The End of My Addiction

afterward.”
    “You are like a little kid,” she teased. “You think everything is marvelous. You tell me, ‘Look at this flower, look at this tree…look how beautiful it is.’”
    “But it is. It’s gorgeous,” I protested.
    She laughed. “Okay, it’s gorgeous, but why are you making such a fuss about it?”
    In hindsight, I realize, on baclofen I was beginning to see beautiful days without the nostalgic melancholy that had shadowed me since childhood. I was beginning to live fully in the present.

    I came upon a reference to a brand-new article in The Lancet by the University of Texas researcher B. A. Johnson et al. The article was entitled “Oral topiramate for treatment of alcohol: a randomised controlled trial,” and the abstract described a twelve-week trial in which 150 alcohol-dependent people were given either placebo or increasing doses of topiramate, a drug thought to facilitate GABA activity in the brain. That caught my eye because baclofen affects GABA activity; perhaps topiramate did so more strongly. The abstract said that those receiving topiramate experienced “27.6% fewer heavy drinking days…, 26.2% more days abstinent…,” and similar reductions in craving for alcohol. 3
    The percentage differences were similar to those reported for naltrexone and acamprosate, which I had already taken with no effect. But I was impressed by the fact that the article was in The Lancet , one of the world’s three most influential medical journals, along with The New England Journal of Medicine and The Journal of the American Medical Association . The other articles I had found were all in smaller, specialized journals. Moreover, the topiramate study was larger and longer than the baclofen studies in the other articles, and it was a randomized controlled trial, the gold standard of modern medicine. Last but not least, it was brand-new.
    “This must be the cutting edge,” I thought. It seemed like my best hope yet for achieving complete abstinence from alcohol. I went to the medical library at the Pompidou Centre to read the entire article and make a photocopy.
    Over a ten-day period, I tapered my baclofen dose down to zero. I used my doctor’s medical card to purchase topiramate, and then I followed the Lancet article’s protocol, taking topiramate for a total of twelve weeks and escalating the dose from 25 to 300 milligrams a day.
    During this twelve-week period, topiramate did not perceptibly reduce my craving for alcohol, and did not at all alleviate my anxiety and muscular tension, as baclofen did. Also unlike baclofen, topiramate had unpleasant side effects, including difficulty concentrating and impaired memory, that did not go away as I became used to taking it. In terms of both combating alcoholism and promoting a sense of well-being, baclofen proved far superior for me. I returned to wondering if a higher dose of baclofen than 180 milligrams a day could be safe.
     
    It was time to let Philippe Coumel know what I had been exploring.
    When I went to visit him in August, he was in the hospital and his appearance shocked me. He was clearly very ill, but his intelligent eyes and his smile were unchanged, and his mind remained razor sharp.
    His wife was with him in the hospital room. It was the first time we had ever met. After a few moments, she excused herself to give Philippe and me some time alone.
    I brought him up-to-date on my recent online investigations and my self-experiments with baclofen and topiramate. I described baclofen’s very different effects on me compared to all the other medications I had taken for anxiety or alcoholism. And I outlined my reasons for surmising that my best future course of treatment was to increase my daily intake of baclofen until it produced complete abstinence or limiting side effects.
    Just as he had when I was reporting my M.D. thesis findings, Philippe listened with penetrating attention, occasionally asking me to elaborate on changes in my anxiety and alcoholism symptoms in response to different medications. Forgetting his own concerns, my mentor, my friend, gave himself completely to helping me sharpen my self-diagnosis and my rationale for treating alcoholism with high-dose baclofen.
    Philippe said, “Olivier, you have always been a splendid listener with your patients, and now you are giving yourself the same benefit: you are giving the most marvelous descriptions. Your supposition that muscular tension and addictive craving must be