Dr. Umanoff: Good morning. This is the first time I'm doing this, so bare with me.

Because I'm a bottom line guy, I'll introduce this talk with the conclusion: Until we reject the sentence, the initial assumption of Dr. Alan Leshner's (Chief of NIDA) Hijacked Brain hypothesis, "The first use of the drug is voluntary," and all its implications as absolutely inimical and unpropitious, we will never make any progress in addictions and you all might as well leave now. Addictions are not caused by the addictors: the drugs, the behaviors or the beliefs. Another way to say the exact same thing is: If you believe you can turn my dog, Lady, into a cat, by sending it to cat school or by giving it the appropriate medications, please leave now. These beliefs are exactly the same. The belief that addictions are controllable, changeable, treatable, preventable and that addicts are teachable and amenable to therapy, in the usual sense of these words, stands between all of you and the reality of addictions. These words all imply that addictions are conscious manifestations of choice, stupidity, or shmuckiness. Rather, use of addictors to a hypoic, someone with Hypoism, is no different from your use of food, water or sex. Addictions are behavioral symptoms of a primary underlying internal entity, not primary entities or diseases themselves. Moreover, they are not caused by external influences whatsoever. The disease or pathophysiology exists in the absence of addictors (drugs or instincts), if that were possible.

First slide please: court scene

The evolution vs. creationism debate continues to this day in general society as well as in addictionology, and I'll bet you all believe you're on the side of evolution. Let me confront you. You are all creationists. Moreover, it is this mistaken belief and the denial it encompasses that keeps addictionology in the dark ages, exactly as creationism keeps human culture and politics in the dark ages.

Let me translate. The Genetics/Environmentalism debate as it relates to addictions and other human behaviors is the evolution/creationism debate all over again. Genetics is evolution, and environmentalism is creationism. There is no debate, however, because you can't debate an intellectual idea against a superstitious belief, a provable idea against an unprovable belief, an intellectual idea against an emotional belief, a cortical idea against a limbic belief.

Real medicine, like evolution and genetics, is intellectual, provable, and cortical. Contrarily, witch craft is based on belief and superstition, the current state of addictionology. The recent addiction hypothesis, as put forth by Begleiter (The Genetics of Alcoholism, Henri Begleiter and Benjamin Kissin, Eds. New York: Oxford University Press, 1995), the so-called temperamental/environmental vector model of addiction etiology, is still witchcraft even though it concedes addiction etiology as partly neurobiological and genetic. It's better than pure environmentalism, but it is not quite enough. Until we are willing to prove and admit that addictions are etiologically neurobiological and genetic with only environmental influences on its expression, we will stay stuck in the dark ages. The vector model is much like the modern creationists who don't dispute evolution, but insist that it is directed by god. The incredibly complicated vector model is much like Aristotle's heavenly spheres model of the cosmos in its attempt to reconcile reality with the geocentric or anthropocentric bias of the universe. Despite its compromises, this complex etiologic hypothesis doesn't change a thing. Humans who believe in creationism will still kill another human in the name of god just like environmentalist addictionologists kill addicts in the name of environmentalism.

So, to begin my talk, I conclude: Until we transform addictionology from witchcraft and superstition into modern medicine we will perpetuate exactly what we all say we want to terminate, the misunderstanding and mistreatment of addictions and addicts.

Around 1992, I became motivated to understand and explore the basis of addictions for personal reasons. I began looking into the realities of addiction etiology rather than relying on the superstitious beliefs I blindly accepted in the past as part of my own recovery, be they psychological or supernatural. Clearly, because of the obvious paradigmatic vacuum in addictionology, neither of them offered any obvious etiological insight, although Alcoholics Anonymous's recovery program, the only barely successful addiction recovery program, did present some hints. I was fortunate to be an addictionology outsider with no deeply held preconceived notions about the disease of addictions except those concerning the general disease concept on which all medical diseases are based as I had been taught in medical school: modern medicine and all medical disease are based on pathophysiology. One pathophysiology - one disease. I began looking for the pathophysiology of addictions, something that did not exist in 1992. I will share what I discovered…..in a minute.

First, let me ask you a question.

What's the only problem with oral sex? ……………………………………….…..The view.

View or perspective is always a problem in interpreting, discovering, and perceiving reality.

So, what's your perspective on addictions?

I would like to put addictionology into perspective.

Compared to the rest of medicine, addictionology is in the dark ages.

The reason is simple: Superstition, bias, and ignorance? Yes.

But mostly ---- the wrong perspective.

Three wrong perspectives are: 1) The "psychological" and "environmental" basis of human nature, behavior, and thus, addictions, an unproven bias, 2) That the addictor is seen as the cause of the addiction, 3) That the addiction is the disease (for example, that alcohol addiction=alcoholism, the disease).

First, evolutionary psychology has buried number one. Human nature and behavior is primarily founded on genetics, behavioral genetics. Absent this principle, evolution and natural selection would have been and are impossible. Environment selects from already existing genetic entities, it doesn't cause them. "Psychology" and "environment" are merely fine tuners and have superficial influences on behavioral genetics, but they are not the primary etiological determinants. Thus, psychology and environment cannot provide a pathophysiology. They cannot provide a primary mechanism on which a disease, any disease for that matter, can be based. The psychological and environmental basis of disease is a wrong and impossible perspective on which to base a disease. Addictionology has been wasting its time and resources traveling this road to reality and thereby misleading the populous as well.

Second, if the addictors (drugs, including alcohol, and behaviors) cause the addiction there would be countless more addicts than there actually are. The reality is that if one hundred people spontaneously use an addictor such as alcohol, opiate, gambling or sex, only ten or so will end up addicted. This is the case with all addictors. There is something special about the people who get addicted, not something special about the addictor. This misperception of addiction etiology promulgated by current addiction paradigms, and especially Dr. Leshner's Hijacked Brain Hypothesis, wrongly places the emphasis on the addictors and perpetuates the drug war and stigmatizing prevention efforts. Leshner's hypothesis is ideology, not science, based.

Lastly, we've been looking at addictions as if they were "the disease" ---- that's wrong!

Why have we made that mistake? Because we are misinformed, and because we have been following the psychology/environmentalism road to nowhere. Behaviors can't be and are not diseases. Behaviors are not primary mechanisms. Cognitive mechanisms are primary. Behaviors result from and are determined by cognitive mechanisms, neurological machines, if you like, as all human behavior is. Diseases of behavior can only be based on cognitive mechanisms which underlie the behaviors. Moreover, behavior can't be genetic, only cognitive mechanisms can be genetic. Hypoism is a cognitive mechanism. In fact, it is the only complete addiction etiologic hypothesis that is based on a cognitive mechanism.

Thus, we have missed the forest (the underlying mechanism) for the trees (addictions)----the perspective has been wrong. We all know in our hearts that what we have been calling the disease just has never made any sense. Yet we persisted at looking at the wrong things. Stupid! Addictionology has been unwittingly stuck in the wrong perspective leading to the following biases which have maintained the wrong perception of addictions:

--Traditional and rigid belief of psychological/environmental basis of human behavior.

--That the addiction is the disease.

--That the addictors cause the disease and the addiction.

--Psychobabble explanations of addicts' motivations.

--Traditional bias towards using antiquated and functionally obsolete words like "alcoholism" as if it were a distinct entity.

--The moralistic/religious bias against addiction as willful "bad behavior" and need to punish this behavior.

--Haven't looked at the whole picture of addiction from afar - no perspective, no overview - only looked at one addiction or compulsive behavior at a time.

--Old biases concerning psychology, environmentalism, addictions, and traditional, noncritical thinking.

--Don't rock the boat mind set--the authorities, old timers, know best. Go with the flow.

--Lack of rational imagination.

--Excess of irrational imagination.

and lastly:

--That the nonaddicts out there just can't identify with what is an addict's inner experience. They can't relate to it, can't conceptualize it, and can't translate it into a realistic hypothesis. Addiction is alien to nonaddicts; nonaddicts have no feel for the reality of addiction much like a eunuch wondering what all the commotion is about sex. Non-addicts look at addicts and just shrug their collective shoulders and wonder; they can't conceptualize it. Use of addictors appears to be a conscious choice because it is for them. Addiction appears to exist by choice and willful, conscious stupidity. Addicts know this is not so, but don't themselves know what is so. Addicts all know that there is something especially different about themselves from birth, but they don't know what it is. That something is the neurobiology of addictions. Thus, the conundrum and conceptual vacuum.

Continuing in the same old psychologically biased direction hasn't worked for addictionology for over 100 years. If nothing changes, nothing changes. Nothing has changed. The mess continues and addictionology nonetheless continues to continue in the same direction. The belief that we just need to keep on keeping on not only hasn't worked but will never work. Stop kicking the dead horse already. It's dead.

The history of medicine is laden with superstitious and psychobabble explanations of diseases especially for those above the neck. These are later replaced by valid pathophysiology and extinction of the psychobabble and superstition. Old examples include the miasma etiology of infections. More recent examples are epilepsy, schizophrenia, manic-depression, depression, ADD, Tourette's syndrome, autism, and even sleep disorders. Differing personalities are now known to be derived from permutations and combinations of genetically based biological temperaments. Even our baseline level of "happiness" or well-being is neurobiologically derived [David Lykken and Auke Tellegen, "Happiness is a Stochastic Phenomenon," Psychological Science, 1996, 7, 186-189)]. Mental and emotional phenomena are being explained by neurobiology, more each day, yet addictionology desperately holds on to psychobabble explanation of addictions for dear life. Superstition is replaced by neurobiology more and more each day. Yet, like the creationists arguing with the evolutionists, no amount of evidence is ever enough. Believe it, for creationists as well as environmentalists, no evidence will ever be enough. The realists need to walk away from the environmentalists and do their own complete and valid work. We need to stop having to prove to the recalcitrant environmentalists they are wrong. They will never accede. They will never surrender. Environmentalism thus needs to be ignored so the rest of us can move on to real science, real medicine, and real addictionology.

There hasn't been a new idea in addictionology in years except for Ken Blum's reward deficiency syndrome (Reward Deficiency Syndrome, Kenneth Blum et. al., American Scientist, Mar-Apr, 1996 or http://www.sigmaxi.org/amsci/articles/96articles/blum-full.html.), but that concept, a pathophysiological concept, the first in addictionology, fell on deaf ears and besides he messed it up for lack of reproducibility, depth and comprehensiveness of theory, and by his conflict of interest to make a buck off of nutritional supplements for the treatment of addictions. Good concept, good idea-bad follow-through. Something as diverse as addictions can not possibly be due to one gene. That idea is narrow-minded and shortsighted, but overall, the reward deficiency syndrome is at least moving us in the right direction.

I dismiss Leshner's hijacked brain hypothesis and Begleiter's vector model. These fail for lack of reality, integrity of research, and conceptual bias. As part of his theory, to explain why all drug user's brains aren't hijacked, to explain why most heroin using Vietnam vets stopped using heroin on return to stateside, Leshner conjured up "absence of environmental cues" as the cause of this occurrence. Has any of you seen an addict stop being an addict by changing his environment? Please. The vets who stopped weren't addicts or hypoics to begin with. Their brains weren't hijacked. The hypoic addicts, the real ones, couldn't stop and required recovery like all real addicts. Addicts' brains aren't hijacked after using a drug, they're hijacked at conception.

Pre-paradigm times are always full of multiple, contradictory, confusing, and superstitious (believed without an iota of proof) ideas. We are now living in such a time concerning addictions. In Chapter 8, Psychodynamics, from Substance Abuse - A Comprehensive Textbook, which is the bible of the present addiction paradigm, are the following statements by the authors in the opening paragraph: "Unraveling the etiology of substance abuse continues to be a challenge. There have been many technological advances in understanding the chemistry of human behavior, including the highly significant discovery of OPIATE receptor sites and endorphins, as well as other neurotransmitter systems. However, the substance abuse field continues to be in a preparadigm stage of development, suggesting a lack of agreement between theory and treatment. Sederer notes: To set foot into the field of psychiatry (or the addictions) is to encounter an overwhelming mass of clinical data, hypothetical notions, and theoretical constructs. Dopamine mingles with denial, and serotonin with symbiosis. Defenses and divorce appear as meaningful, and influential, as gamma aminobutyric acid and the endorphins. Urban drift, ego-deficits, and ventricular enlargement may be found rubbing conceptual shoulders.'" In other words, the field of psychiatry and addictions is one big mess. Yet, the chapter's authors perpetuate the present mess and its myths with a chapter chock full of psychobabble.

We need to imagine a real paradigm of addictions that fits real addicts.

A real medical paradigm works like this:

The equation of a real medical entity is first the normal:

Normal Physiology of the specific system involved in the disease --> Understanding of the normal function of that system --> understanding, insight and accurate policy (treatment, research, laws, attitudes) for that system.

and for the abnormal, the disease equation is: slide 2.

1. pathophysiology (abnormal or diverse physiology) of the system involved in the disease --> 2. Understanding of disease --> 3. Understanding of the symptoms --> 4. rational policy (treatment, recovery, and public and political policies for the disease).

When the left side of the equation (blue) is wrong, the right side (red) is definitely wrong. This is the case today in addictionology.

If we don't understand what system is involved, where it is in the brain, its normal physiology, or its pathophysiology, then we can't expect to understand the disease and the symptoms. How too can we then do appropriate treatment and policy? That is where the current addictionology paradigm stands today. Not only does it not know the physiology, it doesn't even know which physiology and in which neurological system this physiology works leading to the disease and the symptoms. Yet it persists in quite opinionated and emotion driven arguments concerning the policy side of this equation. It's stuck in the right side (red) of the disease equation without knowing or even conceiving of a valid left side (blue). This is an untenable place to be. Valid medicine and accurate policy demands knowledge in depth of the left side of this equation. It doesn't even have a clue of the left side of the equation for addictions. Until today.

Another way to say the same thing is: when a supposed disease has twenty plus etiologies, fifty plus diagnoses, hundreds of treatments, and a multitude of specialists from acupuncture to voodoo to traditional religion to psychology to medicine, we don't yet have a real disease. No well understood medical disease is confused by such a messy hodgepodge of confluent nonsense. This confused mess is present day addictionology. We must acknowledge this.

There is an undiscovered and unconceived disease causing addictions. The emphasis must be on discovering this, the left side of the equation. This is where I want to begin this reorientation of the disease of addictions.

Yes, there is an entity behind the addictions; an entity propping up addictions, without which there would be no addictions. Principles of modern medicine demand this to be the case. Whether the mechanism I discuss below, Hypoism, is that actual mechanism, only time will tell. But, its going to be something like it conceptually.

Addiction is not a choice and is not invented by the patient. Addiction must necessarily resonate with some brain mechanism that already exists in the susceptible person, (Michael Gazzaniga's selection vs. instruction concept of human nature- Nature's Mind: The Biological Roots of Thinking, Emotions, Sexuality, Language, and Intelligence, Michael S. Gazzaniga, (New York: Basic Books, 1992) whom I call the hypoic. Addiction doesn't resonate in the non-hypoic. It doesn't happen in the non-hypoic. It doesn't relate to non-hypoics in any way. It can't. The pathophysiology is just not present in them.

In medicine, for there to be a "disease," there must be an existing, "normal," mechanism behind it. There must be something in the organ involved with the "disease entity" that resonates with it. Diseases in medicine don't come out of a vacuum or psychobabble or superstition. Diseases are real and involve real physiologic mechanisms.

There is a disease, an addiction mechanism, an addiction machine if you will, already in place and only in hypoics, the ones with the disease, that causes addictions. The normal mechanism exists in all humans but is altered in hypoics by genetic alleles acting within that system to produce radically different effects, the inexorable capability to be an addict. Addictions are manifestations of this altered mechanism, addictions and other goofy behaviors. And they come from a mechanism that already exists; it is there in normals seemingly doing something totally separate from addictions, but when it gets altered by the appropriately affected genetic alleles, out come addictions.

That this is the most complex disease in all of medicine and is confounded by the most superstition, pseudoscience and misconceptions is the cause of your past perspective problem. Your conceptualization of addiction has been warped by old and wrong biases.

And, just look at who's been studying this disease, Psychiatrists. They are not trained in the pathophysiological basis of disease for the most part. They don't and aren't trained to think like physicians. Real doctors never wanted to look at addictions because they're too damned hard to comprehend. Medicine left addictions to the witch doctors. No offense intended. Only witch doctors are stupid enough to take on this impossible task. But witch doctors don't have the medical pathophysiological conceptual and principled perspective necessary to explain a real disease. They've been trained, on the other hand, mostly about psychobabble explanations of abnormal behavior. Naturally, therefore, psychobabble explanations have confused the field over the last hundred years in addictionology. Psychobabble is deeply rooted, too deeply rooted, and has led to biased concepts. So deeply rooted, in fact, that it is immortal and infinite. It can't be killed. Therefore, it must be ignored and left to wither or whatever it ends up doing. But it can no longer interfere. We must move on and away from psychobabble and superstition.

Let's, then, bring addictions into the realm of modern medicine and perceive them as part of a real disease, which, of course, they are.

Modern medicine says there is a normal mechanism altered by the pathophysiology of the disease causing the symptoms and that the specific nature of this altered physiology dictate its treatment and policies. The left side of the equation dictates the right side, not the reverse as exists today.

slide 3. please. A List of Addictions

Alcohol Addiction(alcoholism) Drugs, drug addiction, "substance abuse" Cigarettes, nicotine People addiction (so-called co-dependency). Compulsive overeating, food addiction, Bulimia, Anorexia, Self-mutilation, Hair pulling, Narcissism, Body Dismorphic Disorder (BDD), ADD, Obsessive-Compulsive Disorder, Internet addiction

Exercise addiction, body building addiction, anabolic steroid addiction Sex addiction, voyeurism, pedophilia, exhibitionism, etc. Gambling addiction, games, Money addiction, Work addiction, (workaholism), hobbies, Power: Military, police, politicians, Mafioso, religion addiction, cult and gang leaders,

correction and probation officers, and gurus. Shopping addiction, collecting addiction, Risk taking addiction, Comedy, acting, performing, Theft, vandalism, con-men, compulsive and impulsive lying, image (phonies), Violence addiction Hate addiction, Racism Religions addiction, cults, superstitions, self-help addiction, and gangs

These are some of the addictions (symptoms) I listed off the top of my head. I'm sure there are many more. What a mess. These are the trees, the symptoms. Stand back and see it as the forest it truly is. Can you see the disease, or at least the mechanism in there? There is a disease that causes all of these symptoms, they are not individual diseases. What you will readily notice when I point it out is that there is a clue to the disease mechanism right up there on that list. Can you see the common denominator?

Every addiction is either related to a known human instinct (behavioral addictions) or is a neurotransmitter substitute for or stimulator of the natural neurotransmitters used to reinforce the use of the instincts (drugs).

A short list of some human instincts includes: Attachment, Revenge, Gluttony/Eating, Pride, Approval/Ostracism, Superstition, Lust/Sex, Greed, Xenophobia, Authority/Agonic, Envy, Falling in love, Sloth, Risk Taking/Exploration, Jealousy.

This clue, that instincts lead to all behavioral addictions, relates to the presence and location of the disease mechanism, the genetically altered normal cognitive mechanism: The Instinct Regulating and Reward Mechanism present in all humans and bequeathed to us via evolution and natural selection.

Also, like all diseases in medicine, addictions only happen in certain "susceptible" people and not in others, never: Only in those with the pathophysiology. Besides, patients (addicts) don't cause their own disease, therefore, they don't cause their own symptoms, addictions.

Like all diseases, if you have the pathophysiology, you will have it's symptoms. Addictions are thus inexorable in hypoics and only in hypoics; not specific addictions, however, like alcohol addiction, so-called "alcoholism," but some addictions. The mechanism and its pathophysiology are what is genetically transmitted and determined, not necessarily specific symptoms and not specific addictions.