Evolution vs. Creationism Revisited for Addictions
EVOLUTION VS. CREATIONISM REVISITED FOR ADDICTIONS
Hypoism - A global medical neurobiological addiction
Or, Why we need a real disease of addictions and how
to get one.
Presented at the 3rd Millennial National Association for
the Advancement and Advocacy for Addicts (N4A) Conference on Addiction
Etiology, 1/18/2000 - Keynote Address
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
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
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
First, let me ask you a question.
What's the only problem with oral sex?
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
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.
--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
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
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
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
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
Let's, then, bring addictions into the realm of modern medicine
and perceive them as part of a real disease, which, of course,
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
Drugs, drug addiction, "substance abuse" Cigarettes, nicotine People addiction (so-called co-dependency). Compulsive overeating, food addiction, Bulimia, Anorexia,
Self-mutilation, Hair pulling,
Body Dismorphic Disorder (BDD), ADD, Obsessive-Compulsive Disorder,
|Exercise addiction, body building addiction,|
anabolic steroid addiction
Sex addiction, voyeurism, pedophilia, exhibitionism, etc.
Gambling addiction, games,
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.
please go to page 2. of this speech.....