The End of My Addiction

alcohol normally, without losing control and endangering his professional and personal life.
    AA and physicians say that moderate, safe, nondependent drinking is impossible for alcoholics. “Once a pickle, never a cucumber again,” the saying goes. But it is the dream of many problem drinkers. “I wish I could enjoy a few drinks like a normal person,” I often heard others (and myself) say in AA meetings and rehab.
    After baclofen suppressed my alcoholism in February 2004, I had no interest in drinking. But eventually the question of how vulnerable I was to relapse began to prey on my mind. Would one drink plunge me back into the hell of alcoholism? Was I still in the disease, or thanks to baclofen was I now out of it?
    In May 2005, sixteen months after my last drink, I put my recovery to the acid test by subjecting it to three successive challenges.
    The first: while continuing to take my maintenance baclofen dose of 120 milligrams a day, I had three standard drinks (gin and tonics) over a few hours at a social gathering. Right away I observed that I had no urge to guzzle the first drink quickly, as I always did when I was dependent on alcohol. Instead I was content to sip it slowly over some forty minutes. The second gin and tonic, which I also drank slowly, produced a mild euphoria. I began a third gin and tonic, but was unable to finish it, an impossibility during my untreated alcohol dependence. The next morning I woke up feeling completely normal, without any of the remorse, fear, and guilt that accompanied my drinking in the past. Moreover, I had no craving whatsoever for alcohol, and in the following weeks, no alcohol thoughts or drunk dreams.
    For the second challenge, I continued to take my maintenance baclofen dose of 120 milligrams a day, but this time I upped the alcohol. I had five standard drinks, also in a social gathering, this time vodka and tonics, consumed over a six-hour span. Again I had no urge to drink rapidly and experienced only a mild euphoria. But the following afternoon, I had a bout of alcohol craving. An additional 40 milligrams of baclofen suppressed the craving within one hour.
    Several hours later, craving for alcohol returned, suggesting that the greater volume of alcohol in the second challenge had reactivated my old craving cycle. Increasing my daily baclofen dose to a total of 180 milligrams completely suppressed the cravings. Over the next six days, I tapered my baclofen dose back down to 120 milligrams a day with no recurrence of craving. This was another indication, following the animal trials and my previous self-experimentation, that baclofen’s symptom-suppression effects are dose-dependent; that higher doses may be necessary in times of stress; and that an effective maintenance dose is lower than the required symptom-suppressing dose.
    Accordingly, the third and final challenge was to see if a higher-than-normal dose of baclofen would prevent cravings from occurring, even if I consumed a massive amount of alcohol, such as is ingested during heavy drinking or active relapse. The day of the challenge, I took a total of 140 milligrams of baclofen: 30 milligrams in the morning, 30 milligrams eight hours later, and 80 milligrams in the evening at the same time as beginning to drink a 750-milliliter bottle of Scotch. Over the rest of the evening, I drank four-fifths of the bottle, about 600 milliliters.
    Despite a mild hangover the next day, I experienced no craving and no desire to continue drinking. That morning I took 140 milligrams of baclofen, and that evening I took 80 milligrams. For the following six days, I took three 60-milligram doses of baclofen, one each in the morning, afternoon, and evening, for a total of 180 milligrams a day, and then returned to my usual maintenance dose of 120 milligrams a day with no craving.
    It was good to discover that with baclofen I could drink in a nondependent way. On rare occasions since then, I have had a glass or two of champagne, or a vodka tonic or gin and tonic, at gatherings with friends. But given all the alcohol I inflicted on my body during my illness, I prefer not to drink.
    As far as Mr. A.’s alcohol dependence was concerned, his psychiatrist had tried him on oral naltrexone. A dose of 100 milligrams a day temporarily reduced his craving, but then had no benefit. Studies of oral naltrexone show that its effects commonly last for about three months and then fade. Increasing the naltrexone dose to 150 milligrams—an