information on these ideas please read Hypoic's Handbook
and its bibliography present at: http://www.nvo.com/hypoism/bibliography/
Absent the understanding of the science and concepts discussed
therein you will continue the misintepreting and misunderstanding
of an issue you believe you understand. Not good.