The End of My Addiction

think you’re right. The neurons in the insula are predominantly motor neurons that control muscular activity.”
    The chain of events within the body that leads to the dysphoria of anxiety or depression and to addictive craving thus may run something like this: Dysregulated neurotransmission could have its first perceptible effects on the muscles, and subsequently disturb our emotional feelings and thoughts. To treat the underlying dysphoria and addiction alike, we must cut the chain at its first link.
    Much remains to be learned about baclofen, as I have said, but the value of investigating it thoroughly, including testing its efficacy against addiction in randomized trials, is fully established by what is already known about it.
     
    Early in 2008, Professor Thomas Papo, chairman of the department of medicine at Bichat Hospital, one of the University of Paris’s teaching hospitals, contacted me and said that Dr. Catherine DeAngelis, the editor-in-chief of JAMA , in which I have published two peer-reviewed papers on addiction, had told him about my work. This led Professor Papo to invite me to give a lecture at Bichat, which he entitled “Alcoholism: the new deal.”
    Around the same time, Professor Antoine Hadengue, chief of gastroenterology and hepatology at the University Hospitals of Geneva, invited me to lecture on baclofen there later in the spring, and George Koob asked me to consult on prospective baclofen experiments with a colleague of his at the University of California at San Diego. I was honored by both requests, and delighted to accept them.
    Dose-dependent baclofen is slowly gaining the attention it has deserved since Dave Roberts’s groundbreaking 1997 paper showed that it suppresses cocaine self-administration in animal trials. Despite these developments, I fear that a randomized trial of high-dose baclofen in human patients remains far off. Jonathan Chick may have been right when he warned me that it could take up to a generation for medicine to adopt a new treatment approach.
    Meanwhile human trials of naltrexone, acamprosate, and topiramate have been mounted or are going forward, although these studies consistently show very modest results. No matter what the dose, these medications reduce, but do not suppress, the symptoms and consequences of addiction. This is in accordance with animal studies, which show that no matter what the dose, these medications, and likewise vigabatrin, reduce, but do not suppress, self-administration of addictive substances. In this regard, the key difference between baclofen on the one hand and acamprosate, naltrexone, topiramate, and vigabatrin on the other hand is that the latter drugs are under patent (oral naltrexone is available as a generic, but injectable naltrexone is under patent). Pharmaceutical companies readily fund research on them, and their sales representatives regularly visit doctor’s offices to discuss their use (topiramate was FDA-approved for epilepsy, and it is prescribed for alcoholism off-label).
    Baclofen is the one and only medication shown to suppress motivation to consume addictive substances in animal studies; it is the one and only medication shown to suppress the disease of addiction in human beings. Taken together, the data on high-dose baclofen amply support randomized clinical trials of its effectiveness for dependence on alcohol and other substances. Nearly all addiction medication trials are funded by pharmaceutical companies, however, and the cost-benefit analysis they must perform in the interest of shareholders dictates that they cannot spend money on baclofen, which is out of patent.
    The cost-benefit analysis for society looks very different. The sum needed to fund a statistically significant trial of high-dose baclofen for alcohol abuse would be around half a million dollars. This is a small fraction of the costs that governments and corporations incur to treat the mortality and morbidity associated with alcohol, the most popular drug of abuse. Every year more than a hundred thousand people die from alcohol-related causes in the United States alone, around 270 people a day. Worldwide, two million people die every year from alcohol-related causes. The financial cost of alcohol-dependence-related lost workdays, hospitalizations, rehab, and other treatment has been estimated to be almost $200 billion a year in the United States alone. Similar costs arise with other drugs of abuse. 13
    When I wrote about high-dose baclofen