About a week ago, a prof in my MRU loaned me a book he'd just read, saying it would be right up my alley. He was very right. I couldn't put it down. It's already changed a great deal about the way that I think about addiction, as well as the way I think about finding a cure.
The book was "The end of my addiction" by Olivier Ameisen. Half case report, half memoir, Olivier Ameisen was a well-known cardiologist doing some crazy good work in New York. Unfortunately, he was also an alcoholic. After more than a decade of broken friendships, joblessness, and near-death experiences, he managed to end his dependence on alcohol using a drug known as baclofen.
Addiction people will never say that someone is cured. Anyone is, at best, "recovering". People are alcoholics or crack heads even if it's been years or decades since they had their last dose. This is because they are merely abstinent. A single dose of that drug, or even a visit to places where they previously let the good times roll can spark off a huge craving that can trigger the entire cycle again, something a recovering addict must always be on the watch for.
But what if you could cure it? What if you could just take a pill and make it all go away?
Olivier Ameisen was a good person to write this book. Coming from a well-respected doctor, the spiral downward into addiction is even more striking. He does not hesitate to open up about his worst experiences; being committed to a psychiatric ward against his will, verbally abusing friends and family who tried to help, and walking right out of rehab and into a liquor store. He went to up to 3 AA meetings a day and was in rehab three times. He conveys a life of desperation in a simple, direct manner that is incredibly captivating.
One thing he wrote about really stuck with me. He talked about the wonderful feeling of hope and assurance he felt in rehab, how he just knew that this time he would be fine when we got out. But he never lasted. He compared it to the stars who go on shows fresh out of rehab, bright-eyed and talking about what they have discovered and how they will stay clean. And they HAVE discovered something, he says. It just doesn't last. That scenario said more to me about addiction than any number of rehab and relapse reports that I have read.
So what happened? After many years of drinking, the closing of his practice, the death of his parents, and many other things, Ameisen ran across a study done by Dr. Childress, a well-known addiction researcher. She had a patient that had been given baclofen, a muscle relaxant, for his muscle spasms. The guy was also a crack addict, and after starting baclofen, he had a problem: he couldn't get high. Not only that, he didn't even really WANT to get high. Since her finding with this case study, Dr. Childress had performed a clinical study on drug addicts using baclofen, but the doses used didn't have much of an effect on craving or drug use. Other studies had been done with rats and cocaine addiction, and some findings were promising, but levels of the drug seemed too high to put into humans. It seemed like a dead end.
But Ameisen didn't know about the clinical studies. He had only seen the case study and the animal studies, and decided to try baclofen for himself. He called a friend of his who was a neurologist and asked how high he could go.
(An Aside: Baclofen. Beclofen is what is known as a GABA-B agonist. GABA, or gamma-hydroxy-amino-butyric acid, is the major inhibitory neurotransmitters in the brain, and GABA-B is one of its receptors. Alcohol is known to be a GABA agonist, increasing GABA in the brain, which may be cause of its anxiolytic effects. Some research has been done on GABA-A agonists as a possible treatment for alcoholism, but less has been done on GABA-B.)
It wasn't known by researchers at the time, but baclofen was given in much higher doses than those used in the clinical trial. They had been using 40 mg. But it turns out that, for patients with muscle spasms, the dose can go up into the hundreds of mg with very few side effects. It's about as safe as a drug can get, apparently. So Ameisen got a prescription and starting bringing his dose up.
And up. And up. He ended up hovering around 270 for a while, and then bringing it back down to 180 or so. Pretty high doses, and he had to be very careful for sleepiness. But at the highest doses, he felt no urge to drink, no craving. He also got relief from the anxiety which has plagued him for years, and which he believed to be the root cause of his drinking. After several months of this, he published his own results as a case study. This is really an incredibly brave thing to do, and is probably the first time that a physician has made their own drug addiction a published fact in a journal.
There were a couple of things that bothered me about the book. Ameisen is clearly a highly intelligent person, and his family is well-placed in French and American society. But it got to be a little much at times. I know you are a well-known cardiologist and I respect you for it. I am reading your memoir about your addiction. I don't really need to hear your anecdotes about how you know Bette Midler and Elie Weisel.
Additionally, Ameisen clearly had several monetary advantages in his fight that most addicts do not have access to. He has not practiced medicine for many years, and yet was able to afford to go to rehab not once, but three times. Though he does worry about money, and though the most expensive programs are out of his reach, he is still able to go on living for significant periods of time without ever having to reach for unemployment or welfare, advatages which most addicts never get. Still, the book was incredibly well-written and very affecting, not least for its message of hope.
Since Ameisen published his cure, several other case studies have been done, and a couple of preliminary clinical trials. Most have seen at least some success. The book ends in bafflement that more studies are not taking advantage of what could be the cure addiction researchers have been looking for for years.
And I also wonder, why not? The book was published very recently, and I still haven't heard of a large scale clinical trial for baclofen (though I could have missed it, of course). The drug appears relatively safe in high doses (as is known through its use in treating muscle spasms), and appears to provide relief from both the craving and the anxiety that drug users experience. What is going wrong?
Ameisen proposes one theory. He believes that, since baclofen is an old drug and no longer under patnet, drug companies will never fund a large scale clinical trial. There's no money in it. He may very well be right. But I've got another theory. Most researchers who work in addiction know that addiction is a disease. It's something that you simply cannot cure through an exercise of will. It's not a problem with will power or lack of faith. And though we all know this, I wonder how many addiction researchers really believe it. A lot of the resistance that Ameisen encountered was from people who could give no real reason as to why they weren't interested in a clinical trial. Could it have been the concept of a cure? The idea that you just take a pill and make it go away? It is possible that, even though we all know that alcoholism and other kinds of drug abuse are diseases that cost the public billions of dollars per year, that society has still made up believe in will power. That we think, at some level, that addicts should suffer for what they have done. Ameisen had no suffering. He just stopped. Is our society ready to accept that kind of a cure?
Of course, there is a third theory. Perhaps, due to the dead ends in the literature, researchers just didn't believe there was much future in it. There may not be. But we won't know unless we try.
I don't know whether society is ready, but I think that drug addicts and alcoholics have suffered enough. And society is suffering along with them. And on a completely pragmatic level, what harm could a clinical trial do? If it works, we have a cure. If it doesn't, money wasted, but baclofen is a safe drug, and bad side effects are unlikely. I'm not willing to hang my addiction theory hat on a case study, or a series of case studies. A series of anecdotes, however convincing, are not data. But give me a large scale clinical trial, or a series of animal studies (there are already some out there), and then I'll let you know. It may not be a cure, but considering what we have available right now, I think it's certainly worth a try.