The End of My Addiction

my personal life. Last but not least, I give thanks for the opportunity to become a physician, my parents’ crowning gift to me. I hope this book honors that gift and helps others to end their addictions.

Baclofen and Complete Suppression of Alcoholism
    Case Report 1
    Alcohol and Alcoholism vol. 40, no. 2, pp. 147–150, 2005
    Complete and prolonged suppression of symptoms and consequences of alcohol-dependence using high-dose baclofen: a self-case report of a physician
    Olivier Ameisen
    Abstract
    Aims: To test whether the dose-dependent motivation-suppressing effect of baclofen in animals could be transposed to humans, and suppress craving and sustain abstinence. Methods: Neurologists safely use up to 300 mg/day (10 times the dosage currently used for alcohol dependence) of high-dose oral baclofen, to control spasticity, in order to avoid invasive therapy. I am a physician with alcohol dependence and comorbid anxiety. I self-prescribed high-dose baclofen, starting at 30 mg/day, with 20 mg increments every third day and an (optional) additional 20–40 mg/day for cravings. Results: Cravings became easier to combat. After reaching the craving-suppression dose of 270 mg/day (3.6 mg/kg) after 5 weeks, I became and have remained free of alcohol dependence symptoms effortlessly for the ninth consecutive month. Anxiety is well controlled. Somnolence disappeared with a dosage reduction to 120 mg/day, now used for the ninth consecutive month. Conclusions: High-dose baclofen induced complete and prolonged suppression of symptoms and consequences of alcohol dependence, and relieved anxiety. This model, integrating cure and well-being, should be tested in randomized trials, under medical surveillance. It offers a new concept: medication-induced, dose-dependent, complete and prolonged suppression of substance-dependence symptoms with alleviation of comorbid anxiety.
    Introduction
    Alcohol dependence symptoms (craving, preoccupation) are defined as chronic (Morse and Flavin, 1992), and current therapeutic approaches are based on the idea that such symptoms can be attenuated but not suppressed. Therefore, medical trials set abstinence with lower-grade craving as the declared goal (Addolorato et al ., 2000, 2002a; Pelc et al ., 2002; Froehlich et al ., 2003; Johnson et al ., 2003, 2004).
    I am a physician diagnosed with alcohol dependence and comorbid anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) (American Psychiatric Association, 1994). I had been hospitalized for acute withdrawal seizures. Anxiety disorder had long preceded addiction.
    I had tried recommended dosages of medications proposed for promotion of abstinence and reduction of craving (see Patient and Methods ). I had achieved prolonged abstinence with and without medications. But I had always experienced cravings and preoccupation with alcohol, and achieving abstinence in such conditions required daily planning as well as constant and full attention.
    Baclofen is a potent gamma-aminobutyric acid (GABA B ) receptor agonist clinically used to control spasticity (Davidoff, 1985):
    (i) In alcohol-dependent patients, low-dose baclofen at 30 mg/day (~0.5 mg/kg) was shown to be effective in promoting abstinence, reducing alcohol craving and consumption, with no limiting side-effects (Addolorato et al ., 2000, 2002a,b).
    (ii) In rats, at doses up to 10 times higher (5 mg/kg), baclofen suppresses cocaine self-administration, motivation to consume alcohol and attenuates self-administration of cocaine, alcohol, heroin, nicotine and D -amphetamine (Roberts and Andrews, 1997; Shoaib et al ., 1998; Xi and Stein, 1999; Colombo et al ., 2000, 2003; Fattore et al ., 2002; Brebner et al ., 2004). Effects are dose-dependent for each substance. For alcohol, up to 3 mg/kg are required.
    (iii) In multiple sclerosis, neurologists safely use long-term high-dose oral baclofen (270 mg/day), to control spasticity, in order to protect patients from risks of invasive intrathecal therapy (Smith et al ., 1991). Given the safety record of baclofen since 1967, neurologists with experience in spasticity do not hesitate to use up to 300 mg/day of baclofen, as long as somnolence and/or muscular weakness do not limit treatment (John Schaefer, Cornell University Medical College, personal communication). In the highest recorded baclofen overdose (acute ingestion of 2 g), the patient survived (Gerkin et al ., 1986).
    I postulated the notion