The End of My Addiction

following day.
    I suggested that the next step was a study of baclofen’s dose-dependent effectiveness for other alcoholics. She responded that I shouldn’t worry about other alcoholics, but should concentrate on my own life now that my ordeal with alcoholism was over. She expressed skepticism that other alcoholics would even want to try baclofen, and warned me that agitating for baclofen studies would only alienate people in addiction medicine.
    Her response was baffling, to say the least. In retrospect, I think it may have stemmed from her concern for me as her patient. She knew better than I how entrenched certain views were in the field and how difficult it would be to introduce a new perspective. And perhaps she did not quite trust in the fact of my recovery.
    Before I left, she wanted to make an appointment to see me again in a month. Given that I had been completely disease-free for one year, I could not see the point of that.
    Dr. S. then rewrote my standing prescription for baclofen. She reduced it from 180 milligrams a day to a maximum of 75 milligrams, because the higher dose I was taking was normally prescribed only for muscular issues—and she was not comfortable prescribing it for addiction, she said.
    The complete remission of my alcoholism could not be maintained at that dosage. In addition to which, a daily dose of 120 milligrams of baclofen was indeed calming my chronic anxiety. In medicine there is something called off-label use, or off-label prescribing. It is common. Once a medication has been approved for a specific application, it is perfectly acceptable for physicians to prescribe it for other conditions. Over 23 percent of all prescriptions, and over 60 percent in cancer care, are off-label. The American Medical Association says that the deciding factor in off-label prescribing is “the best interest of the patient.” 1
    The standard maximum dose for baclofen in France, as in the United States, is 80 milligrams. But as I had learned from John Schaefer, as well as from the Smith et al. paper on patients taking up to 270 milligrams a day, neurologists had been prescribing more than that off-label for a few decades without their patients experiencing any lasting side effects.
    I decided not to press the point with Dr. S.
    The meeting rattled me, but I regrouped, and on returning home e-mailed the head of Dr. S.’s department to say that I had heard about the plan to discuss my self-case report at the next day’s staff meeting. Would he like me to attend to elaborate on my experiences or answer questions? He quickly e-mailed back, saying no thanks. He also sent his “Bravo to Jonathan Chick,” the coeditor-in-chief of Alcohol and Alcoholism , for publishing my self-case report. Noting that the paper failed to specify the kind of anxiety I suffered, he suggested, “Perhaps [Dr.] Descombey could give the precise diagnosis.” And finally: “Dr. S. will stay in touch with you for follow-up on your case.”
    It escaped me why the specific kind of anxiety I had should matter. That had not concerned Jonathan Chick or the two addiction research experts who had so strongly recommended the publication of my self-case report. The e-mail at least demonstrated that the head of Dr. S.’s department had read my paper. But it was disappointing, and rather odd in terms of usual practice, that a group of physicians preferred to discuss a paper in a medical journal without taking advantage of the opportunity to engage the author in question-and-answer, especially when the physician author was also the patient and had successfully experimented on himself with a treatment protocol of his own design. My eye was drawn to the statement “Dr. S. will stay in touch…for follow-up on your case.” That suggested pretty strongly that the department head did not take my paper seriously, but saw me only as a perhaps temporarily abstinent alcoholic.
     
    A deafening silence ensued. Except for Giovanni Addolorato and a few of his colleagues in Italy, no one inside or outside the field of addiction research and treatment seemed to have any interest in the first peer-reviewed report of complete suppression of the deadly disease of alcoholism with alleviation of comorbid anxiety. I began to worry that my self-case report was largely going to be ignored, and that perhaps it deserved to be ignored because it was not really worthwhile.
    In February my friend Georges Moroz, a psychiatrist and psychopharmacologist who