The End of My Addiction

by self-experimenting with high-dose baclofen. My self-case report, “Complete and prolonged suppression of symptoms and consequences of alcohol-dependence using high-dose baclofen: a self-case report of a physician,” described the success of the experiment, called for randomized trials of high-dose baclofen, and proposed a new treatment model for addiction, “integrating cure and well-being”: “suppression of substance-dependence symptoms with alleviation of comorbid anxiety,” or in more general terms, “the blockade of the clinical expression of addiction symptoms with simultaneous relief of underlying dysphoria.” (See the appendix for the complete report.)
    Subsequently, I have proposed in articles published in peer-reviewed medical journals, and in personal communications with members of the addiction research and treatment community, that anticraving agents should be classified as either craving-reduction agents (CRAs) or craving-suppression agents (CSAs). CRAs, including low-dose baclofen, do not raise addicted patients to the threshold of true remission. They keep patients in the disease, so to speak, whereas high-dose baclofen took me out of the disease of alcoholism and freed me from all its symptoms and consequences.
    So far, high-dose baclofen is the only known CSA, but more CSAs should be sought and studied. No medication works effectively for everyone, and baclofen is surely no exception.
     
    In February 2008, I was excited to read the abstract of a paper in the journal Science by D. T. George et al. entitled “Neurokinin 1 receptor antagonism as a possible therapy for alcoholism.” According to the abstract, “LY686017 [a drug developed by Eli Lilly] suppressed spontaneous alcohol cravings, improved overall well-being, [and] blunted cravings induced by a challenge procedure.” In a comment on the paper, its senior author, Dr. Markus Heilig, the clinical director of the National Institute on Alcohol Abuse and Alcoholism, said that LY686017 represented “a fairly new approach to treating alcoholism,” because it targets “the anxiety that leads many alcoholics to reach for the bottle in the first place.” 5
    In contrast to the abstract, the paper itself plainly said that LY686017 only reduced cravings in the study, as opposed to suppressing them as high-dose baclofen does. At the end of the trial, patients in the study still had persistent craving, as measured on standard craving scales. The imprecision in describing LY686017’s effect is unfortunate; The American Heritage Dictionary says that to “suppress” something means to put an end to it or to halt it completely, not decrease it, and other dictionaries give similar definitions. Nonetheless, the language of the abstract signals a growing recognition that addiction medicine needs craving-suppression agents that will also address underlying dysphoria.
    I would be glad to see baclofen joined by other craving-suppression agents, once they are shown to be as safe in long-term use as baclofen. In the meantime, baclofen is the best hope for addiction treatment. All the available data indicate that it is as safe for long-term use as it is effective. Late in 2007, Giovanni Addolorato et al. published an article in The Lancet reporting that low-dose baclofen could safely be used by people whose severe alcohol dependence had brought about liver cirrhosis. 6
    I have already discussed the safe use of high-dose oral baclofen for comfort care in neurology since the mid-1960s at doses up to 300 milligrams a day, ten times the amount given in trials to date with alcohol-dependent patients. After I published my self-case report, I learned that high-dose oral baclofen has been safely used to provide comfort care to children and adolescents as well as adult patients. In a study with an eight-year follow-up conducted at Columbia University Medical Center, children and adolescents with problems such as gait control were started on doses of 40 milligrams a day and received as much as 180 milligrams a day without limiting side effects. 7
    Yet for the past twenty years, addiction researchers have not budged above 30 milligrams a day in studies of alcoholism and 60 milligrams a day in studies of cocaine addiction. These doses translate, respectively, to about .5 milligram and 1 milligram per kilogram of body weight for the average adult male, well below the 1 to 3 milligrams per kilogram of body weight at which baclofen suppresses self-administration