Hypoism Research Proposal

A few years ago, after reading Hypoic’s handbook, Harold Gordon, PhD, a project director and scientist at NIDA, suggested that I do some treatment research using Hypoism recovery vs. standard treatment to show the skeptics that Hypoism as a theory actually worked. He hoped that this would stimulate interest in Hypoism as a valid hypothesis in the field. One stipulation was that I would have to find a rehab in which to do this seminal research. When I settled myself in Boynton Beach, I made several requests to various treatment facilities in the area to do this work. None responded. I post this protocol and its rationale for the purposes of hopefully finding a rehab that would be interested in doing this work. The rationale and the research protocol follow.

Justification for Study

The field of addiction treatment is plagued by opinionated beliefs on efficacy despite the absence of valid studies supporting them. Many invalid studies recognize their own shortcomings but don’t ever correct them. Moreover, despite these shortcomings their conclusions are still reported in addiction journals and become part of the addiction treatment vernacular. Many even get reported in media outlets and disseminated to the public only to be shown to be ineffective at some later date[1]. I have collated many of these methodological shortcomings and searched the literature for studies that might incorporate and study all of them. After a review of the literature I was unable to find a study of any drug and/or alcohol addiction treatment incorporating all the following (listed below) essential diagnosis, follow up, and outcome criteria, as well as being over five or more years in duration, to observe the long-term effects of various treatments.

            When this list is assessed, no one studying addiction treatment would deny that all of them are important contributors to the validity and comparability of addiction treatment outcomes. Yet, they have never all appeared in the same study. I’ve queried addictionologists about this and was given many reasons for this. The most common were that they are so difficult and expensive to do that they wouldn’t get funded. My response to this is that it is better to do one study correctly than to do a thousand incorrectly. This would save time, effort, and money in the long run. The addiction treatment literature supports this contention. This deficiency has left us with very little to say about what treatments, if any, are actually effective, the whole point of these studies, and therefore how to best treat addicts.

A recent and thorough review[2] studied 33 alcoholism treatment modalities, including 12 step programs, from 381 published studies. Using a quite complex and blind evaluation of these studies by at least seven different addiction professionals for each study this review showed brief intervention to be far and away the best treatment modality for alcoholism. They then admit that the patients in those studies had the least severe alcoholism of the entire group of studies. From Miller’s paper’s conclusion, “The negative correlation between scientific evidence and treatment-as-usual remains striking, and could hardly be larger if one intentionally constructed treatment programs from those approaches with the least evidence of efficacy.” Nowhere in this paper is even mentioned that approaches to treatment ought to be based on a proven theory of addiction causation. In fact, it quotes Funk[3] as if to chide the field of addictionology, “To be a critical scholar means to make empirical, factual evidence -- evidence open to confirmation by independent neutral observers -- the controlling factor in [professional]  judgments.  Noncritical scholars are those who put dogmatic considerations first and insist that the factual evidence confirm [their] premises.  Critical scholars adopt the principle of methodological skepticism: accept only what passes the rigorous tests of the rules of evidence.”

Thus, even with this massive and painstaking review, we are left with no good way to quantify addiction treatment results because they are just not similar enough to compare and clearly didn’t study the patients or the treatments in a comparable way. I found the same mess in the addiction literature that I personally reviewed. Another treatment research study[4] found similarly disconcerting treatment results. In this paper, Dr. Adrian goes right to the crux of the problem, “If we are to determine if interventions work, we must first determine what is the nature of the problem which we are attempting to resolve. For example, what do we mean by the problem of addiction?” This is the paradigm vacuum[5] I believe is the origin of the current problems in addiction treatments. This problem will only be solved through grants supporting only scientifically valid and self-critical addiction research.

The conclusion I reached after reviewing the current treatment literature is that after all this money, time, and effort, there are no thorough and valid studies that tell us what is happening to addicts in various treatments over the long haul. It may be that none of the treatments used today have any salutary effect on the recovery of addicts compared with any other modality and that addicts who happen to recover have to find their recovery by chance or luck. Personally, I believe three things about current addiction treatments that have caused this mess. 1) None are based on a proven valid theory of addiction etiology and pathophysiology, 2) They are variations of therapies purported to be effective in other non-addiction behavioral disorders, and 3) They were modeled around the treatment program of AA absent any scientific reason for this except that some alcoholics in the past have gotten sober this way; sort of a tradition.

As a trained physician I find this method of designing treatment for a “disease” to be spurious and rather goofy. It has also resulted in quite poor results for addicts. In fact, a recent paper[6] on the treatment of heroin addicts was so pessimistic about the value and efficacy of non-pharmacological treatments as to advocate methadone maintenance as the number one treatment for this addiction although it stated parenthetically that other help should be tried on heroin addicts after they have been stabilized on methadone maintenance. I thought this recommendation bizarre to say the least. However, that it actually might be better and safer for addicts to be chronically drug addicted than to achieve drug-free recovery is a good example of how bad things are today in addiction treatment.

Over the last ten years I have developed an addiction paradigm, Hypoism[7], from the same neurobiology, epidemiology, genetics, animal addiction experiments, twin studies, and clinical addictionology available to everyone else. The only difference between my paradigm and the current ones, the ones the current ineffective treatment is based upon, is that my hypothesis reconciled all the valid science of addictions into one paradigm rather than picking and choosing just what science to use to develop a paradigm. A funny thing happened when I put all this together. Its implications for treatment, prevention and public policy were found to be exactly opposite from the current accepted addiction paradigm, the hijacked brain hypothesis, as well as all other existing psychological and moralistic paradigms. To me this was good evidence it was probably correct.

Over the last five years I attempted to get well-credentialed researchers in addictions to study my paradigm. Even though most of these researchers agreed with the basis of my paradigm, none would incorporate it into their ongoing or future studies. Thus, out of a deep desire to help other addicts and to clarify addiction science as much as I possibly can, I have decided to do some of this research myself. Incorporated in my proposed study are the criteria and methodologies I found missing in current treatment studies. These are listed below.

Criteria:

• Strict diagnosis of definite addiction using an accepted diagnostic method. Only full-fledged addicts will be included in the study.
• Matched control group compared to experimental group.
• Results determined by random forensic laboratory tests on all subjects.
• Documentation of medications in control group. Experimental group will by design be medication-free.
• Documented relapses with repeat inpatient treatment if necessary in experimental group.
• Documentation of patient’s use of other recovery methods, either professional or non-professional such as AA etc.
• Documentation of concurrent behavioral addictions, eg. gambling, sex, eating disorders, etc.
• Documentation of problems in significant relationships, vocation, education, criminal justice issues, health, etc.
• All treatment services received by the subjects are documented.

Basis of treatment methodology

• The experimental group treatment model is defined by a theoretical addiction paradigm based on the brain science of addictions.

Outcome criteria:

• Total abstinence and length of abstinence at the end of the study period as primary success criterion.
• Secondary outcomes will be survival, retention in study, number and duration of relapses.

Duration:

• Minimum of five year follow up on all patients with an aim toward indefinite follow up of all subjects.

Brief Proposal

Justification of study: In order to quantitatively and qualitatively test the utility and practicality of Hypoism recovery (as defined in book) vs. “standard” treatment in drug and alcohol addicts who are admitted to a large rehab; to compare recoveries between routine and the Hypoism oriented paradigm for effectiveness (abstinence from primary addiction and other drugs and behaviors to be decided upon for each individual, utilization of sponsor, surrender of decision-making) and quantify recovery time, numbers and depth of relapses, survival, recovery attitudes and behaviors. We will exclude patients with major mental illnesses such as manic depressives and schizophrenics for the time being for simplicity sake. Theoretical justification – see above.

Methodology:

Take two groups of matched (by various criteria to be decided upon) addicts.

One group goes through the rehab. as usual.

The experimental group does all the rehab’s activities except where my recovery program is substituted for theirs as time requires: lectures on Hypoism, Hypoism group, begin to do the first 3 Hypoism steps in rehab and the others after discharge, individual interaction with me or someone trained to do what I do which will include autobiography and family tree eval., they get a local sponsor trained to do Hypoism sponsoring (I will be that in the beginning as well as find and train people – hired staff - like me to do Hypoism sponsoring techniques. Eventually we will use recovering patients - free of charge - who remain local to do this as would be the case in real life), Hypoics not-anonymous meetings will substitute for some of the AA or NA meetings they are required to attend. Fun activities decided upon by the patients and me together, health, occupational and educational needs, Etc. Family teaching and recovery as far as is possible absent the patient. No psychiatric meds.

Both groups will have done and be followed as defined over a 5 year period of time for the study (and indefinitely if possible):

• initial eval by me or my staff to delve into the course of their disease and all Hypoism symptoms prior to entering rehab
• family tree
• Initial hair, urine and breathalyzer testing
• Random urine and breathalyzer testing over the course of the study
• Course of recovery and relapses and occasional interviews for disease and recovery attitudes and behaviors
• Rigorous follow-ups as far as possible after discharge for data collection
• Monitoring of prescribed medication in control group.

Data collection and statistical analysis

Results

Discussion

I would require:

• my own space [office(s) and group room(s)], for evaluations, individual and group work, family stuff and lectures.
• Money for all salaries, including mine, staff, and staff training, forensic testing, some of the fun activities, and treatment grants for some of the patients if they don’t have the do-re-me to pay for the rehab., phones, traveling expenses, and whatever we deem we need.
• Access to full real library and online library.
• Administrative personnel and/or services.
• Access to occupational, medical and social services.
• Whatever else we think of.