The End of My Addiction

to a physician-scientist responsible for directing addiction research at one of the world’s most important government health institutes, he replied, “The chances of commercial success hinge on the patent life of a molecule, and we have our hands full with stuff that has that sort of potential.” In other words, it does not matter how good a generic medicine is, or how many people die while the search for a patentable, likely inferior substitute drags on.
    At a conference on alcoholism in 2007, I spoke to a world-renowned researcher about the need for a randomized clinical trial of high-dose baclofen. He said that he might look at baclofen for alcoholism one day and had the funding to do so, but in the meantime he had “other fish to fry.” And then he laughed and said, “After all, it’s not cancer.”
    As he walked away, I wished this man had been with me in the detox ward of a hospital a few years earlier, when drinking ruled my life. At the end of her rope, a woman patient burst out, “Why didn’t God give me breast cancer? At least then my children would visit me.”
    Directly or indirectly, addiction kills as many people every year as any single form of cancer (not to mention the fact that smoking is the largest single cause of cancer). According to Brandeis University’s Schneider Institute for Health Care, one in four U.S. deaths is attributable to alcohol, tobacco, or illegal drugs. Addiction’s impact on the lives of the people who suffer from it, and their families, is no less devastating than cancer. Often it is more devastating, because of the social stigma it carries.
    Lingering moral judgments about addiction as a self-inflicted malady, not a proper disease, constitute an enormous obstacle to the compassionate treatment of those who are substance-dependent. Such judgments ignore the overwhelming evidence that vulnerability to addiction is no more under the individual’s control than cancer is. And cancer was once viewed in equally disparaging moral terms, until science slowly built up a better understanding of it. Just as some people persist in wanting to see cancer, or the failure to survive it, as somehow connected to a lack of positive thinking, so do many people inside and outside the medical community resist the trend to defining and understanding addiction as a biological disease.
     
    On March 28, 2007, Senator Joseph Biden introduced a bill, the Recognizing Addiction as a Disease Act of 2007, to change the name of the National Institute on Drug Abuse to the National Institute on Diseases of Addiction, preserving the NIDA acronym, and to change the name of the National Institute on Alcohol Abuse and Alcoholism to the National Institute on Alcohol Disorders and Health.
    Many scientists and physicians welcomed the proposed changes, noting that 10 percent of the population is vulnerable to becoming dependent on alcohol, and significant percentages are vulnerable to developing dependence on other drugs (this does not count the larger number who engage in hazardous drinking or drug use but are not dependent). Others criticized them as coddling addicts and encouraging victimhood.
    Understanding addiction as a biological illness does not mean the end of the need for personal responsibility, motivation, and willpower in recovery. As the two dropouts from Pascal Gache’s baclofen patient group show, a person must still want to stop using a drug of abuse. I have spoken to several alcohol-dependent people who resist the idea of taking baclofen because they are not sufficiently motivated to stop drinking. Unless we are going to subject people to enforced treatment, they must still want to get and stay well by taking appropriate medication.
    Likewise, treating addiction with baclofen, or any medication that is shown to suppress addictive craving and motivation, does not spell the end of rehab, twelve-step programs like AA and NA, and addiction-related cognitive behavioral therapy. To the contrary, it will give them all new life.
    The sad fact is that relapse rates after rehab are extremely high, and have even been estimated to be up to 90 percent. Twelve-step programs also have a very high relapse rate. Precise numbers for failure to achieve or maintain abstinence despite faithful participation in AA, NA, and addiction-related CBT are hard to come by. To some extent, this is because of the anonymity practiced in AA and similar programs, which makes it difficult to obtain patient data. 14
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