The End of My Addiction

a small fraction of substance-dependent people join twelve-step groups or go to rehab or outpatient treatment programs, and only a small fraction of them become abstinent. The high cost of addiction treatment plays a significant role in this, but so do the poor results of all conventional addiction treatments.
    A stay in rehab or participation in an outpatient program could provide the perfect setting to establish an individual’s effective dose of baclofen or a newly developed craving-suppression agent under medical supervision. With this, success rates of these programs would improve, which would then encourage more people with addiction to try them.
     
    Addiction is indeed a complex disease with biological and non-biological components. However, I could not utilize the life lessons of AA and CBT, many of which I was taught in rehab, until baclofen suppressed my craving and controlled my underlying anxiety. Desperately trying as hard as possible to stay with the program, only to relapse because of overwhelming craving, is the rule, not the exception, for people afflicted with the disease of addiction. It defies common sense, as well as the accumulating scientific evidence, to say that all these people are deficient in willpower, moral virtue, and/or spiritual faith.
    Until a randomized clinical trial of dose-dependent baclofen is mounted, I ask all physicians who treat addiction to consider prescribing baclofen off-label for care of those patients who remain ill despite existing therapies and have no alternative treatment for a devastating and often deadly disease. For physicians and patients alike, the scientific papers reprinted in the appendix offer a starting point for discussing baclofen and deciding whether it is appropriate on a case by case basis. As Dr. Markus Heilig, clinical director of the National Institute on Alcohol Abuse and Alcoholism at the NIH wrote me, “There is certainly nothing wrong with physicians prescribing [baclofen] off-label.” 15
    In the interest of public health and on behalf of all who suffer from addiction, I also call on government health agencies and officials, politicians, nongovernmental health organizations, and citizens to support full-scale randomized clinical trials of high-dose baclofen. There is a recent model for this activism in the development of the so-called AIDS cocktail of retroviral drugs, which dramatically reduced the mortality and morbidity associated with AIDS. With the same energy and commitment on the part of addiction patients, their families, and advocates for their care, it need not take a generation to mount the randomized trials required to establish definitively the safety and efficacy of baclofen and the value of craving suppression as a treatment model for both drug and nondrug addictions.

    On a sunny day shortly before the manuscript of this book was due at the publisher, I went to visit my parents’ graves in the Montparnasse Cemetery. I go there now and then. Following Jewish tradition, I place on their graves a few stones that I have picked up on a walk in the park or a visit to the seashore or the mountains. And I stay by the graves while I talk to my parents in my mind, letting them know that I am finally well and that alcohol is no longer a part of my life. I tell them, too, about others who have gotten well thanks to baclofen.
    In these moments I mourn their passing and I miss them and I feel close to them, sensations that are not in conflict with one another but in harmony. For I have no regrets. I feel the loss of so much because of alcoholism: the heartbreaking damage to my family, especially to my mother’s last years and my relationship with Jean-Claude and Eva, the extreme disruption of my personal life, the collapse of my career as a cardiologist. Yet no human life is without suffering, and we must all do our best to learn from it.
    Instead of being regretful, I am grateful. I give thanks for my loving parents and their shining example; for all that I have learned about myself and others, including the extraordinary wisdom for living of AA; for all the ways I have been challenged to grow and change; for the friends who stood by me in my illness and helped rescue me from despair; for the joys of music and laughter, and the beauty and harmony of nature, which sustained me in dark hours; for baclofen; and for all the blessings of the end of my addiction, especially my reconciliation with Jean-Claude and Eva and the new stability in