The End of My Addiction

connected by an unknown mechanism makes perfect sense. Don’t let yourself be crushed by disappointment if you are wrong. But your plan could work, and I believe it should work. I will look forward to hearing your results.”
    It had been four years since Philippe had spurred me on to save myself. He had so memorably written me, “I never let you down, and I will never drop you as a friend. More important, I cannot believe that a man of your intelligence cannot find the solution.”
    He had been true to his word. And I was doing everything I could to be true back to him.

7. Cutting Through Craving
    A HISTORIC LATE-AUGUST HEAT WAVE struck Paris. Many elderly people died in this unusual heat.
    My tragedy did not compare: I only lost my computer. It crashed totally, with no backup. All the key abstracts I had compiled to try to save my life were gone. A cold sweat broke out over my whole body, and I nearly fainted. I thought I might develop a heart attack. The calming effect of the 180 milligrams of baclofen a day I was taking evaporated in the face of this traumatic shock. I immediately took 80 more milligrams and lay down.
    To my surprise and relief, within an hour I started to feel better. Without baclofen, I would have been in a hopeless state for days or weeks. Positive thoughts came to mind: “Look, you’re alive. You can gather it all again as you did before.” In fact, I had printed out the most important abstracts, and thanks to my good memory and a new set of online searches, I soon duplicated most of my research base. Regathering my confidence bit by bit, I reviewed all I had learned and inferred about alcoholism, addiction in general, and baclofen. And as I did I came to an important conclusion:
    One characteristic that separates addiction from the vast majority of other diseases is that it is symptom-driven and symptom-dependent. In addiction, the symptoms are the disease.
    In nearly all other diseases, symptoms do not drive the progression of the disease. When symptoms are discernible, they can often be suppressed, while the disease itself rages on in the body. Think of the fever of tuberculosis, the abdominal pain of pancreatic cancer, and the angina of severe coronary heart disease. Stopping the symptoms does nothing to stop the disease.
    Many illnesses—say, forms of cancer and heart disease—are asymptomatic. Because patients experience no discernible symptoms, medicine speaks of these conditions as “silent killers,” which are often detected too late to save the patient’s life. But when it comes to addiction, it is impossible to separate it from its symptoms. Stopping the symptoms of addiction—the cravings, obsessive thoughts, and the motivation to consume an addictive substance or engage in an addictive behavior—would in fact stop the disease. The patient would go into complete remission.
    Knocking out the symptoms of addiction would inactivate the disease by taking away all its weapons.
    There is a similarly tight connection between illness and experiential symptoms in the preaddiction morbidities—such as anxiety and panic and depression—that I had heard so many addicts (myself among them) describe as the cause of their turn to addictive substances. Here, too, stopping the discernible symptoms stops the disease. If someone has pain from a cancerous tumor, it is necessary to both alleviate the pain and remove the tumor. If someone no longer feels anxious or depressed, there is nothing left to treat.
    Craving for an addictive substance, or a compulsive behavior, is the primary symptom of addiction and compulsion in two senses. From the suffering patient’s point of view, craving is the constant enemy that must be battled—even after years of abstinence. And, from the point of view of the disease process, craving is now recognized as the number-one cause of relapse.
    Yet in other ways, craving remains a hotly contested subject in addiction research. Some researchers say that addictive craving is too elusive a concept to have practical value. To which I say: Like pain, it is only elusive if you don’t have it.
    The vast majority of researchers acknowledge the centrality of craving in addiction, and some seek to define distinctions between different categories of craving. In a 1999 paper in the journal Alcohol and Alcoholism , R. Verheul et al., of the Amsterdam Institute for Addiction Research at the University of Amsterdam, reviewed research on three types of craving, each