by Bert Johnson (1/16/98)
All of us are struggling for an answer to the question: Why does one person become addicted while others do not? This book has the most reasonable explanation I've heard. Please read it with as open a mind as you can. My personal journey with it's author, Dan Umanoff, started with him leaving "against medical advise" from the detox/rehab where I was working as a counsellor. He was flushed, angry, and fed up with "treatment methods," but still wanted to get straight.
He had stayed sober in A.A. for over eight years, relapsed, and had struggled to get sober again for a few years. I suggested he do what had worked before, that is, join an A.A. group, attend meetings, find a sponsor, and let him run his recovery. I said, "Your own best thinking doesn't work for you." Some nerve, eh?, coming from a counsellor to a successful doctor.
Time passed and Dan showed up at a meeting and asked me to be his sponsor. He had surrendered the idea of self-sufficiency. Recovery was now possible.
However, the question of "why us?" remained. A.A. had learned what to do but not why it worked. Or "why us?" Dr. William Silkworth, Bill Wilson's doctor, had speculated that alcoholism might be a manifestation of an allergy to alcohol. That idea served many, including myself, for many years. We latched onto this disease concept in order to better accept our condition. It worked superficially, but it was wrong. It did, however, attempt to put addiction on some biological level rather than being perceived as a moral or psychological problem.
Dan's medical training set him on the path to finding a real biological basis for addictions. This effort became a major part of his recovery and my education. So much of what I'd been taught in counselling schools, conferences, and extensive reading didn't ring true. The experiences of sober alcoholics, and other addicts I'd known over the last 30 years, led me to the conclusion that psychology, religion, and pharmacology had little to offer when compared to 12 step recovery. Two essential questions Dan answers are: 1. What are we really recovering from? and, 2. Which parts of the A.A. program are necessary and responsible for this recovery, and which parts are just superfluous and mythological. Further, even A.A. perpetuated myths that could interfere with recovery. Therefore, any real progress in addiction recovery requires a precise hypothesis on causation of addiction. If we don't know the cause, we can only treat some symptoms, and even then, we're using faulty and haphazardly derived premises, the current state of affairs.
In 1971, The Hughes Act put "professional" treatment on a paying basis. A mad scramble to chase insurance payments and government dollars ensued. The hodgepodge of questionable treatment modalities we see today is the result. Alcoholics did receive better detoxification. In the beginning, rehabs were staffed with recovering alcoholics. They had personal experience with recovery. However, this rapidly changed over to a psychological model dominated by psychotherapeutic theories. Therapeutic communities also sprung up based on abusive Pavlovian-like disciplinarian methods. Cults got into the act as well. Dr. Bob Smith, co-founder of A.A., had warned about the dangers of the psychological approach. His warnings weren't heeded. A.A. virtually abdicated their responsibility to drunks by turning newcomers over to the "professionals." Some of these newcomers arrived in A.A. and N.A. indoctrinated with psychobabble. The simple and effective method of one addict helping another has been dissipated by so-called therapy of all sorts.
The studies on identical twins of alcoholic parents made the case for inheritance, but did not indicate "what" was inherited. Genetics was the key. But to what? Dan worked long and hard to gain a clear understanding of genetics as applied to the limbic system. He called the inherited part of the brain which causes addictions "The Feel O.K. System" (FOKS). His research covered a wide field, and he'd bounce his ideas off me in seemingly endless discussions. This effort enhanced his recovery, which was initially my primary concern. The basic premise was that too few of the feel O.K. neurotransmitters in someone's brain chemistry somehow drove him to seek relief in mood-altering drugs and addictive behaviors. He delved deeply into the effects of the FOKS on the decision-making process and discovered how that actually happened. The hypothesis fit all the realities of all addictions and for the first time in my long career there was an addiction theory that finally made sense to me. He called the disease Hypoism and he called us hypoics.
I decided to test this theory with the patients in detox and did so with more than 2000 addicts over a period of three and a half years. I first listed the most common chemical and behavioral addictions. Then, I asked the patients how many of their blood relatives had a history of these addictions. The answer was never less than 75% and averaged 85%. It dawned on me that some patients might not know their heritage and I asked about that. Most who had not given an affirmative answer either were adopted or did not know for sure who their fathers were. Add to this the twin studies, and the case for inheritance of Hypoism was effectively made across the board for all addicts. Specific addictions may be tied to particular FOKS deficiencies, but that is still speculative.
Next, I presented Dan's theory to the patients in a very simple form:
1. The genetic blueprint includes the FOKS of brain chemistry (with a brief description of limbic and cortical function).
2. I then suggested that we are conceived with low FOKS activity, on the extreme low (hypo) end of the bell-curve of FOKS activity (limbic diversity).
3. Addictions make us feel more O.K. We used addictors to raise low FOKS activity.
4. The chemicals we use to get high are not the real things, but only fool the brain into thinking it is getting what's missing. Therefore, MORE is the message our mind gets from the FOKS.
5. The addiction has to fail in the long run due to neurological mechanisms that oppose long-term artificial FOKS elevation. So the hunt is on for someother way to raise the FOKS (switching addictions), which also fails in the long run. A vicious and repetitive cycle.
We would talk about what has not worked for them and why it failed. All of the therapies start with the idea that the patient is in control and just needs psychotherapy and pharmacotherapy to change what they are. None of this worked for the people I was seeing.
In essence, Dan's theory says, "It's O.K. not to be O.K." This is the equivalent of Popeye saying, "I am what I am." This is acceptance based on biology. The patients, for the most part, accepted Dan's analogy that our FOKS was acting like a faulty thermostat, always giving a demand for more heat.
We shared what worked for them when they stayed straight. All who had had any significant periods of abstinence did so in A.A. or N.A. with a sponsor. All relapsed when they stopped doing this. Without another hypoic giving them "reality checks" for their decision-making process, they were left with their own faulty feedback. Relapse was apparently inevitable, regardless of how long they had stayed sober. Addicts in pain could see this.
Professionals had a much more difficult time accepting Dan's theory. Even recovering people working in the treatment field had been so indoctrinated to psychotherapy that they would say, "Yes, but." They would then repeat what they'd been taught about the psychological paradigm of addictions, environmental influences, psychoactive drug therapy, and other unproven and disproven treatment myths. The Hypoism theory has been a very hard sell to professionals with a personal stake in maintaining the status quo. (If nothing changes, nothing changes.)
I hope that Dan's book will take us out of our current morass of unsubstantiated theories and cast the light of scientific reason on this devastating condition.
The acceptance of Hypoism could result in the following:
1. Our misguided "drug policy" could go the way of the Volkstead Act.
2. The prison population would drop by 50%.
3. Confidentiality/anonymity would no longer block real outcome studies.
4. Bigotry against alcoholics and addicts could become "politically incorrect."
5. Cultism would be exposed as the fraud it is.
6. Psychotherapy could shed its myths and deal with real science.
7. Twelve Step programs could unite in their commonality and drop the superstitions.
8. Most importantly, with the general acceptance of Hypoism, we hypoics can be who and what we are and live useful lives in recovery, freed from addictions and bigotry.
My big fear for the future is genetic engineering. It will soon be possible not only to identify the causative genes of hypoics, but also to re-engineer hypoics into "normal people." I am of an age where "Master Race" theories turned into a nightmare. Never again, thank you. Let's accept and keep in high esteem the hypoics like Mozart, Van Gogh, Jack London, and millions of talented low FOKS people who have enhanced the human condition.
Congratulations, Dan Umanoff. Well done.
Bert Johnson, CASAC- Hypoic