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Here's your quote for the day:
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 this inevitability. [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/
 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.
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 behavior. 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. 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 behavior.
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 system, somewhere 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 alleles, not reasons 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
addictors).
These questions are:
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 and policy.
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.
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On the left is MacLean's Tripartite BrainYou can take the addiction out of the hypoic, but you can't take the Hypoism out of the addict.
