We've been focusing on the symptoms of the disease and mistakenly calling them "diseases." Normal doesn't have the pathophysiology. Normal is not not addicted. Normal is not even capable of being addicted. Only someone with the disease can have the symptoms, get it? Just like in any other disease. You can't have the symptoms unless you have the disease. Just like any other disease. Only hypoics can be addicts. That makes sense to anyone, especially doctors. I want this to make sense to all of you.

So----Some people have a disease, Hypoism, whose symptoms are addictions…..and other goofy behaviors. The disease involves a "perversion" of a normal brain mechanism by a pathophysiology and leads to the "natural history" of that disease which includes all the signs, symptoms, complications, course, prognosis, etc. It will also lead to the accurate recovery. The specific symptoms are variable and diverse because the genes making up the disease in different people are different in each different hypoic. Different low activity genes making up the diseased instinct regulating and rewarding mechanism are present in different hypoics. The underlying disease works the same, though, in each hypoic. The emphasis must be on the properties of the underlying disease, not on its symptoms, the particular addictions.

Like all diseases, environment can alter the expression of the symptoms, but cannot alter the etiology, the existence of the disease in that person. The etiology is genetic neurobiological pathophysiology of a normal brain mechanism. The environment may affect which and how addictions and other symptoms may occur, but not whether or not a person has the disease of Hypoism and that they will always have some definite hypoic symptoms.

To summarize, just like any other disease in medicine the principles involving a disease, the perspectives, must be, and are:

1. What's the normal brain mechanism involved?

2. What does this normal brain mechanism do normally for the normal person?

3. How does it work?

4. What causes its perversion?

5. How does this perversion change the function of this normal mechanism?

6. What are all the signs and symptoms of this perverted physiology?

7. What is the course?

8. What are the complications?

9. What can we do to help someone with this disease ONCE WE KNOW THE ABOVE; just like any other disease?

Many many years ago addictionology began looking at addictions starting at number 9. Treating the symptoms and working backwards towards number 1. BACKWARDS. Wrong perspective. That's not always necessarily bad or wrong. Many diseases get discovered and worked out this way. It just hasn't happened with this one. We can change that. During this backwards journey we lost perspective and were waylaid by what we call in medicine, "THE WHITE BEAR SYNDROME." The big, scary, white bear, the major manifestation, is just so formidable and obvious it monopolized our perspective. We called it alcoholism. We called it drug abuse. We called it compulsive gambling, co-dependency, sex addiction, religious fanaticism, compulsive overeating, anorexia, etc. 50 white bears, but no disease. Others looked solely at the molecular and subcellular levels for the molecular biological problems they could readily fix with drugs. This view was too close and narrow. No one looked at the whole picture from the molecular level to the functional organizational level to the clinical level. No one looked at or for the disease, the whole disease. It's time to return to real medical concepts, the real disease concept, the whole disease, principles 1 through 9 above, and in the correct order.

When we do this we discover a single disease that puts the jigsaw puzzle of addictions and the rest of those goofy hypoic behaviors into a single, although quite diverse, pathophysiology.

Diverse because there are many different ways to mess with the same physiology of the normal brain mechanism. These diverse ways of altering the pathophysiology lead to different addictions, different combinations of addictions, and combinations of other goofy behaviors; ALL COMING OUT OF VARIOUS PERVERSIONS OF THE SAME SINGLE NORMAL BRAIN MECHANISM CAUSING HYPOISM.

Refer to the list of 9 principles of approaching a real medical disease:

1. What's the normal brain mechanism involved? slide 4.

I call this brain mechanism: THE DECISION-MAKING APPARATUS (FOKS/DMA).

Feel O.K. System (FOKS) - This is the key emotional evaluative organ that determines Hypoism and inexorably produces addictions in hypoics while working within the decision-making apparatus (DMA) of the brain. The FOKS exists in all people and has the same function in all people, but works very differently in hypoics. This is the physical location where the diverse genes produce their effects in Hypoism. It is this hard-wired evaluation mechanism and its connections to the common pathway of reward which basically gives us our genetic level of how well we like ourselves (self-esteem), how we respond emotionally to our own internal needs (instincts), external stimuli, and, finally, how we place emotional content onto decisions and emotional conceptualization of past events and future outcomes. Its role in our brains lies in its key position in the decision-making apparatus. In hypoics, the FOKS is stuck in the ON or YES position concerning certain FOKS-raising stimuli. These stimuli, in general, all consist of mood-raising chemicals (drugs, alcohol, substances), ideas and beliefs (instincts), certain people (via instincts), and behaviors related to the instincts which internally raise FOKS activity (gambling, falling in love, violence, racism, work, etc.). This state of being stuck on YES is what an addiction is. The cause of this stuck position is the critically low-activity level of the FOKS, defined by the genetically transmitted diverse (different from normal, the most common) alleles of the genes making up the physiology of the FOKS. It is the basic feedback mechanism that tells us (via emotional feelings) internally how we are doing, evaluates our thinking, feelings, behavior, and experiences. It gives emotional context to every experience, both internal and external, and is included in our memories. Obviously, it is quite important to the continuity of our lives, survival, and quality of our existence. Another more romantic way to look at the FOKS is that it is the soul or spirit of the individual. This is the irrational, emotional, and individualistic face of each person. It is the person's uniqueness. There is no FOKS just like your own. As nebulous as it may seem, it still is a physical and substantial organ, not ghostly or phantasmagoric.

2. What does this normal brain mechanism do normally for the person?

It has evolved to handle the unconscious use of instincts in the organism, decisions, and evaluations of external and internal information.

(See: The Hypoism Addiction Hypothesis, An Evolutionary Psychology Perspective at: http://www.nvo.com/hypoism/thehypoismaddictionhypothesis/ Presented at the 6/7-11/00 Human Behavior and Evolution Society Conference, Amherst College)

3. How does it work? Slide 5.

Look at the FOKS/DMA diagram. That's my simplified scheme. It's manufactured and regulated by and from genes and gene products. It is, for the most part, located in an unconscious part of the brain, the limbic system. The conscious mind is aware of it's activity only through feelings and urges to act in certain ways. These urges are overwhelming in hypoics as long as the ATB, autonomous thinking belief, the believer of one's thinking, is intact, and autonomous; self-sufficiency. Functions of this mechanism?

1. instinctive behavioral decisions
2. emotional evaluations of situations
3. emotional interpretations of events
4. maintaining beliefs

Slide 5.

4. What causes its perversion?

Genetic diversity making up the FOKS and other regulating/evaluating mechanisms of this system. Existence of multiple low activity alleles of these regulatory genes acting in this system. Clinically this is recognized as low levels of various neurotransmitters as demonstrated on PET scans in various drug and behavioral addicts including overeaters (Wang et al) and self-mutilators. In extensive animal studies, as documented in the addiction literature, and reviewed in "Substance Abuse - A Comprehensive Textbook," ('97) chapter 6 by Eliot Gardner, and by Crabbe and Li in "Psychopharmacology: The Fourth Generation of Progress," Chapter 69, and Uhl et al. Chapter 153, multiple neurotransmitter deficiencies have been discovered in, or bred into, rodents, associating multiple drug addictions in these animals with their specific neurotransmitter system deficiencies. I will summarize here a massive amount of experimental work accomplished using rats and other rodents whose brains, at least the parts we're talking about, are quite similar to the same parts of the human brain. In these animal studies:

· 1. Certain specific strains (genetically identical animals), and not other strains, voluntarily get addicted to certain drugs and not to others, and do so predictably over and over again. Thus, there is delineation, similar to my delineation between hypoic and non-hypoic humans, between genetically similar strains of rats who get addicted and those who don't get addicted even when exposed to the same drugs.

· 2. These specific strains are found to have specific genetically transmitted defects (deficiencies) of specific gene products located in specific places in the reward system.

· 3. The drugs to which these animals voluntarily get addicted are specifically the same ones to which humans get addicted.

· 4. These drugs all exert their actions specifically in the reward system pathways as well as in the specific locations where these defective genes (alleles with deficient activity) are located.

Some of the details of the experimental work are located in the referenced chapters by Gardner, Crabbe and Li, and Uhl et al. This work is critical in that it rules out any effect of environment on causing drug addictions. Drug addictions in humans originate exactly the same way. A review of the genetics of many human addictions can be found at: http://www.nvo.com/hypoism/recentgeneticstudiesonvariousaddictionsfromalargetwinregistr/

An important caveat is discussed in the above article and I will repeat it here briefly: Because the individual addictions are not what is being inherited, the heritability numbers are high (60-80%), but lower than 100% and do not represent the actual heritability of the disease, Hypoism, itself whose genetics have never been studied. This is just one of the mistakes made by the current addictionologists using their misperception of addiction etiology and what they call the disease, the addictions, which are symptoms, not diseases. The genetics of symptoms are actually irrelevant to understanding the genetics of the disease causing them. I predict that when studied correctly, the genetics of Hypoism will be 100% heritable.

slide 6.

The hypoic FOKS causes the hypoic to incessantly prowl for a FOKS raising experience or neurotransmitter substitute, and it is never satisfied even when it finds one. The neurophysiological adaptation mechanism makes sure of that.

slide 7.

This mechanism is also responsible for craving, progression (worsening severity of the disease symptoms over time), tolerance, withdrawal, and early relapses due to the low FOKS activity lasting for prolonged periods of time after detox. It is basically caused by downregulation of the system, the baseline FOKS activity is lowered. Downregulation is when the genes for receptors and neurotransmitter system component production are turned down or off by the presence of an excess of neurotransmitter substitutes (drugs) or neurotransmitters produced by excessive use of instinctive behaviors that raise endogenous neurotransmitter levels in the regulatory neurons.

5. How does this perversion change the function of this normal mechanism?

Only a critically low (HYPO) genetically transmitted level of activity of this system can lead to addictions and manifestations of the disease. Thus, Hypoism. This produces the capability of being an addict and other manifestations caused by these genes perverting "normal" function of this system. Ordinary decisions in nonhypoics become addictions in hypoics. The critically low FOKS activity demands constant use of FOKS activity raisers, drugs and instinct use that specifically raise the levels of the genetically deficient neurotransmitters.

Hypoism - The name of the disease I hypothesize for the purpose of developing the global concept of addictions as a real disease. A chronic, progressive, and frequently fatal (albeit recoverable) thinking and decision-making disorder due to the effects of genetically transmitted [unless caused by physical damage to the FOKS by encephalitis, trauma, intracerebral hemorrhage, etc.] critically low activity of the FOKS resulting from various physiologic deficiencies of the limbic neurotransmitter systems working within the instinct regulating decision-making apparatus. The hypoic FOKS turns the decision-making apparatus into an addiction machine. Hypoism has three inevitable manifestations: 1) addictions to substances, ideas, people, and behaviors, 2) decision-making difficulties leading to disasters, and 3) situation and self-evaluations mistakes having damaging repercussions in the hypoic's life.

Corollary 1. Low activity of any neurotransmitter system activity for any particular instinct stimulates motivation to use that instinct, another instinct which can raise the activity of the same system, or the use of a neurotransmitter substitute drug that raises the activity of that system, all at a level below consciousness, allowed by the ATB and rationalized and ensured by the conscious cerebral cortex.

Corollary 2. Instinct Diversity - Different people have genetically different levels of strength of instinct rewards and will, therefore, prefer the use of higher strength instincts to perform the FOKS raising job depending on the neurotransmitter system effected by the deficiencies.

addiction - Use of an addictor (below), a substance, person, thought, feeling or behavior, for the purpose of changing how you feel, irrespective of the consequences to yourself, your family, your job, your loved ones, or your country against your own will. It has short-term personal (feeling) benefits but long-term deleterious effects because of addiction and progression. All addictors raise FOKS activity and are turned into addictions by the hypoic FOKS/DMA addiction machine. They specifically raise the activity of the deficient neurotransmitter within the FOKS (and the neurological reward cascade), which is genetically determined. That is exactly how they change how you are feeling. Addictions are used by the addict to self-treat his disease of Hypoism. Addictions work in the beginning, but backfire in the end due to downregulation leading to more excessive and toxic use of addictors. Only hypoics get addicted. One other issue I'd like to clarify is that of the many euphemisms for the word addiction that minimize and help addicts deny that they are addicts: dependency, obsession, co-dependent, habit, fixation, craving, fetish, preoccupation, compulsion, and/or abuse. These words mean only one thing to the hypoic: ADDICTION. A distinction needs to be made between the neurophysiological addictions associated with and caused by Hypoism as part of the Hypoism entity and the physical addiction that can occur to anyone, including non-hypoics, who receives prolonged medically-prescribed, physically-addicting drugs such as opiates, benzodiazapines, barbiturates, etc. This inadvertent physical addiction ends once the use of these drugs ceases. Non-hypoics addicted in this fashion have no antecedent or subsequent signs or symptoms of neurophysiological (hypoic-type) addictions or thinking disorder. addictor - Hypoics get addicted to anything that raises their genetically determined critically low FOKS activity level. These FOKS elevators are called addictors. Addictors come in two varieties, neurotransmitter substitutes and the FOKS-raising built-in instincts. These addictors all work by stimulating the reward cascade or final common pathway of all addictions, either directly such as neurotransmitter substitutes, the actual drugs, or indirectly by the FOKS activity raising instincts, the precursors of behavioral addictions.

See: http://www.nvo.com/hypoism/aimingatanunderstandingofaddictions/

Slide 8. The Reward System

Addictors are turned into addictions only in hypoics by the hypoic FOKS/DMA addiction machine, the neural machine that evolved to deal with and reinforce instinctive decisions. These instincts and their neurotransmitter reinforcers are the clues I mentioned earlier at the time I produced the list of addictions that led me to the brain mechanism responsible for all addictions.

6. What are all the signs and symptoms of this perverted physiology?

The natural history of the disease Hypoism- needs to be studied all over again from scratch because it has never been studied correctly to date.

7. What is the course?

The natural history of the disease Hypoism- needs to be studied all over again from scratch.

8. What are the complications?

The natural history of the disease Hypoism- needs to be studied all over again from scratch.

9. What can we do to help someone with this disease ONCE WE KNOW THE ABOVE, just like in any other disease?

When we look at just the addictions and the outdated addiction model of today, psychobabble plus isolated neurotransmitter deficiencies, then it seems as though the treatment ought to be to raise neurotransmitter levels with either medications or neurotransmitter precursors such as nutritional supplements and psychotherapy. When we look at the new pathophysiology, however (slide 5.), we notice right away that the addictions originate from anything that raises neurotransmitter levels (FOKS activity). Raising neurotransmitter levels causes addictions in hypoics. So, raising FOKS activity can't be therapeutic, and, of course, it's not. Secondly, using psychotherapy to change the decision-making process also seems to make sense except when it is realized that the decision-making apparatus is in an unconscious part of the brain (The Emotional Brain - The Mysterious Underpinnings of Emotional Life, Joseph LeDoux, (New York: Simon and Schuster, 1996) and thus, the FOKS/DMA is not listening or participating in the psychotherapeutic process. This is why these two approaches have never worked for recovery. The third possible way to stop addiction, by blocking the reward system, is unconscionable, yet is being used and further considered.

Remember, recovery needs to be from the disease, not just getting rid of the particular addiction. FOKS raisers and psychotherapy may have occasionally been found to stop the initial addiction, but they lead to substitute addictions and frequent relapses, and don't take into account the other (unrealized) manifestations of the disease such as decision-making disasters and evaluation mistakes. From the diagram and from the pathophysiological disease concept of medicine, one needs to intervene on the whole disease to assure recovery, not just on the symptoms. Hypoism is the target of recovery, not the addiction. Remember? The Perspective? The forest and the trees? The forest is Hypoism, the disease. The trees are the addictions, symptoms.

Look again at slide 5. What we do notice is that the Autonomous Thinking Belief (ATB) is available for intervention. Intervention here allows for recovery from the disease without needing to change the person into someone else or changing his brain in any way, or by the production of new addictions from FOKS raising medications, and thus can allow full acceptance of the hypoic's self. The hypoic can remain himself and also be safe from his disease. The ATB was the clue from A.A. I mentioned at the beginning of this talk; the need for surrender of control to an A.A. sponsor.

What the hell is the ATB? It's the brain's believer of the thoughts and feelings produced by the previous few steps in the DMA. The ATB permits the thought to become a decision. You can also call it self-sufficiency, pride, and arrogance if you like. I call it unconscious thinking belief or autonomous thinking belief because it usually occurs below the level of consciousness, and is thus autonomous. When asked, "Why did you do that?" the hypoic responds, "It seemed like a good idea at the time," a common occurrence in hypoic decision-making. Hypoism recovery allows the hypoic to surrender control of the ATB and use another person to be a decision consultant without having to change his thinking, feelings, or biochemistry. This is the major essence of real recovery in A.A. even though A.A. doesn't realize this itself. No need to change how one feels, how one thinks or how and why one acts. Also no need for medications and psychotherapy. The recovering hypoic needs to know he has the disease, realize its effects on himself, his decisions and life, surrender control of the ATB, and accept the feelings and the recovery process as directed by his sponsor as OK. Surrendering of self-sufficiency for a hypoic is the recovery process in a nut shell and is OK. The process of surrender also reduces the urgency of the communication from the unconscious part of the brain (FOKS/DMA) to the cortex and relieves the compulsivity and neediness of the patient. This process can only work, however, when the brain mechanism is known, understood, and accepted by the hypoic. Thus the need for teaching the workings of this normal brain mechanism among the populous which by necessity, includes all hypoics as well. Once this disease is understood and accepted by the general population, it will be immediately be destigmatized and amenable to rational policy decisions by politicians and regulators just like any other disease. Massive recovery and prevention now becomes a reality.

That's a brief overview of our problems with addictions today and a summary of a possible pathophysiological mechanism to conceive of the disease that causes addictions.

So, to summarize the Hypoism paradigm of addictions:

• The Decision-Making Apparatus is derived from 100's of millions of years of evolution and exists in all animals including humans. Its function is the unconscious regulation of instincts and direction of survival behaviors little influenced by cortical control because of the paucity of cortico-limbic inhibitory neurons.
• These instinctive decisions are rewarded and reinforced by the reward system involving numerous neurotransmitter systems resulting in dopamine release in the nucleus accumbens.
• Natural selection has allowed to exist numerous alleles of genes making up this reward system including low activity alleles useful to survival. These low activity alleles developed in periods of scarce commodities and were important for stimulation of instinctive survival behaviors producing the most rewards.
• In the presence of widely available commodities (goals of instincts) and neurotransmitter substitutes (drugs) a subset of humans with critical reward system (FOKS) deficiencies (hypoics) inexorably seek out and get addicted to these addictors unconsciously and against their will and cortical inhibitions. Instead of inhibiting this behavior, the cortex consciously justifies and rationalizes this behavior in the presence of an intact Autonomous Thinking Belief.
• Attempts to control and change this hypoic system from without and from within result in perpetuation of addictions and other symptoms.
• Because this behavior is caused by perturbations (genetically transmitted) of "normal" non-hypoic physiology and results in negative consequences to the hypoic, Hypoism can be called a Disease. Addictions, decision-making disasters, and evaluation mistakes, three of the majors manifestations of Hypoism, are but the symptoms of this disease.
• Only surrender of control over the hypoic Decision-Making Apparatus and the ATB result in prevention and recovery of addictions and allow for recovery fromthe disease of Hypoism and all its manifestations. This recovery can only occur with the complete cooperation of the hypoic in the face of his/her understanding of the disease process.
• Only surrender of the ATB relieves the obsessions, compulsions, and cravings characteristic of Hypoism.
• Changes in public attitudes and policies concerning addictions and addicts can only occur with their complete understanding of the Hypoism paradigm of addictions as well.