The End of My Addiction

high-dose baclofen therapy. All had failed to respond to conventional alcoholism treatments, including inpatient detoxification, rehab, and medications. Dr. Gache and I had several conversations about how to manage high-dose baclofen therapy, and over the course of the winter and spring we were periodically in touch about his patients’ reactions to the drug. After several months, he could report that one patient had not responded well: he constantly fell asleep on baclofen. (I was glad that I had warned Pascal that none of his patients should drive or do anything hazardous while they were getting used to baclofen.) But the other three patients, the woman who had first shown him the Top Santé article and two men, were doing wonderfully.
    These three patients found that baclofen suppressed their alcohol cravings at very different dosage levels. The woman patient had experienced craving suppression at 75 milligrams of baclofen a day. The other two patients required higher doses, with one of them taking 300 milligrams a day.
    Dr. Gache shared with me an e-mail message from the woman patient, who wrote, “I am amazed that I no longer think of alcohol, especially during critical situations…It’s fantastic. So far no somnolence, but very slight vertigo. I am thrilled at the state I am in. Thank you for proposing this treatment.” The vertigo soon passed.
    The other two patients expressed similar feelings. They also experienced minor side effects, including somnolence, but like the vertigo, the side effects were temporary.
     
    In June I went to Geneva to give the lecture on baclofen therapy that Pascal Gache had arranged. It was both gratifying and amusing to find that Pascal had entitled my lecture “Coup de pied dans la fourmilière de l’alcoologie: l’important c’est la dose” (A kick in the anthill of alcohology: what’s important is the dose). The subtitle was a play on Gilbert Bécaud’s hit song “L’important c’est la rose” (What’s important is the rose). Quite a few people in the audience had read my report, and there were many penetrating questions about baclofen and the probable mechanisms by which it could suppress addictive symptoms in both laboratory animals and human subjects.
    Before I left Geneva, Pascal told me that he had identified several other patients who seemed good candidates for baclofen therapy. Like the first four, these men and women had failed to respond to conventional alcoholism treatment, including both outpatient and inpatient therapy and medications. We agreed that Pascal would consult me about his baclofen patients, and that I would advise him on a pro bono basis.
    The other positive news was that Dr. Bucknam’s patient Mr. A. continued to thrive on his baclofen therapy of 100 milligrams a day, with up to 40 milligrams more in times of stress. After ten months, Mr. A. still had no alcohol cravings, still found 100 to 140 milligrams of baclofen mildly relaxing with no somnolence or grogginess to interfere with his hectic worklife, and still drank alcohol moderately in a nondependent fashion. This was in stark contrast to his experience on other anticraving medications such as naltrexone.
    When Mr. A. drank, he experienced only a mild euphoria and never wanted more than three drinks at a time. This kept him well below the five drinks at a time for a man that are the diagnostic standard for problem drinking and bingeing—and well below his previous hazardous intake.
    Mr. A. informed me directly of another element in his state of well-being: the end of his alcohol dependence had dramatically improved his relationship with his wife, and he no longer feared for the future of his marriage.
    With my encouragement and consultation, Dr. Bucknam drafted a case report on Mr. A., which he submitted to Jonathan Chick at Alcohol and Alcoholism . After the usual peer review process and revisions, the case report was accepted and Jonathan Chick scheduled it for electronic publication on December 15, 2006, almost exactly two years to the day after my self-case report.
     
    Around the same time, I learned that PHRC had rejected the proposed study of “baclotrexone” versus naltrexone. There were concerns about the safety of “baclotrexone,” as well as hesitancy about the planned 120 milligram doses of baclofen.
    In one sense I was relieved, because “baclotrexone” was an untested drug combination and its safety was unknown, and because its use in the trial would have made