The End of My Addiction

CBT and AA techniques to resist drinking. During cravings, the knowledge that I could reliably limit the struggle to 1 h with the additional baclofen dose was very useful. Since day 15 not one alcohol dream occurred (normally more than once a month). On day 37 (February 14, 2004), on 270 mg/day of baclofen (3.6 mg/kg), I experienced no craving or desire for alcohol for the first time in my alcoholic life. Even in a restaurant with friends, I was indifferent to people drinking. This had never occurred before. Somnolence prevented me from increasing the dosage of baclofen further, and there was no need for the extra 20–40 mg dose. For 12 days, at 270 mg/day, absence of craving persisted, and I remained indifferent to alcohol. In this condition, somnolence became an inconvenient side-effect, and I therefore progressively reduced the dosage to 120 mg/day (1.6 mg/kg) from days 49–63. Since day 63 I have stabilized the dosage around this value with occasional additions of 40 mg p.r.n. in stressful situations. I have not experienced somnolence again; muscular weakness never occurred and there were no other side-effects. Blood tests remained within normal limits.
    At the end of my ninth month of complete liberation from symptoms of alcohol dependence, I remain indifferent to alcohol. Abstinence has become natural to me. I no longer plan my life around alcohol. Alcohol thoughts no longer occur. I undertook personal and professional projects, which I was unable to do before as I had to anticipate consequences of unpredictable drinking episodes (cancelling appointments when possible and blackouts). As taught in CBT, I avoided places, situations, social settings, and vacations where alcohol might have been present. I no longer notice liquor sections in supermarkets. Some of these changes have been pointed out to me by relatives and friends.
    I no longer suffer anticipatory anxiety of relapse, of embarrassing or dangerous alcohol-related situations. I am no longer depressed about having an incurable stigmatizing disease.
    Liberation from symptoms of alcohol dependence substantially improved my self-esteem.
    Discussion
    I have never come across a report of complete medication-induced suppression of craving or other symptoms and consequences of alcohol dependence in AA, CBT, rehabilitation centres or in the medical literature.
    Here, I describe how, using high-dose baclofen, I succeeded in completely suppressing all signs and consequences of alcohol dependence, while simultaneously and for the first time controlling comorbid refractory anxiety for the ninth consecutive month. However, I wish to underline the ‘personal point of view’ aspect of this report, since I did not use validated scales to evaluate cravings, anxiety and depression.
    Notion of symptom-suppressing dose (SSD)
    The baclofen dosage that suppressed my craving and other symptoms of alcohol dependence (SSD) was 270 mg/day (nine times the dosage used in clinical alcohol dependence studies). But the subsequent maintenance dose of ~120 mg/day (1.6 mg/kg) that controlled anxiety prevented craving from reoccurring altogether. This suggests that the maintenance dose is much lower than the SSD. I attained the SSD empirically. In clinical trials, I believe that the SSD (leading to complete indifference to repeated exposure to the strongest cues) should be determined clinically, based on the patient’s feedback to the physician and the use of validated scales. I had no choice but to initiate and conduct dose escalation under my sole supervision. But escalation should be tested solely under properly designed studies and should be not replicated by any patient without a strict medical surveillance, which may require an inpatient condition, because of risks associated with somnolence, possible muscular weakness and other side-effects of baclofen.
    Issue of well-being, comorbidity and compliance
    My alcoholism did not appear in a vacuum: chronic anxiety had long preceded alcoholism. I used alcohol as a tranquilizer until it became an addiction. Associations between alcohol and most substance use disorders and independent mood and anxiety disorders are overwhelmingly positive and significant (Grant et al ., 2004). Alleviation of anxiety promotes well-being, which renders ‘extra’ relief from alcohol useless.
    A recent trial established the superiority of topiramate over placebo in improving the quality of life of alcohol-dependent individuals (Johnson et al ., 2004).