The End of My Addiction

e-mail addresses, although not necessarily the most up-to-date ones. In May, as I was contemplating what to write to David Roberts, the physiologist whose studies of cocaine-addicted rats laid the foundation for all subsequent addiction research with baclofen, I got an e-mail from George Koob.
    Apologizing for his slow reply, Professor Koob said that I’d written to an old e-mail address and told me, just as Georges Moroz had predicted, “I found your case history fascinating.” Noting that he had just concluded an experiment on baclofen’s ability to suppress alcohol intake in alcohol-dependent laboratory rats, he added, “I personally hope that our animal data and your ideas will ultimately translate to some consideration of baclofen-like compounds in the treatment of alcoholism.”
    Spurred by this encouraging e-mail, I sent my self-case report to David Roberts, expressing my profound thanks for the hope his papers had given me when I was investigating baclofen between binges. He quickly replied, “Please be assured that your letter has helped me regain my enthusiasm for doing further work with baclofen and related drugs. I also believe that by publishing your experiences you have helped convince a very skeptical readership that baclofen deserves a thorough assessment.” He forwarded the self-case report to Anna Rose Childress, who wrote me in similar terms.
    Koob later put me in touch with another of the world’s leading addiction researchers, Charles O’Brien, Kenneth E. Appel Professor of Psychiatry at the University of Pennsylvania, whose medical center includes the Charles O’Brien Center for Addiction Treatment, and a senior colleague of Anna Rose Childress’s. Professor O’Brien wrote me, “Your paper has already influenced me and others. I believe that Anna Rose Childress has told you about our research with baclofen. The question, of course, is whether our dose is too low.”
    There was one physician-scientist in New York whose opinion I was especially eager to get: Jerome B. Posner, world-renowned as the founder of neuro-oncology. In addition to being a professor of neurology and neuroscience at Weill Cornell Medical College, Dr. Posner is Evelyn Frew American Cancer Society Clinical Research Professor and George C. Cotzias Chair of Neuro-oncology at Memorial Sloan-Kettering Cancer Center. Although we had been neighbors in the same apartment building and had said brief hellos to each other in the elevator and lobby, I didn’t really know him and thought he might not remember me at all. But I so admired him. I sent him the self-case report with trepidation, because he had what my colleagues at New York Hospital had told me was a well-deserved reputation for demolishing faulty arguments with a few blunt words. He responded the very same day:
    Dear Olivier,
    Many thanks for the note and reprint. First, let me congratulate you on the successful treatment of your illness, of which I was unaware. Your treatment is reminiscent of the way in which George Cotzias was able to prove that L-dopa could successfully treat parkinsonism. Others had tried the drug with little success because they were unwilling to push the drug to full tolerance.
    Sincerely,
Jerry
    Coming from the Cotzias Chair of Neuro-oncology at Memorial Sloan-Kettering, there could be no greater words of encouragement.
     
    The Business Week article had not triggered any contacts from researchers or the media. However, what it did trigger was, in a sense, more heartening—and heartbreaking. I began to hear from addicts and their families. I spent countless hours via e-mail and telephone answering questions about baclofen and advising people on how to speak to their physicians about it. In almost all cases, sadly, they could not convince their doctors to prescribe an unfamiliar medication off-label. I told the patients I would be glad to talk to their physicians about how to manage high-dose baclofen therapy. None contacted me.
    One of the patients who tracked me down was Mr. A., a senior business executive in the Midwest. Mr. A. was dependent on alcohol, and he feared that if he kept drinking excessively he risked losing his career as well as his marriage. He also told me that he was seeing both a psychiatrist and a psychologist for treatment of anxiety and depression that preceded his drinking. But total abstinence was not Mr. A.’s aim. His job often required socializing with clients and staff, and his goal was to be able to drink