For the benefit of newbies and lurkers I have copied below Dr Ameisen's responses to questions about baclofen and addiction. While its a couple of years old, and some of his answers could probably be updated based on recent experience with baclofen, it still accurately presents an overall, comprehensive case for successful treatment of alcoholism with high dose baclofen.
Q Medical dogma says that addiction is incurable and that abstinence is the only answer. What has changed?
A There is a generic prescription medicine with a proven safety record, a muscle relaxant called baclofen, that can completely eliminate the symptoms and consequences of addiction and bring rapid, effortless relief to the millions of sufferers from addiction and their families. Baclofen ends the daily struggle to remain abstinent and makes the patient indifferent to alcohol or another addictive substance or behavior. Baclofen produces these results within a few weeks of beginning to take it, and the results do not fade over time.
Q Is addiction a real disease?
A The consensus of medical science and medical authorities such as the World Health Organization (WHO) and the American Medical Association (AMA) is that addiction is not a problem of willpower or morality, but a biological disease like cancer, diabetes, or heart disease. All drug and nondrug addictions (such as gambling addiction, binge eating, compulsive shopping, and sex addiction) have been shown to produce the same general pattern of imbalanced neurotransmission in the brain.
Q What makes people vulnerable to addiction?
A Anxiety disorders, mood disorders such as depression, post traumatic stress disorder (PTSD), and impulse and control disorders also produce the same general pattern of imbalanced neurotransmission seen in addiction, and the likeliest explanation of vulnerability to addiction is a preexisting imbalance in neurotransmission from such a disorder. The National Institute of Health?s National Epidemiological Survey on Alcohol and Related Conditions (NESARC) found that ?associations between most substance use disorders and independent mood and anxiety disorders were overwhelmingly positive and significant.?
Q Is taking baclofen substituting one drug for another?
A Baclofen has been confirmed to be non-addictive and non-euphoric. There is no craving for baclofen. Daily use of baclofen for addiction is not substituting one drug for another, but is exactly like daily use of beta blockers for hypertension.
Q What makes baclofen different from other medications for addiction?
A Other medications at best slightly reduce the symptoms and consequences of addiction. Baclofen can stop them completely.
Q Does medical science know why baclofen acts differently from other medications for addiction?
A Baclofen is one of only two substances known to affect the GABA-B receptor in the brain, and the only one that is itself non-addictive. Through the GABA-B receptor, baclofen has a beneficial effect on three neurotransmitters ? dopamine, glutamate, and GABA ? that are part of the brain?s reward system and are involved in all addictive and compulsive behaviors, as well as in disorders such as anxiety and depression. More research is needed to discover exactly how baclofen does this.
Q What is the evidence for baclofen?s effectiveness against addiction?
A Multiple animal studies have shown that baclofen suppresses the motivation to consume addictive substances at doses in the range of 1 to 5 milligrams per kilogram (2.2 pounds) of body weight. Laboratory animals addicted to alcohol, amphetamine, cocaine, heroin and other opiates, and nicotine lose all interest in them when given baclofen in this dosage range.
I was the first person to transpose these findings to human addiction, completely freeing myself from severe alcoholism as described in my book. Since then, a growing number of patients have found that following the protocol I established for baclofen therapy has completely freed them from their addictions (see below).
Q Is baclofen safe?
A Baclofen is established as a safe, non-addictive medication with no limiting side effects. It was originally approved by the FDA to treat muscle spasms and similar problems. Neurologists have used it for long term comfort care of both adults and children since the 1960s. A comfort care drug has to meet the highest standard of safety, because you are not trading off the side effects of the drug in order to have a chance of survival from a lethal condition, but simply taking it to improve your quality of life.
Q Has baclofen been specifically approved for addiction?
A Prescribing baclofen for addiction is what is known as an ?off-label? use. Once the FDA has approved a medicine for a specific purpose, physicians can prescribe it off-label for other conditions they think it can help. The AMA says the deciding factor in off-label prescribing is ?the best interest of the patient.? Off-label prescriptions are very common. Over 23% of all prescriptions, and over 60% in cancer care, are off-label.
Among the commonly prescribed medications for addiction, topiramate has been approved by the FDA for epilepsy and is prescribed for addiction off-label. Naltrexone has been specifically approved for addiction at a dose of up to 50 milligrams a day, but it is often prescribed at higher doses off-label. Neither medication has been shown to be as effective against addiction as high-dose baclofen.
Prescribing baclofen for addiction is a legitimate off-label use of the medication. According to Markus Heilig, M.D., Ph.D., clinical director of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (NIH), ?there is certainly nothing wrong with physicians prescribing [baclofen] off-label.?
Q Are there problems getting used to taking baclofen?
A When you first take baclofen or an increased dose, which like all prescription medicines should only be done as prescribed and supervised by a physician, it can make you feel sleepy or induce muscular weakness for a day or two. This passes, and you can then increase the dose again, until you find the level that frees you from craving and other symptoms and consequences of addiction. Based on what I have seen in myself and other patients, temporary sleepiness on baclofen is a sign that the medication is beginning to work. Other side effects may include headache or vertigo. In the majority of patients who have tried high dose baclofen for muscular problems or addiction, the side effects pass in a day or two, and in all cases they are completely reversible. At my maintenance dose I have no side effects.
Q How much baclofen does a patient need?
A It varies from patient to patient, depending probably on physical size, extent of dependency, and other factors. Studies have shown that animals lose all motivation to consume addictive substances when they are given baclofen in the range of 1 to 5 milligrams per kilogram (2.2 pounds) of body weight.
The evidence from my case and other patients is that the threshold dose needed to break the cycle of addictive craving, preoccupation, and obsessive thoughts is higher than the maintenance dose needed to keep a patient completely free from addiction.
Q To stay free from addiction, does a person need to keep taking baclofen?
A Yes, it?s like taking insulin for diabetes or medicines for other chronic conditions like hypertension.
Q How did you find out about baclofen?
A I was a desperate alcoholic, and my physicians and I thought I was going to die from drinking. A friend who had often heard me say that I suspected my chronic muscular tension and anxiety were connected with my later addiction to alcohol, noticed a story in The New York Times about baclofen, which said that a paraplegic cocaine addict who was taking baclofen to control his muscle spasms complained that the baclofen blunted his cocaine ?high,? but that baclofen also limited his craving when he couldn?t get cocaine. The newspaper story set me on a long journey, between binges, to learn more about baclofen. Because the conventional treatments for addiction weren?t helping me ? unfortunately, they do not help most people with severe addiction to stop for good ? I eventually decided to experiment on myself with baclofen, something I was able to do because I am a physician and could self-prescribe the medication. Through trial and error I found the dose that completely ended my craving for alcohol, and I have been disease-free since then ? five years and counting!
Q What addictions is baclofen good for?
A In animal studies it eliminates the motivation to consume alcohol, cocaine, heroin, methamphetamine, and nicotine. There is also promising evidence that it can eliminate the craving for food in bulimia and binge-eating. Research has recently established that people with drug addictions share common patterns of neurotransmission with people who have what are called nondrug addictions, such as compulsive gambling, compulsive shopping, binge-eating, and sex addiction. Baclofen has the potential to transform the treatment of many or all of these closely related illnesses.
Q Does baclofen help with the comorbidities of addiction, such as anxiety, depression, and compulsive disorders?
A Yes. Anxiety, depression, and compulsive disorders trigger patterns of neurotransmission that are very similar to those seen in both drug and nondrug addictions. In all these cases, the levels of the neurotransmitters dopamine, glutamate, and GABA are out of whack. Baclofen helps balance dopamine, glutamate, and GABA levels through its action on the GABA-B receptors in the brain. It is one of only two known substances ? and the only non-addictive substance ? to affect GABA-B. Baclofen has a documented beneficial effect on anxiety and panic, and there are good clinical indications that it is also helpful for depression and other mood disorders and compulsions. I had a tendency to be a compulsive shopper, and one of the first things baclofen did for me was to free me from that behavior.
Q Why isn?t baclofen already widely used for addiction?
A The evidence for baclofen?s effectiveness against addiction dates back only to the 1990s, and dogma is slow to change. As Albert Einstein said, ?It is harder to crack a prejudice than an atom.? Despite overwhelming evidence ? and there is more all the time ? that addiction is a biological disease, there are lingering assumptions that it is mainly an issue of willpower and moral virtue, and thus that the existing treatments are sufficient.
Second, it?s practically a full time job for doctors today to keep up with all the advances in their own specialties, much less what is happening in other medical specialties. So even most physicians specializing in addiction treatment simply don?t know about baclofen?s spectacular results in animal studies or its exemplary safety record in neurology. As a cardiologist, I know a lot about heart medicines, but even though I have some good friends who are neurologists, I never heard about baclofen until November 2000.
Finally, baclofen is a generic, and major addiction trials are pretty much all funded by pharmaceutical companies. There is no incentive for them to spend research and marketing money on a generic medication. Given the financial and human toll of addiction, the incentive for society as a whole is huge, but too few people have yet learned about baclofen to get it the attention it deserves.
Q How much would a randomized trial of baclofen for addiction cost?
A A randomized trial with a statistically significant number of patients would probably cost around $500,000. Weigh that against the fact that every year more than 100,000 people die from alcohol-related causes in the United States, around 270 people a day. Worldwide, the death toll from alcohol-related causes is 2 million people a year, around 5,500 a day. In the U.S. alone, the financial cost of alcohol-dependence-related lost work days, hospitalizations, rehab, and other treatment has been estimated to be almost $200 billion a year. Add in the financial costs of other addictions, not to mention incalculable human pain and suffering, and the cost of a randomized trial looks pretty low.
Q Haven?t there been some limited trials of baclofen for alcoholism and cocaine addiction?
A Yes, but at very minimal doses that are too low to stop the symptoms and consequences of addiction. In fact, the amount of baclofen used so far in alcoholism trials is less than the amount that neurologists start children on for relief of muscle spasms. I tried baclofen on myself at the same doses that have been shown to eliminate the motivation to consume addictive substances in animals, and it completely freed me from alcoholism. Only afterwards did I learn how safe baclofen is and that I was still taking less baclofen than neurologists give patients for comfort care.
Q Weren?t you afraid that baclofen might be harmful?
A Yes, very much so. My greatest fear was that baclofen would relax my muscles so much that I would stop breathing in my sleep. But after years of struggling with alcoholism, I thought it was better to die with dignity in the search for a cure. It was wonderful to learn later that baclofen is such a safe drug.
Q Why do you think you became an alcoholic?
A In Alcoholics Anonymous I constantly heard people say that they suffered all their lives from physical and/or emotional ?dis-ease,? because of anxiety, depression, or a similar disorder, and that drinking was the only thing that helped. From my early childhood I experienced the same kind of underlying dysphoria, to put it in medical jargon, because of chronic anxiety. In my teenage years and adulthood, the anxiety frequently escalated into crippling panic attacks. None of the medications I was prescribed for these problems helped much, and I turned to alcohol as a tranquilizer, especially in stressful social situations. For quite a while I was a moderate social drinker, but eventually I plunged into full-blown alcoholism. Baclofen has been so helpful to me because it has resolved my pre-existing anxiety as well as my alcoholism. Again, it can likely do this because the same neurotransmitters that are involved in addictive and compulsive behaviors are also involved in anxiety and depression.
Q What is your attitude towards Alcoholics Anonymous (AA)?
A Profound gratitude and admiration. I went to AA meetings constantly and always benefited from the inspiring people I met and the life lessons I learned there. Without AA I might not have survived until I found an effective medication in baclofen. It taught me a great deal about accepting my illness and about my fellow sufferers, but it couldn?t stop my cravings or the uncontrollable anxiety that led me to drink. Alcoholics Anonymous and Narcotics Anonymous (NA) are both extraordinary organizations that do great good in the world, but they are not enough on their own to help most people with severe addictions to stop relapsing into addictive behavior.
Q Does giving addicted people baclofen let them evade personal responsibility for their actions and for getting their lives in order?
A Not at all. Understanding addiction as a biological illness does not mean the end of the need for personal responsibility, motivation, and willpower in recovery. People still have to be motivated to end their addictions and to do everything in their power to achieve that. I have spoken to a number of problem drinkers and alcoholics who resist the idea of taking baclofen because they are not really motivated to quit.
Likewise, treating addiction with baclofen does not spell the end of rehab, twelve-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), and addiction-related cognitive behavioral therapy (CBT). To the contrary, it will make all these programs more effective.
I could not put the wisdom of AA and CBT to work fully in my own life until baclofen freed me from addictive craving. Since then, not a day goes by when I do not draw on the life lessons of AA and CBT to function in a better, healthier way than I ever could before.
Q Have any other physicians ever come forward to admit to suffering from addiction, and why did you break your own anonymity to do so?
A The rate of addiction among physicians seems to be at least as great as among the general population, but so far as I have been able to find out, no other physician has ever published an account of his or her addiction using his or her real name.
Even though I had my successful experience with baclofen to report, I hesitated to reveal my identity because of the moral stigma associated with addiction. But I decided to do so, first in an article in a peer-reviewed medical journal and second in this book, because it is long since time for addiction to be seen in proper moral terms as a biological disease like any other. As one of my teachers, the great cardiologist Philippe Coumel, said to me, ?As a physician, how can you be embarrassed about having a disease??
In addition, one of my aims in the book was to connect the personal experience of addiction with the science of addiction, something I don?t believe has been done before, and I felt the most compelling way to do that was under my true name.
Q Did you ever lose hope during your alcoholism?
A Many times I despaired, but at the same time I always believed that alcoholism was a biological illness and that an effective medical treatment was possible, and I clung to the hope that I would survive to see it. You might say I was too stubborn to give up. I was convinced that ten minutes after I died from drinking, the treatment would be discovered.
The way I clung to hope against all odds is owing mainly to my parents. They taught me the courage and power of dreams. In World War II, at a time when nothing seemed to stand against Hitler, my father was a French officer in a German prisoner of war camp and my mother was in Auschwitz. But as my parents told my brother and sister and me when we were children, they both believed without a doubt that Nazi Germany would be defeated.
Because of my parents? example, I often thought during my alcoholism, ?For a miracle to happen, you must first believe that it is possible.? Baclofen works because of scientific facts, but its effects certainly feel miraculous.
Q Do you have any advice for people suffering from addiction?
A My heart goes out to all those struggling with addiction, and to their families and loved ones, who are the disease?s collateral victims. I urge them all to hold onto hope and to believe in the chance of recovery.
My book is not a self-help manual and it is in no way intended as a guide to self-treatment. Baclofen is a prescription drug that should only be taken as prescribed and closely supervised by a licensed physician. But for those with addiction who have not found sufficient help in conventional treatments, my book provides a basis for discussing with their physicians whether baclofen might be an appropriate treatment for them, as it has been for me.
Q Medical dogma says that addiction is incurable and that abstinence is the only answer. What has changed?
A There is a generic prescription medicine with a proven safety record, a muscle relaxant called baclofen, that can completely eliminate the symptoms and consequences of addiction and bring rapid, effortless relief to the millions of sufferers from addiction and their families. Baclofen ends the daily struggle to remain abstinent and makes the patient indifferent to alcohol or another addictive substance or behavior. Baclofen produces these results within a few weeks of beginning to take it, and the results do not fade over time.
Q Is addiction a real disease?
A The consensus of medical science and medical authorities such as the World Health Organization (WHO) and the American Medical Association (AMA) is that addiction is not a problem of willpower or morality, but a biological disease like cancer, diabetes, or heart disease. All drug and nondrug addictions (such as gambling addiction, binge eating, compulsive shopping, and sex addiction) have been shown to produce the same general pattern of imbalanced neurotransmission in the brain.
Q What makes people vulnerable to addiction?
A Anxiety disorders, mood disorders such as depression, post traumatic stress disorder (PTSD), and impulse and control disorders also produce the same general pattern of imbalanced neurotransmission seen in addiction, and the likeliest explanation of vulnerability to addiction is a preexisting imbalance in neurotransmission from such a disorder. The National Institute of Health?s National Epidemiological Survey on Alcohol and Related Conditions (NESARC) found that ?associations between most substance use disorders and independent mood and anxiety disorders were overwhelmingly positive and significant.?
Q Is taking baclofen substituting one drug for another?
A Baclofen has been confirmed to be non-addictive and non-euphoric. There is no craving for baclofen. Daily use of baclofen for addiction is not substituting one drug for another, but is exactly like daily use of beta blockers for hypertension.
Q What makes baclofen different from other medications for addiction?
A Other medications at best slightly reduce the symptoms and consequences of addiction. Baclofen can stop them completely.
Q Does medical science know why baclofen acts differently from other medications for addiction?
A Baclofen is one of only two substances known to affect the GABA-B receptor in the brain, and the only one that is itself non-addictive. Through the GABA-B receptor, baclofen has a beneficial effect on three neurotransmitters ? dopamine, glutamate, and GABA ? that are part of the brain?s reward system and are involved in all addictive and compulsive behaviors, as well as in disorders such as anxiety and depression. More research is needed to discover exactly how baclofen does this.
Q What is the evidence for baclofen?s effectiveness against addiction?
A Multiple animal studies have shown that baclofen suppresses the motivation to consume addictive substances at doses in the range of 1 to 5 milligrams per kilogram (2.2 pounds) of body weight. Laboratory animals addicted to alcohol, amphetamine, cocaine, heroin and other opiates, and nicotine lose all interest in them when given baclofen in this dosage range.
I was the first person to transpose these findings to human addiction, completely freeing myself from severe alcoholism as described in my book. Since then, a growing number of patients have found that following the protocol I established for baclofen therapy has completely freed them from their addictions (see below).
Q Is baclofen safe?
A Baclofen is established as a safe, non-addictive medication with no limiting side effects. It was originally approved by the FDA to treat muscle spasms and similar problems. Neurologists have used it for long term comfort care of both adults and children since the 1960s. A comfort care drug has to meet the highest standard of safety, because you are not trading off the side effects of the drug in order to have a chance of survival from a lethal condition, but simply taking it to improve your quality of life.
Q Has baclofen been specifically approved for addiction?
A Prescribing baclofen for addiction is what is known as an ?off-label? use. Once the FDA has approved a medicine for a specific purpose, physicians can prescribe it off-label for other conditions they think it can help. The AMA says the deciding factor in off-label prescribing is ?the best interest of the patient.? Off-label prescriptions are very common. Over 23% of all prescriptions, and over 60% in cancer care, are off-label.
Among the commonly prescribed medications for addiction, topiramate has been approved by the FDA for epilepsy and is prescribed for addiction off-label. Naltrexone has been specifically approved for addiction at a dose of up to 50 milligrams a day, but it is often prescribed at higher doses off-label. Neither medication has been shown to be as effective against addiction as high-dose baclofen.
Prescribing baclofen for addiction is a legitimate off-label use of the medication. According to Markus Heilig, M.D., Ph.D., clinical director of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (NIH), ?there is certainly nothing wrong with physicians prescribing [baclofen] off-label.?
Q Are there problems getting used to taking baclofen?
A When you first take baclofen or an increased dose, which like all prescription medicines should only be done as prescribed and supervised by a physician, it can make you feel sleepy or induce muscular weakness for a day or two. This passes, and you can then increase the dose again, until you find the level that frees you from craving and other symptoms and consequences of addiction. Based on what I have seen in myself and other patients, temporary sleepiness on baclofen is a sign that the medication is beginning to work. Other side effects may include headache or vertigo. In the majority of patients who have tried high dose baclofen for muscular problems or addiction, the side effects pass in a day or two, and in all cases they are completely reversible. At my maintenance dose I have no side effects.
Q How much baclofen does a patient need?
A It varies from patient to patient, depending probably on physical size, extent of dependency, and other factors. Studies have shown that animals lose all motivation to consume addictive substances when they are given baclofen in the range of 1 to 5 milligrams per kilogram (2.2 pounds) of body weight.
The evidence from my case and other patients is that the threshold dose needed to break the cycle of addictive craving, preoccupation, and obsessive thoughts is higher than the maintenance dose needed to keep a patient completely free from addiction.
Q To stay free from addiction, does a person need to keep taking baclofen?
A Yes, it?s like taking insulin for diabetes or medicines for other chronic conditions like hypertension.
Q How did you find out about baclofen?
A I was a desperate alcoholic, and my physicians and I thought I was going to die from drinking. A friend who had often heard me say that I suspected my chronic muscular tension and anxiety were connected with my later addiction to alcohol, noticed a story in The New York Times about baclofen, which said that a paraplegic cocaine addict who was taking baclofen to control his muscle spasms complained that the baclofen blunted his cocaine ?high,? but that baclofen also limited his craving when he couldn?t get cocaine. The newspaper story set me on a long journey, between binges, to learn more about baclofen. Because the conventional treatments for addiction weren?t helping me ? unfortunately, they do not help most people with severe addiction to stop for good ? I eventually decided to experiment on myself with baclofen, something I was able to do because I am a physician and could self-prescribe the medication. Through trial and error I found the dose that completely ended my craving for alcohol, and I have been disease-free since then ? five years and counting!
Q What addictions is baclofen good for?
A In animal studies it eliminates the motivation to consume alcohol, cocaine, heroin, methamphetamine, and nicotine. There is also promising evidence that it can eliminate the craving for food in bulimia and binge-eating. Research has recently established that people with drug addictions share common patterns of neurotransmission with people who have what are called nondrug addictions, such as compulsive gambling, compulsive shopping, binge-eating, and sex addiction. Baclofen has the potential to transform the treatment of many or all of these closely related illnesses.
Q Does baclofen help with the comorbidities of addiction, such as anxiety, depression, and compulsive disorders?
A Yes. Anxiety, depression, and compulsive disorders trigger patterns of neurotransmission that are very similar to those seen in both drug and nondrug addictions. In all these cases, the levels of the neurotransmitters dopamine, glutamate, and GABA are out of whack. Baclofen helps balance dopamine, glutamate, and GABA levels through its action on the GABA-B receptors in the brain. It is one of only two known substances ? and the only non-addictive substance ? to affect GABA-B. Baclofen has a documented beneficial effect on anxiety and panic, and there are good clinical indications that it is also helpful for depression and other mood disorders and compulsions. I had a tendency to be a compulsive shopper, and one of the first things baclofen did for me was to free me from that behavior.
Q Why isn?t baclofen already widely used for addiction?
A The evidence for baclofen?s effectiveness against addiction dates back only to the 1990s, and dogma is slow to change. As Albert Einstein said, ?It is harder to crack a prejudice than an atom.? Despite overwhelming evidence ? and there is more all the time ? that addiction is a biological disease, there are lingering assumptions that it is mainly an issue of willpower and moral virtue, and thus that the existing treatments are sufficient.
Second, it?s practically a full time job for doctors today to keep up with all the advances in their own specialties, much less what is happening in other medical specialties. So even most physicians specializing in addiction treatment simply don?t know about baclofen?s spectacular results in animal studies or its exemplary safety record in neurology. As a cardiologist, I know a lot about heart medicines, but even though I have some good friends who are neurologists, I never heard about baclofen until November 2000.
Finally, baclofen is a generic, and major addiction trials are pretty much all funded by pharmaceutical companies. There is no incentive for them to spend research and marketing money on a generic medication. Given the financial and human toll of addiction, the incentive for society as a whole is huge, but too few people have yet learned about baclofen to get it the attention it deserves.
Q How much would a randomized trial of baclofen for addiction cost?
A A randomized trial with a statistically significant number of patients would probably cost around $500,000. Weigh that against the fact that every year more than 100,000 people die from alcohol-related causes in the United States, around 270 people a day. Worldwide, the death toll from alcohol-related causes is 2 million people a year, around 5,500 a day. In the U.S. alone, the financial cost of alcohol-dependence-related lost work days, hospitalizations, rehab, and other treatment has been estimated to be almost $200 billion a year. Add in the financial costs of other addictions, not to mention incalculable human pain and suffering, and the cost of a randomized trial looks pretty low.
Q Haven?t there been some limited trials of baclofen for alcoholism and cocaine addiction?
A Yes, but at very minimal doses that are too low to stop the symptoms and consequences of addiction. In fact, the amount of baclofen used so far in alcoholism trials is less than the amount that neurologists start children on for relief of muscle spasms. I tried baclofen on myself at the same doses that have been shown to eliminate the motivation to consume addictive substances in animals, and it completely freed me from alcoholism. Only afterwards did I learn how safe baclofen is and that I was still taking less baclofen than neurologists give patients for comfort care.
Q Weren?t you afraid that baclofen might be harmful?
A Yes, very much so. My greatest fear was that baclofen would relax my muscles so much that I would stop breathing in my sleep. But after years of struggling with alcoholism, I thought it was better to die with dignity in the search for a cure. It was wonderful to learn later that baclofen is such a safe drug.
Q Why do you think you became an alcoholic?
A In Alcoholics Anonymous I constantly heard people say that they suffered all their lives from physical and/or emotional ?dis-ease,? because of anxiety, depression, or a similar disorder, and that drinking was the only thing that helped. From my early childhood I experienced the same kind of underlying dysphoria, to put it in medical jargon, because of chronic anxiety. In my teenage years and adulthood, the anxiety frequently escalated into crippling panic attacks. None of the medications I was prescribed for these problems helped much, and I turned to alcohol as a tranquilizer, especially in stressful social situations. For quite a while I was a moderate social drinker, but eventually I plunged into full-blown alcoholism. Baclofen has been so helpful to me because it has resolved my pre-existing anxiety as well as my alcoholism. Again, it can likely do this because the same neurotransmitters that are involved in addictive and compulsive behaviors are also involved in anxiety and depression.
Q What is your attitude towards Alcoholics Anonymous (AA)?
A Profound gratitude and admiration. I went to AA meetings constantly and always benefited from the inspiring people I met and the life lessons I learned there. Without AA I might not have survived until I found an effective medication in baclofen. It taught me a great deal about accepting my illness and about my fellow sufferers, but it couldn?t stop my cravings or the uncontrollable anxiety that led me to drink. Alcoholics Anonymous and Narcotics Anonymous (NA) are both extraordinary organizations that do great good in the world, but they are not enough on their own to help most people with severe addictions to stop relapsing into addictive behavior.
Q Does giving addicted people baclofen let them evade personal responsibility for their actions and for getting their lives in order?
A Not at all. Understanding addiction as a biological illness does not mean the end of the need for personal responsibility, motivation, and willpower in recovery. People still have to be motivated to end their addictions and to do everything in their power to achieve that. I have spoken to a number of problem drinkers and alcoholics who resist the idea of taking baclofen because they are not really motivated to quit.
Likewise, treating addiction with baclofen does not spell the end of rehab, twelve-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), and addiction-related cognitive behavioral therapy (CBT). To the contrary, it will make all these programs more effective.
I could not put the wisdom of AA and CBT to work fully in my own life until baclofen freed me from addictive craving. Since then, not a day goes by when I do not draw on the life lessons of AA and CBT to function in a better, healthier way than I ever could before.
Q Have any other physicians ever come forward to admit to suffering from addiction, and why did you break your own anonymity to do so?
A The rate of addiction among physicians seems to be at least as great as among the general population, but so far as I have been able to find out, no other physician has ever published an account of his or her addiction using his or her real name.
Even though I had my successful experience with baclofen to report, I hesitated to reveal my identity because of the moral stigma associated with addiction. But I decided to do so, first in an article in a peer-reviewed medical journal and second in this book, because it is long since time for addiction to be seen in proper moral terms as a biological disease like any other. As one of my teachers, the great cardiologist Philippe Coumel, said to me, ?As a physician, how can you be embarrassed about having a disease??
In addition, one of my aims in the book was to connect the personal experience of addiction with the science of addiction, something I don?t believe has been done before, and I felt the most compelling way to do that was under my true name.
Q Did you ever lose hope during your alcoholism?
A Many times I despaired, but at the same time I always believed that alcoholism was a biological illness and that an effective medical treatment was possible, and I clung to the hope that I would survive to see it. You might say I was too stubborn to give up. I was convinced that ten minutes after I died from drinking, the treatment would be discovered.
The way I clung to hope against all odds is owing mainly to my parents. They taught me the courage and power of dreams. In World War II, at a time when nothing seemed to stand against Hitler, my father was a French officer in a German prisoner of war camp and my mother was in Auschwitz. But as my parents told my brother and sister and me when we were children, they both believed without a doubt that Nazi Germany would be defeated.
Because of my parents? example, I often thought during my alcoholism, ?For a miracle to happen, you must first believe that it is possible.? Baclofen works because of scientific facts, but its effects certainly feel miraculous.
Q Do you have any advice for people suffering from addiction?
A My heart goes out to all those struggling with addiction, and to their families and loved ones, who are the disease?s collateral victims. I urge them all to hold onto hope and to believe in the chance of recovery.
My book is not a self-help manual and it is in no way intended as a guide to self-treatment. Baclofen is a prescription drug that should only be taken as prescribed and closely supervised by a licensed physician. But for those with addiction who have not found sufficient help in conventional treatments, my book provides a basis for discussing with their physicians whether baclofen might be an appropriate treatment for them, as it has been for me.
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