The End of My Addiction

thought to have its own distinctive pathway of neurotransmission in the brain: hedonistic “reward” craving; a desire for decreased tension dubbed “relief” craving; and “obsessive” craving, in which one is unable to stop thinking about the addictive substance or behavior. This paper and other studies have attempted to link the three types of craving to different manifestations of addiction, postulating for example that “reward” craving tends to define early-onset addiction and “relief” craving tends to define late-onset addiction.
    As I considered the issue of craving in 2003, I thought that these distinctions might well prove important in medicine’s ultimate understanding of addiction. Yet I also wondered how effectively they could be separated in terms of treatment. My alcoholism was very much a late-onset addiction, and most of my craving could best be described as craving for relief from extreme tension. But I also regularly experienced craving for reward—wanting to feel good for a change—and was frequently burdened by obsessive craving in which I could not stop thinking of alcohol.
    I wondered just how different the different types of craving actually were. We like to think that it’s the subtle differences that secretly, really count. But perhaps the common denominators in neurotransmission that have been observed in addicted people and animals count for far more than the subtle differences in neurotransmission do.
    In this regard, it fascinated me that baclofen had suppressed laboratory animals’ self-administration of alcohol, cocaine, heroin, methamphetamine, and nicotine. With enough baclofen, the animals lost their motivation to consume the addictive substance—whatever it was. The lab animals could not tell researchers whether reward, relief, or obsessive cravings were uppermost in their minds. It certainly made no sense to distinguish between early-onset and late-onset addiction in animals deliberately addicted to a substance as part of a scientific experiment. And they did not stop consuming addictive substances because they understood the behavior was detrimental to their health or had an awakening. But they stopped.
    The more I learned, the more I came to believe that at a high enough dose of baclofen, I too could reach a point where I would lose the motivation to consume alcohol. But how high? Baclofen had suppressed laboratory animals’ motivation to consume alcohol at 1 to 3 milligrams per kilogram of body weight; it had suppressed their motivation to consume a variety of other addictive substances at 1 to 5 milligrams per kilogram of body weight. The range of doses at which different individual laboratory animals stopped consuming the same addictive substance suggested that the severity of an individual’s dependence might be a factor. My doctors told me that my alcoholism was extremely severe. So, again, how high a dose would I have to take?
    And at what risk? It remained a distinct possibility that a high enough dose to suppress craving—my craving—could also kill me. Perhaps it would relax my muscles so much that I would stop breathing in my sleep. Although it seemed better to die with dignity in the search for a cure than to resign myself to the messy indignities of an alcohol-related demise, I had no death wish.
     
    I struggled on. There were experiments with other treatments; other binges, other accidents. As the year waned, I mapped out a protocol for increasing my baclofen intake. Then, on January 8, 2004, I decided it was now or never. If I continued to follow my doctors’ advice and the conventional treatments for alcoholism, I was going to keep lapsing into binges and eventually die from drinking. I had to take my treatment into my own hands.
    To give my baclofen protocol a fresh start, I went down to a low dose of 30 milligrams and added 20 milligrams every third day, allowing an additional 20–40 milligrams a day to deal with heightened craving for alcohol or a spike in my stress level. Because my alcohol cravings were always worse in the afternoon and evening, I divided the baclofen into three unequal doses, taking less in the mornings and more later in the day. I planned to go as high as 300 milligrams a day, assuming there were no limiting side effects. That would be 4 milligrams of baclofen per kilogram of my body weight, above the dosage range, 1 to 3 milligrams per kilogram of body weight, shown to suppress motivation to consume alcohol in