Could this pill Cure alcoholism?
Doctor drinking himself into an early grave tells of his ‘fairy tale’ recovery
Alcoholism affects one in 20 adults and is notoriously difficult to treat. Leading American cardiologist Dr Olivier Ameisen was a compulsive drinker for years until he was ‘cured’, he says, by a drug commonly prescribed for muscle spasm.
His claims have created a huge stir in the medical world. Here, in an extract from his bestselling book, he tells his extraordinary story…
As I came to my senses I took stock of where I was: in a taxi, with blood streaming down my face and spattering my coat. I looked out the window. The church on the corner reminded me it was Sunday, and I looked at my watch. It was almost midnight.
I asked the driver to take me to the casualty department at the New York hospital where I worked as a consultant. I wondered what on earth had happened. Had the taxi braked suddenly so that I hit my head, or had I been injured in some other way before I hailed it?
I knew I’d been drinking, but not where or how much.
Staggering into A&E, I thought: ‘They will see I’m drunk; that’s not so good – but at least I know they will fix me up right.’ As well as working at the hospital, I was also a clinical professor of medicine at its partner institution, the prestigious Cornell University Medical College. I knew I’d receive good care.
Inside the emergency room, I passed out again. When I came to, one of my ex-students, Matt, now a doctor, was preparing to stitch the wound in my forehead. So as not to be left with a scar, I asked him to use surgical tape instead.
He did and then left me to lie quietly for a few hours so I could sober up enough to walk home safely. He was plainly even more embarrassed to treat me in my drunken state than I was to need treatment.
This hadn’t been my first blackout drinking. But the blackouts were getting more common, whole stretches of evenings expunged from my memory. And this was the first time I’d come out of a blackout with a physical injury. (I never did discover how it happened.)
The next morning, deciding I was too hungover to go to work, I asked my office assistant to reschedule the day’s patients. As my drinking had increased, I had scrupulously honoured my first duty as a doctor – to do no harm. I never worked when I was not completely sober.
But the fact is, I was terrified of living without alcohol. Without it, I would be an anxious wreck. Despite the outward successes – at the very nadir of my alcoholism I was awarded the French Legion of Honour for services to medicine – I struggled with a deep sense of failure, and feared that the world would see that my accomplishments were nothing but a sham.
I was terrified of living without alcohol
Admitting my problem drinking to my friends and colleagues terrified me, too. I feared being ostracised, and since I felt that drinking should be under my control, I felt ostracism would be justified.
Through the next two months after going to A&E, I managed to abstain. Then one afternoon I bought a bottle of vodka. Over the next few weeks I drank myself back into A&E. I didn’t realise what had happened at the time – I lost consciousness except for a vague impression of medical personnel milling in the lobby of my building or on the street. But when I awoke I was attached to several intravenous tubes and a urinary catheter.
One of my first visitors was Professor John Schaefer, an outstanding neurologist whom I knew very well and greatly admired. With matter-of-fact kindness and no hint of moral judgment, he explained that I had suffered multiple seizures, which had been controlled with intravenous Valium.
I had been kept heavily sedated for two days and I was continuing to receive Valium intravenously to treat acute withdrawal.
The seizures were so violent that they produced rhabdomyolysis, a breakdown in muscle tissue that is toxic to the kidneys and is measured by the level of CPKs – creatine phosphokinase isoenzymes – in the blood.
The same thing can happen to people who suffer from traumatic injuries (a colleague told me that on seeing my chart in intensive care, he assumed I must have been in a massive car crash, because my CPKs were extraordinarily high).
When I’d been admitted, I’d been in an ongoing seizure state that put me near death. ‘You also almost lost your kidneys, my boy,’ John said.
His characteristic jovial ‘my boy’ cheered me up and made me feel I could talk to him about the real problem: my excessive drinking.
‘I am going to resign from here,’ I told him. John shook his head. ‘Are you crazy? You don’t resign because you have an illness.’
‘I know alcoholism is a disease,’ I replied. ‘But in my case that’s not what it feels like. I know I should be able to control my drinking, but I have not succeeded so far. I guess it’s a weakness on my part.’
‘ No,’ John said. ‘ It is an illness. One you will have to recover from, and then you will come back and work normally.’
‘It’s an illness you will recover from’, the professor said
I wondered if things would ever be normal again. One fact was clear and could no longer be denied: I had become an alcoholic.
They say alcoholism runs in families. Not mine. But I have come to believe that it isn’t addiction that recurs through the generations so much as it is dysphoria – a chronic, underlying distress that predisposes people, to varying degrees, to addiction and other compulsive behaviours.
In the field of addiction medicine, it’s long been recognised that people addicted to various substances frequently suffer from anxiety, depression, and other mood disorders. But I was troubled by anxiety long before I became an alcoholic.
I told all my doctors: ‘I use alcohol as a tranquilliser. If you rid me of anxiety, I’ll stop drinking.’
My doctors all told me: ‘You’re anxious because you drink. Stop drinking and your anxiety will subside.’
When, much later, I began attending Alcoholics Anonymous meetings, I discovered this was a standard refrain. People would say: ‘I never felt OK in myself’, ‘I never fitted in’, or ‘I never really relaxed’ – until they started drinking.
I felt the same way, and my suspicion is that chronic physical uneasiness triggers addictive behaviour and then is exacerbated by this self-medication gone wrong.
But my anxiety really took off in my 40s, when I went into private practice; for the first time in my working life I did not have a guaranteed income, and became increasingly concerned about my finances.
I worried about my age, and felt that time might be running out to marry and have children. Beyond that, I feared I would lose everything and become completely impoverished.
I began to have paralysing panic attacks. These began innocuously enough with a twitching in my calf muscles (or ‘benign idiopathic fasciculation’ – some people experience it as a fluttering eyelid).
The next symptoms were tightness in my chest; I felt I couldn’t breathe. And then unstoppable panic took over my whole being.
I tried everything, from rehab to Prozac
I began increasing my intake of the drug that brought relief: alcohol. Talk about a slippery slope. The more I drank to ease my anxiety, stave off panic and counter insomnia, the more I had to drink for the same effect.
I managed OK during the morning, but every afternoon the craving for alcohol welled up in me like a flood tide. I resisted for as long as I could, a day, two days, a week or more, but then it captured me and I binged.
I was an accident waiting to happen. When, in August 1997, I wound up in New York Hospital with acute withdrawal seizures that nearly killed me, it was devastating – and a great relief. I thought: ‘I am no longer hiding my drinking from anyone. Now I will get proper treatment and recover.’
Over the next three years I tried everything from rehab – eight times – to prescriptions for tranquillizers and anti-depressants such as Prozac.
A psychiatrist I was seeing for alcohol dependency also prescribed Antabuse. This blocks the liver from breaking down alcohol – if you drink you almost immediately experience the nastiest symptoms of severe intoxication: accelerated heart rate, flushed skin, shortness of breath, nausea and vomiting. Keep drinking and you could die.
Very few problem drinkers can stick to an Antabuse regimen; I was not one of them.
I also tried acupuncture and hypnotherapy, both of which had zero effect. I consulted a highly recommended specialist in cognitive behavioral therapy (CBT), to try to resolve the emotional experiences that triggered drinking.
He seemed more interested in turning me from a binge spirits drinker into a moderate wine drinker.
I told every doctor and therapist I saw that my fundamental problem was anxiety. None took this seriously. But Joan, an old girlfriend, remembered it well – perhaps because she heard me talk about it more times than any doctor did.
A muscle relaxant to treat cravings of cocaine addicts?
One day in November 2000, she came across an article in the New York Times about a researcher studying the effect of a muscle relaxant called baclofen on a drug addict’s craving for cocaine. She sent me the article.
When it arrived, I was in the middle of a huge binge and tossed it aside. A few days later I vaguely recalled it and went looking for it, but I couldn’t find it. I assume I spilled drink on it and the cleaning lady threw it away.
My life continued as before, a cycle of bingeing and hospital treatment. It wasn’t until a year later that I dimly recalled the article. I asked Joan to track it down.
This time, I was not intoxicated when it arrived, and I read with fascination about how scans conducted by the psychologist Dr Anna Rose Childress, an addiction researcher at the University of Pennsylvania, showed a remarkable quieting of brain activity in a cocaine addict who was taking baclofen to control spasms. The addict said this medication reduced his craving substantially.
I did not want to get my hopes up too much, but I did wonder: Could baclofen help me stop drinking? Perhaps it could relax my chronic muscular and nervous tension, keep it from intensifying into chronic anxiety and panic, and thereby short-circuit the craving for alcohol to resolve that extreme distress.
After further research I was all the more eager to try baclofen. A number of studies in specialist journals suggested it worked to relieve anxiety and depression; one study even showed it reduced the craving for alcohol in rats.
But was it safe? I needed to talk to someone who actually prescribed it. Baclofen had been described as ‘an older medication, used for years to treat muscle spasms’. This meant baclofen was probably used in neurology, and my colleague John Schaefer was a top neurologist.
Studies showed a ‘remarkable’ quieting of brain activity
But I didn’t want him to know the real reason I was interested. I feared he would say: ‘Ah, baclofen – you’re asking about that for alcoholism. But, Olivier, you must not try to be your own doctor.’
So when I called, I said: ‘Do you remember the benign idiopathic fasciculations in my calf muscles?’
‘Sure,’ he said. ‘What about baclofen for that?’
‘Not a bad idea, my boy. It’s not addictive; it’s a good, safe medication.
‘Any contraindications?” I asked.
‘Not for you. Olivier, it’s a very safe drug. Don’t worry.’
Over the next couple of months, I started taking baclofen, steadily increasing my dose to 180 milligrams a day. The short-term results were remarkable. It relaxed my muscles completely and gave me a peaceful sleep – both things I had never experienced before.
It reduced my craving for alcohol and enabled me to remain abstinent for longer periods between binges. But I still had binges – and with them came the blackouts and accidents.
In order to reach a point where I would lose the motivation to consume alcohol at all, it seemed I’d have to increase the baclofen dose.
But I was in unknown territory, already taking six times the dose used in previous brief experiments with alcoholics.
The greatest potential risk seemed to be the possibility that baclofen would relax my muscles so much that it would suppress respiration, and I might suffocate in my sleep. I had no death wish so I struggled on.
But in January 2004, I decided it was now or never: if I continued to follow my doctors’ advice, I was going to keep lapsing into binges and eventually die from drinking. I had to take my treatment into my own hands.
Based on animal studies, I decided that by increasing the dose gradually I could tolerate up to 300 mg. At 270 milligrams I went out with friends for tea. I saw a man to my right drinking whisky – and I felt neutral. I looked at him again.
Again I felt neutral. Since the onset of my alcoholism, this had never happened – I’d have wanted a drink, too. Within five weeks of taking the higher does, baclofen had made this change in me happen.
I can have a glass of champagne – and not crave anymore
I dared to look at the bar with its gleaming bottles. No alcohol thoughts came to mind; no craving for alcohol troubled me. I thought: ‘I am in a fairy tale or a dream. In a moment the spell will break, and I will wake up to the horror of needing a drink.’ But I didn’t.
Over the next 12 days I reduced my intake to 120mg; going up to 270 mg had apparently triggered a threshold response which could now be maintained at the lower dosage.
Even in the best scenario, other ‘anticraving’ drugs such as naltrexone and topiramate leave patients in a diseased state; they still must struggle, sometimes hour after hour, against addictive craving.
Moreover, these medications do not relieve dysphoria – the underlying anxiety or depression – that makes so many people vulnerable to addiction. Baclofen is unique in showing the ability, in animal studies, to suppress completely the motivation to consume alcohol etc, and to help treat dysphoria.
The usual criterion for saying an addict is doing well is abstinence – success in resisting the addictive substance. I was not just abstinent with regard to alcohol: I was effortlessly indifferent to it.
Everyone noticed the change in me. They remarked on how cleareyed and vital I looked. Friends and acquaintances said: ‘You are like a new man.’
Sixteen months after my last drink, I put my new regimen to the challenge – and have discovered that I can have a glass or two of champagne, or a vodka tonic, but not crave any more.
Five years on, and baclofen has both freed me of all craving for alcohol and resolved the underlying disorder – overwhelming anxiety – that made me vulnerable to addiction. By completely suppressing my addiction, baclofen saved my life. I believe it can save and improve the lives of many others.
source: Mail Online