The End of My Addiction

I decided to call him and ask him about baclofen again.
    Before I could tell him about the effect of baclofen on my alcoholism, John remarked on the healthy sound of my voice. He was delighted to hear about my recovery, and he laughed heartily when I said how afraid I had been to mention my drinking during our first conversation about baclofen.
    I said, “Do you prescribe over 80 milligrams a day to your own patients, John?”
    He said, “Sure.”
    “What’s your limit? Do you go up to 100 milligrams?”
    “Higher.”
    “200 milligrams?”
    “Higher, depending on the individual case, of course.”
    “300 milligrams?”
    “That’s as far as I go.”
    “400 milligrams?”
    “No, my boy, 300 milligrams a day is my limit. You can quote me on that in your paper.”
    John explained that 300 milligrams of oral baclofen a day was the conservative limit for neurologists of his generation, and that he had quite a few patients who took that much without any side effects. Younger neurologists tended to switch patients receiving over 120 milligrams a day to a spinal pump that had recently come on the market. But many neurologists saw no compelling reason to do this, given the common reports of infection and other complications from the spinal pump.
    Hearing this, I regretted my inability to ask John about the dose earlier and save myself a year and a half of agonizing over how much I could safely take. But truly, the knowledge was better late than never.
    In light of the successful experiments with high-dose baclofen in addicted laboratory animals and the routine prescribing of high-dose baclofen for comfort care of human patients in neurology, it perplexed me why addiction researchers used such small doses in their experiments with human beings. Could those in addiction medicine and research really be unaware of how neurologists had been using baclofen for decades? As I was to find out, the answer was yes, they were—an unfortunate result of the increasing specialization of medicine.

    While I was drafting my case report, I went through intense emotional swings. In some moments I dared to hope that my paper could help bring relief to other alcoholics and addicts. In others I was sure that an alcoholic physician, even an ex-alcoholic physician, would never be taken seriously.
    It seemed to me that as the only one who knew the secret code about baclofen, as it were, I must finish the article as soon as possible. I repeatedly told the woman typing the article for me, “If something happens to me before the article is finished, e-mail everything to Boris Pasche.” She patiently kept telling me that she would.
    Writing the paper was a considerable challenge, because I was describing something new in the annals of human addiction: not craving reduction but craving suppression; not abstinence or an aid to abstinence but complete, effortless indifference to alcohol, with simultaneous alleviation of comorbid anxiety.
    “You made exist what did not exist before,” said Jean-Claude, who offered me valuable feedback and suggestions after I had completed the draft. I was a little concerned that he might be biased in favor of the paper because he was my brother, but we had always been brutally honest with each other in intellectual matters, and his research achievements as an immunologist went far beyond mine as a cardiologist. Jean-Claude introduced the concept of apoptosis, programmed cell death, for the understanding of AIDS and other diseases in pioneering, sole-authored articles, and he has written many other important papers in collaboration with his research colleagues. He would never mince words with regard to medical and scientific questions.
    One of the vital points I wanted to make in the case report was that alcoholics and other addicts tend to have a preexisting, life-long dysphoria associated with disorders such as anxiety and depression. However, I feared that a journal editor or peer reviewers would argue that this was only an anecdotal claim based on my personal observation, and insist on cutting it. To my great relief, however, a major article substantiating my observation appeared at just this time. Writing in the August 2004 issue of Archives of General Psychiatry , Bridget F. Grant et al. reported on the U.S. National Institutes of Health’s National Epidemiological Survey on Alcohol and Related Conditions (NESARC). NESARC’s primary finding, which I cited in chapter 2 , was that “associations between