Strange Brew

I was reading some speeches today made by the new directors of the NIAAA and NIDA, National Institute for Alcohol and Alcohol Abuse[i] and National Institute for Drug Abuse respectively, two poorly named Institutes as if addicts actually abused drugs and other addictors rather than the other way around. In fact, they should be made into only one institute, the National Institute of Addictions to cover all addictions, substances, behaviors, and beliefs. What I discovered from these speeches was a lot of hype, promises, jargon, and outright unsubstantiated untruths[ii], but no comprehension about which they claim to be experts. I think I realized why they are in such a mess, besides the fact that these experts haven�t a clue about what an addict actually is except in theory (and that theory is wrong besides.)

There�s a very peculiar disconnect or discontinuity in the field of addictions between the major players in the field, the doctors and scientists on the one hand, and the recovery movement, the addicts, and treatment people on the other. We can leave the politicians out of this for the time being because they only gets briefed by the doctors and are therefore being misinformed. These two separate groups are the oil and water. I think this is a historical disconnect and part of the culture of psychiatry. As you can see from the title, I belong to both groups and because of that have a perspective neither of the two groups have. My contention is that this makes a big difference.

The doctors and scientists want to be doctors in the usual sense where they prescribe and therapize to addicts and talk like doctors, the control/change (the patient) paradigm of medicine, while the recovery movement and treatment people, most of whom are also in recovery, act more like witch doctors, priests or shamans and use spiritualistic practices reminiscent of the dark ages of medicine, pre-modern medicine, the superstitious/surrender/acceptance (believe/give in/accept from on high) paradigm. Nevertheless, they do have a feel for what an addict is, something the doctors don�t have. The disconnect that exists between these two groups is that neither group works with or even understands the other group. They have different languages and have no good way to communicate with each other on an equal basis. In fact, the dialogue if there is one is very skewed and paternalistic. The two sides don�t even seem to want to communicate with each other because they don�t see themselves as equals. They have been at war with each other for too long. Although they think they�ve been cooperating, they�ve actually been at war. Addicts are being hurt because of it. One group is the experts and the other group is the patients. There�s a wall between them. Thus, the doctors have no feel for what an addict is and study and treat them as if they were objects and stereotypes completely derived from outdated psychobabble. The patients know there�s something biologically different about themselves, but don�t know what it is and don�t demand the doctors listen to them to discover this difference, their reality.

The control/change paradigm of modern medicine, excepting addictionology, has advanced fairly well using this �patient as object� �doctor as beneficent father� paradigm, but only when it has used the pathophysiological basis of understanding diseases (what is actually going on in the particular bodily machine involved with the disease) and developing drugs and therapies based on that pathophysiology, never when they used psychobabble paradigms, all of which have been discredited. On the opposite pole, the spiritualists of the recovery movement use spiritualism and faith in a higher power that loves the patient to allow the patient to turn their problem over to that power and accept his will. There�s no theory, therapy, medications, or other techniques of modern medicine used here. Their motto is, �Don�t analyze, utilize.� In fact, the prototype recovery program, the 12 step movement, is so totally disconnected from the �doctors� that it has never been systematically studied and doesn�t allow itself to be. That�s quite peculiar because at the same time modern medicine was getting going with the advent of penicillin, around 1940, AA was simultaneously starting up, and fortunately for many addicts of all kinds, fortuitously succeeded in helping about 5%[iii] of addicts in the country at any one time, a small but significant number. I say fortuitously because absent any valid theory, AA evolved from a completely ineffective spiritualistic recovery movement by chance, having no new basis except for gut level feelings by its founders. This feat was remarkable because before that essentially 0% of addicts were helped by anyone. Moreover, absent AA and other 12 step programs, there would still be little recovery from addictions because no other �treatment� has ever been shown, independent of AA, not pills, psychotherapy, rehabs, or anything else, to have any documented success better than chance.

So, we have the doctors schooled in psychobabble lacking a pathophysiology[iv] acting like doctors, treating addicts as objects with no success, and we have 12 step programs at the other extreme getting about 5% success overall using a recovery program that they don�t understand and don�t seem to want to. Neither groups is telling the other group what it knows or what it is doing. All this after 70 years of AA doing what it can to be the be all and end all of addiction recovery and addiction doctors doing their thing as if AA didn�t exist except to send their patients to as an adjunct to their treatments. When I call addictionology a mess, this is the mess I�m referring to.

When penicillin was discovered to kill bacteria in people, massive research was stimulated that led to a very thorough understanding of bacterial physiology resulting in innumerable antibiotics for all varieties of infectious diseases. This was an example of the use of the principle of the pathophysiological basis of medicine. However, when AA was invented and shown to be somewhat successful in helping addicts, physicians never studied it in any similar way. In fact, it still isn�t being studied despite its being the only form of recovery of any kind for a multitude of addictions. THIS IS THE DISCONNECT. Medicine, including the NIH branches studying addictions and treatments, is out in left field doing doctor stuff with no results in any arena while the 12 step movement has stagnated in right field at 5% success rate and hasn�t had any success in expanding this number or, for the most part, because of the way it is structured, in improving prevention methods, public attitudes or policies concerning addictions because it has no valid theory, no pathophysiology, either. When modern medicine gets the pathophysiology correct for any particular disease, effective prevention, treatment, and humane and helpful public policy automatically follow. That these have not occurred in addictions is more proof that the doctors don�t have the pathophysiology correct, despite their protestations to the contrary.

I entered the scene in 1992 with my first paper on the pathophysiology of addictions and its treatment, recovery, and public policy implications, called Hypoism. A funny thing happened - Nothing. Neither side of this polarized addiction field showed even the slightest interest in it, no less willingness to even read about it. There was a peculiar closed-mindedness on both sides. Later, in 1998, I published my book that for the first time in the history of addictionology brought together the two disconnected sides of the addiction mess. I quote from the book, �The paradigmatic nature of Hypoism is not merely the biologic model, but the synthesis of a complete and global concept. This paradigm incorporates recent knowledge in neurobiology, evolutionary biology, evolutionary psychology, behavioral genetics, and addiction sciences coupled with the essence of the steps of A.A., the program that originated the revolution in recovery, as I interpret them within the Hypoism paradigm.� No one in addictionology ever thought of or tried doing this. I did. Why? Because modern medicine, a field I was trained in with the demands of pathophysiological discipline, dictates it. It is quite apparent that the psychiatrists running the field of addictions either were absent from school on the day when this was principle was instilled or lost it along the way in their later training. My guess is that they lost it within the psychobabble culture omnipresent in psychiatry; a culture that instils mythology rather than pathophysiology.

In the book I reviewed all the valid addiction science (as well as the massive amounts of invalid and fraudulent science) and from this synthesized the likely brain mechanism and its genetic alterations that cause the disease that causes addictions (pathophysiology). I then looked deeply into the 12 step program, the program I had used for over 20 years personally and knew intimately, to find what part or parts of the program related to this genetically altered brain mechanism making the 12 step program even somewhat effective. I found it. Out of the large number of behaviors and beliefs 12 step people perform in 12 step programs only one part of their program related to this brain pathophysiology could be identified that might be helping addicts recover. It wasn�t the higher power part, and because of this I believe it was unacceptable to 12 steppers. I did what no one, neither the doctors nor the witch doctors, ever even thought of doing. I reconciled the medical side with the recovery side of this mess. I won�t tell you what it turned out to be. Because you won�t understand what it means without having read the science that develops the pathophysiology and the logical sequence of how to understand it as it is presented in the book, you need to read the book to find this out.

I turned the addiction mess into a solved puzzle that merely needs to be researched and perfected just like any other real medical paradigm. I shared this work with thousands of addiction doctors including the NIH as well as with countless 12 step people. Neither group would read the book. I explained what I had accomplished and its implications to numerous families of addicts, journalists, politicians, and anyone else I could collar. No one would read the book. They all told me I was nuts and wrong without ever having read the book. This reaction is classical bias. Two NIDA scientists who actually read the book agreed with it. One science journalist from Newsday told me Hypoism was hokey and wouldn�t do a story about it without ever having read anything about it. I experienced a counterproductive rigidity of belief and severe bias from both sides. It was like a cold war without both sides realizing they were really on the same side, the side of the addict. Neither side was for the addict. Both sides were protecting their institutions. The polarization was one of longstanding belief and bias on both sides similar to two religions facing off against each other for the sake of the institutions rather than the people, the addicts, the losers in this war[v].

As you hopefully know, nothing has changed or improved in the field of addictions since 1992, and long before that as well. In fact, both sides of the addiction mess continue to say the same things they�ve been saying for many years, �We are solving the problem.� Yet, neither side is solving anything. The doctors are looking for medications to cure addicts, something that my brain mechanism predicts will only injure addicts as they have in the past, while AA plods along helping 5% of addicts while the world falls apart from the problems addictions are causing. In other words, while the rest of medicine is flourishing using the same concepts and intellectual tools I use in my book, the two sides of the addiction mess persist in using the wrong concepts and tools, concepts and tools that have not worked to do what is needed to fully help addicts. Both sides are still ignoring each other. I bring them together and am ignored by both sides. The NIH and the rest of addictionology have never said, �You know, AA is the only thing to ever help any significant number of addicts. We�re going to study AA deeply and see what it is about AA that makes scientific and neurobiological sense.� Likewise, AA has never said to the doctors, �You know, we think we have something here. We don�t know what it is that gets many addicts sober, but we want to improve our program. Why don�t you study us, find out what it is that is actually helping addicts and why, then maybe we can change and improve our program?� You would think that both sides of this mess would have said these things a long time ago. But, they haven�t. Read their literature! The doctors are completely in left field while AA is completely in right field. They are in separate universes. They don�t know anything about each other. AA is written in stone and has no mechanism for change. Addictionology is ignoring AA and making believe they�re acting like and being doctors by looking for pills to change addicts into non-addicts or persisting to try to change addicts with proven ineffective psychotherapy. According to Hypoism, the only pathophysiologically based addiction hypothesis in existence that reconciles all valid science, both sides are wrong and acting like prideful babies; irresponsible babies at that. They are both acting like religions. This is why I named their paradigm The Psychological/Religious (P/R) Paradigm of addictions. In the meantime, the addicts, their families, and society at large are suffering deeply from this nonsense.

Read my book, read its bibliography, read my web site that updates the book, and see what you think. I think Hypoic�s handbook and the Hypoism hypothesis brings the oil and water, the strange brew, together by getting the pathophysiology correct along with the correct understanding of addicts as real people, solves all the problems of all addictions simultaneously, and will lead to effective prevention, recovery, and public policy for addictions and addicts if both sides use it. Otherwise, we are in for a prolonged and non-productive mess.

[i] Read these and weep: http://www.niaaa.nih.gov/about/statement03.htm, http://www.nida.nih.gov/about/welcome/message.html They are the same old, same old blah blah, with no results backing their statements. This is politics, folks, not science. The disconnect is severe.

[ii] They�ve gotten away with this for years because there is absolutely no accountability. Both groups are mandated to testify in front of congress oversight under oath, but the oversight committees never demand any proof of anything that is testified to. Thus, no accountability.

[iii] AA would say they have a much higher success rate. However, since most addicts never even go to AA, for reasons having to do with AA itself, something AA won�t acknowledge or take responsibility for, the overall recovery rate for addicts across the board is estimated at about 5%.

[iv] As proof of this, here�s an admission from one of these doctors taken from Substance Abuse � A Comprehensive Textbook, the bible of addictionology, in the chapter entitled Psychodynamics [mythology]: "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 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.�

[v] One of the outgrowths of the Hypoism paradigm is an organization of addicts for addicts, The National Association for the Advancement and Advocacy of Addicts, Inc., the N4A. It is a 501-c-3 not-for-profit charity to which the net proceeds from the book, Hypoic�s Handbook, goes. Thus, this article, if it helps sell any books, financially benefits the N4A, not me personally. The N4A is the first and only organization ever to exist of addicts for addicts, actually, hypoics for hypoics. The oil and water disconnect has been so thorough as to have prevented an organization like this from ever existing. All other organizations in existence that say they are for addicts are actually fronts for the addiction treatment industry, anti-addict moralists, religions, various belief systems, legalization of various drugs or behaviors, or the government. None except the N4A are for addicts and their families primarily and solely where the addict comes first not the institution.