The End of My Addiction

it impossible to discover anything about and would also have cast doubt on the value of high-dose baclofen alone. But of course I was frustrated that there was no chance to carry out the multicenter trial of high-dose baclofen, as originally contemplated.
    I would continue to work within normal academic channels to stimulate a randomized trial of high-dose baclofen. But at this point it seemed to me that if baclofen was to get a fair hearing, I would also have to go outside those channels and present the evidence to the public at large, including scientists, physicians, and addiction patients. I began to write this book.

9. How Baclofen Works: What We Know, and Need to Know
    “ IT IS SO GOOD to see you as you were before,” my brother, Jean-Claude, said.
    “Not at all,” I said. “I never felt this way before in my life. I may have seemed okay, but in reality I was miserable.” Freed by baclofen not only from the biological prison of addiction, but also from the crippling anxiety that preceded it, I was finally at ease with myself and others. I felt that I was finally the person I was always meant to be.
     
    As we reach the end of the first decade of the twenty-first century, many aspects of the addiction process remain unknown. But medical science is fitting large pieces of the puzzle together, and a comprehensive understanding of this deadly disease is beginning to emerge. Amid fierce competition by pharmaceutical companies to discover and patent an effective treatment for addiction, the evidence points to high-dose baclofen as the best hope for a cure.
    According to the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV ), addiction, or substance dependence, can be diagnosed with the presence of three or more of the following criteria in the same twelve-month period:
Tolerance to a substance, so that the same amount no longer has the desired effect and increased amounts are required to produce that effect.
Withdrawal dysphoria.
Loss of control during substance use, so that use is longer or more extreme than intended.
Inability to limit further use of the substance.
Substance use, including procuring the substance and withdrawing from it, occupies large amounts of time.
Substance use affects normal life activities.
Substance use continues despite recognition of its serious adverse effects. 1
    The fact that these symptoms and consequences all manifest themselves in one way or another in the mind and awareness of the substance-dependent person naturally suggests the hope, or expectation, that addiction is subject to conscious influence or control. On the one hand, this leads to moral judgments about substance-dependent people, that they lack virtue or willpower or require spiritual enlightenment. On the other hand, it points the way to nonjudgmental twelve-step programs, psychotherapy, and rehab, which aim to enhance substance-dependent people’s ability to recognize and modify their unhealthy behaviors.
    Addiction treatment based on twelve-step programs, psychotherapy, and rehab has remained virtually unchanged since the founding of AA in 1935. There is scarcely another major illness whose treatment has been static over the last seventy or more years. While these forms of addiction treatment have enabled a minority of substance-dependent people to remain abstinent, they have not enabled the vast majority of substance-dependent people to do so.
    The far less static field of neurobiology, however, has, over the last few decades, evolved and developed in a way that offers greater hope for new addiction treatments. With increasing precision, neurobiology has shown how the symptoms and consequences of addiction are mediated at the molecular level by neurotransmission in the brain, especially that involving the neurotransmitters dopamine, gamma-aminobutyric acid (GABA), and glutamate. For example, dopamine plays what seems to be the leading role in the experience and recall of pleasant experiences, and thus is clearly crucial to addiction. But one transmitter always acts in concert with or opposition to another, and every brain activity recruits multiple neurotransmitters, which may play somewhat different roles in different combinations.
    The receptors for different neurotransmitters respond directly or indirectly to many different substances, which in turn excite or slow the release of the neurotransmitters. Threshold responses mean that the