The End of My Addiction

that dose-dependent suppressing effects could be transposed to humans and that by using baclofen in dose ranges used in animal studies, one might reach a critical dose at which craving and motivation to drink alcohol might be suppressed in alcoholics, thus substantially reducing relapse risk.
    Baclofen has also been used successfully in anxiety disorders (Breslow et al ., 1989; Drake et al ., 2003), and was shown to be effective in ameliorating some affective disturbances in alcoholic patients, including anxiety and depression (Krupitsky et al ., 1993; Addolorato et al ., 2002a,b). Anxiety is an overwhelmingly prevalent comorbidity of alcoholism (Grant et al ., 2004), and efficacy on anxiety has not been shown for other agents used for alcohol dependence (disulfiram, naltrexone, acamprosate or topiramate). I had used baclofen for > 1 year (2002–2003) to reduce anxiety. I had progressively increased the dosage to 180 mg/day, which improved personal and general well-being considerably, but did not suppress cravings and alcohol relapses. Being unaware then that higher dosages were safe, I had not exceeded 180 mg/day.
    By analysing the literature, I subsequently realized that baclofen was the only monotherapy that could, in theory, completely suppress cravings, while alleviating comorbid anxiety simultaneously. Although my doctors remained unconvinced, I decided to self-prescribe high-dose baclofen, choosing 300 mg/day (4 mg/kg) as the maximal daily dosage, as long as side-effects were not limiting.
    Patient and Methods
    On January 9, 2004, I was a 50-year-old white French-American male physician with alcohol dependence and comorbid pre-existing anxiety disorder. Since 1997, there had been numerous emergency hospitalizations, emergency room visits, detoxifications, years of inpatient and outpatient rehabilitation treatments. I bear no medical sequelae. On a typical drinking day, I consumed ~750 ml of Scotch. Treatment had included 500 mg/day of disulfiram (I did drink while taking it). Thereafter, I had consecutively and for each medication been on 12–18 months of naltrexone (50 mg/day), acamprosate (2 g/day) and baclofen (180 mg/day). I have subsequently been on topiramate (300 mg/day) for 3 months. Naltrexone and acamprosate had been discontinued because there had been no perceptible effects on cravings or relapse reduction. During this time, I benefited from cognitive behavioural therapy (CBT) and Alcoholics Anonymous (AA) meetings. I attended around two AA meetings a day, making roughly 700 meetings a year, over a period of 7 years.
    Anxiety was refractory to buspirone, specific serotonin re-uptake inhibitors, valproate and carbamazepine. In May 2003, hoping to achieve complete abstinence, I tapered baclofen and self-prescribed topiramate following an outlined schedule (Johnson et al ., 2003). I continued with 300 mg/day of topiramate for 3 months despite side-effects (memory, speech). Topiramate had no efficacy in reducing anxiety and I suffered a severe relapse.
    On January 9, 2004, day 1 of post-relapse abstinence, I started oral baclofen monotherapy: 10 mg three times daily (30 mg/day), adding 20 mg/day every third day; optional 20–40 mg/day p.r.n. at a time was available for cravings or important inter-current stress or anxiety. Since cravings appeared during afternoons or evenings, dosages were divided unequally: lower in mornings, i.e. on day 31 (230 mg/day) I took 50 mg, then 90 mg, then 90 mg.
    Primary outcome measures included, in addition to abstinence from alcohol, the personal assessment of indifference to alcohol (speech, sight, places or odour in restaurants) under any circumstances (stressful situations or anxiety), of cravings, preoccupation and alcohol dreams.
    Other outcome measures included the personal assessment of anxiety, muscular tension, quality of sleep, general well-being and side-effects of baclofen. Blood tests assessing haematological parameters, biochemistry, including liver enzymes, were performed at the third and fifth months.
    Results
    I have not had a drink since January 9, 2004. Detoxification was marked by less malaise than with benzodiazepines. From day 1, anxiety was substantially reduced, muscular tension had begun to subside and sleep had become restful. At the onset of cravings, I took an additional 20–40 mg of baclofen that induced a state of deep relaxation within the hour, followed by somnolence. During the deep relaxation phase it was much easier for me to use