The End of My Addiction

unusually high dose and thus off-label; 50 milligrams is standard—did nothing, but the psychiatrist was unwilling to prescribe baclofen off-label.
    Mr. A. continued to see his psychiatrist and psychologist for anxiety and depression, and I advised him on finding another psychiatrist who was open to prescribing baclofen for his alcohol dependence. In the summer, after being turned down by a couple of doctors, he found William Bucknam, an addiction psychiatrist in Ann Arbor, who agreed to work with him and discuss the case with me.
    Dr. Bucknam appropriately first wanted to see for himself how Mr. A. responded to conventional anticraving medications. He had Mr. A. keep taking 150 milligrams a day of oral naltrexone, and when that proved of no benefit combined it with 2 grams a day of acamprosate, which again had no positive effect on Mr. A.’s craving and drinking. Finally he tried him on topiramate, with even worse results. Not only did topiramate do nothing for his craving and drinking, it also impaired his word-recall memory. This was a disaster for Mr. A., because he often spoke before large audiences at business meetings and conventions. While taking these medications, Mr. A. continued to drink heavily, an average of twelve drinks at a time.
    In September Mr. A. began taking baclofen, gradually increasing the dose over the course of a month to 100 milligrams a day. He contacted me daily by e-mail or phone, as Dr. Bucknam had urged him to do, so that I could coach him on what to expect from the medication and help him handle any problems that arose, and he was also reporting regularly to Dr. Bucknam and seeing him on a weekly basis.
    Before the month was out, Mr. A. reported that he came home from his daily three-mile run one evening and, for the first time since his drinking became problematic, he reached into the refrigerator and took out a bottle of water instead of a beer. Ordinarily, he had three or four beers before dinner, with more alcohol while eating. This evening, he felt no desire to drink, although craving for alcohol returned later that evening, because he did not think of taking any more baclofen.
    When Mr. A. reached 100 milligrams of baclofen, occasionally adding another 40 milligrams when he felt especially stressed, he said that heavy drinking became “an alien world” and called baclofen “my miracle drug.” He never felt the urge to have more than three drinks at any one time. He could now drink moderately while socializing with clients and others, without the risk of losing control and drinking to excess. Moreover, he experienced no somnolence and no other side effects while increasing his baclofen dose to the 100–140 milligram range and maintaining it at that level.
    Mr. A. continued to take an SSRI for his anxiety and depression. It seemed possible to me that he could dispense with the SSRI if he increased his baclofen dose. At doses above 140 milligrams of baclofen a day, however, Mr. A. experienced some somnolence. The evidence not only from my own case, but also from the safe long-term use of baclofen for comfort care in neurology patients, was that if he had taken a few days off work, the somnolence at the higher dose might well have passed. But he found the SSRI effective in managing his anxiety and depression and preferred to keep his baclofen dose at 100–140 milligrams.
    Although I expected things to go well, I was enormously relieved. Meanwhile, as I learned around this time, another alcoholic in the United States had entirely ended his drinking thanks to high-dose baclofen.
    On August 24, 2005, Dr. Jon Hallberg, a regular medical commentator on Minnesota Public Radio, reported on the air that a patient of his, “a hardcore alcoholic,” had asked for baclofen after finding my self-case report online. “In my patient’s case,” Dr. Hallberg said, “[high-dose baclofen] has worked amazingly well. He was drinking a liter of hard liquor every day. And within a couple of days of taking this, he stopped.”
    So now we had three humans and a bunch of laboratory rats responding to baclofen. It remained to be seen if this therapeutic outcome would continue for Dr. Bucknam’s and Dr. Hallberg’s patients, as it had for me, but the early signs were good.
     
    What I dreamed of were studies—randomized clinical trials to show either that others could achieve complete remission of addiction symptoms and consequences with baclofen, or that I was an anomaly. In a peer-reviewed