Can a Pill Cure Your Addiction?
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Fast
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the time he turned 50, Olivier Ameisen was a successful cardiologist living in
New York City. Still, the French-American physician couldn’t shake the feeling
he was “an imposter waiting to be unmasked.”1
Ameisen
was an alcoholic, a fact that “numerous emergency hospitalizations, emergency
room visits, detoxifications, [and] years of inpatient and outpatient
rehabilitation treatments” had failed to change.2 “I detested
the taste of alcohol, but I needed its effects to exist in society,” he writes
in his book The End of My Addiction. All told, he estimates that at
this point in his life a typical night of drinking consisted of 750 ml of
Scotch,3 the equivalent of 17 drinks.
This
is where Ameisen’s life stood on January 9, 2004, when, inspired by a report inThe
New York Times,4 Ameisen decided to take a new approach.
For years, doctors had used the drug baclofen to treat muscle spasms in people
with multiple sclerosis or spinal injuries. But according to one patient
prescribed the medication, the effects went one step further, acting like a wet
blanket tossed over the fires of his cocaine-addicted brain’s cravings.
Cured
by a Pill?
This
wasn’t the first instance in which the drug had demonstrated the potential to
reduce and even eliminate what Dr. Anna Rose Childress, the researcher behind
the New York Times report, refers to as “throbbing, pulsing
desire states” brought on by drugs and alcohol.5 Previous
studies in rats 6 and, to a limited extent, humans 7 had
indicated the drug’s potential beyond treating muscle spasticity. Nevertheless,
Ameisen’s doctors “remained unconvinced” when he approached them with the idea.
And so a desperate Ameisen did the only thing left to do and self-prescribed
the drug, slowly increasing and then decreasing his dose until finally striking
on an amount that shielded him from the desire to drink while minimizing the
most significant side effect of drowsiness.8
In
December 2004, the Journal of Alcohol and Alcoholism published
Ameisen’s report on his one-man study. This was followed four years later by
the cardiologist’s best-selling memoir.9
The
response was immediate. Hundreds flocked to message boards where they passed
notes back and forth on dosage size and frequency. Meanwhile, doctors around
the country began prescribing it to patients. 10 As they
did, the research kept coming in.
Inspired
by Ameisen’s story, addiction psychiatrist Dr. William Bucknam prescribed a
high dose of baclofen to an alcoholic patient, who quickly found drinking
became “an alien world” to him. What’s more, the man found that when he did
drink, he was able to do so in moderation.11
In
2011, the Journal of Alcohol and Alcohlism, the same journal
that published both Ameisen’s and Bucknam’s studies, published yet another on
baclofen. The results: A daily dose of 30 mg for 12 weeks resulted in a 53
percent reduction in the number of drinks a person had each day. Bump that up
to 60 mg, and this number jumped to 68 percent.12
To
understand how baclofen and similar drugs work, it’s important to understand a
little bit about cellular receptors, and specifically those located on the
surface of the cell. The idea is simple, really. The receptors act like
messengers ferrying news, which arrives in the form of a molecule, into the
cell from the outside world. Block the receptor and you block that molecular
message from ever reaching the cell.
As GABA-B
receptor agonists, baclofen and its relatives do exactly that. They act like
guards standing watch against those molecules responsible for binding with
cells in order to produce a drug-induced high or alcohol’s warm glow. For
years, journalist Gabrielle Glaser has reported on alcoholism for places like
theNew York Times and The Atlantic. Eventually,
she decided to give baclofen a try herself. “It made a second glass of wine
seem about as enjoyable as a glass of Dimetapp.” 13
When
this happens, that is to say as soon as a substance is robbed of its feel-good
qualities, avoiding it no longer demands the same energy and attention as
before. In the case of Ameisen, this new-found freedom meant he “would no
longer plan life around alcohol. Alcohol thoughts no longer occur. I undertook
personal and professional projects, which I was unable to do so before as I had
to anticipate consequences of unpredictable drinking episodes (cancelling
appointments when possible and blackouts). As taught in [Cognitive Behavioral
Therapy], I avoided places, situations, social settings and vacations where
alcohol might have been present. I no longer notice liquor sections in
supermarkets.” 14
Roadblocks
In 2013,
the cardiologist died of a heart attack at the age of 60. But the research he
helped pioneer continues.
Just last year a study found that 68
percent of patients randomly assigned baclofen remained abstinent during a
12-week high-dose period when compared to just 24 percent of those given a placebo.
Reflecting
on the results of the 56-person study, Dr. Philippe Jaury told Medscape
Medical News: “When you go to Alcoholics Anonymous, people say to
themselves, ‘Today, I won’t drink.’ So alcohol is still in their mind, they
just have to tell themselves that they are not going to drink today. But with
baclofen, abstinence is passive; when it works, thoughts of alcohol are not in
your mind anymore. You can drink if you want to, but you can stop, and that’s
what has impressed me about this drug ― after patients start drug therapy, they
tell me, ‘I don’t need to drink anymore, I don’t like it,’ and that was not
their objective before they started treatment.” 15
And
yet despite all this, few addicts will ever even hear the word baclofen.
Glaser, the journalist who decided to give baclofen a go herself, estimates
that a mere one percent of those suffering from alcohol use disorder “are ever
given the choice… to take any sort of medication.” 16 John
Bowersox, spokesman for the National Institute of Alcohol Abuse and Alcoholism,
puts it at two percent. 17 Though much higher among those
treated primarily for either heroin (27 percent) or opioids (18 percent), the
number remains very much in the minority. 18
Dr. Petros
Levounis is the chair of the Department of Psychiatry at Rutgers New Jersey
Medical School and a member of the American Psychiatric Association Council on
Addiction Psychiatry. According to him, there is good reason for this, at least
in the case of baclofen and alcohol addiction.
“What
has been lacking is substantial clinical research to show whether high-dose
baclofen is truly helpful in the treatment of alcohol use disorder,” he said,
arguing that studies to date have been too limited in their scope to justify
such a fundamental shift as officially toting the drug as a cure for addiction. 19
“It
is at best premature and at worst irresponsible and dangerous to tell patients
who suffer from alcoholism that now you can drink if you want to but you can
stop, because of presumed protection from baclofen,” he warned. 20
Of
course, there are a number of drugs designed to fight addiction that are vetted.
In 1972, the FDA approved methadone for opiate addiction. Touted as a safer
alternative, Suboxone was introduced in 2002 for the same purpose. Then in
2006, the FDA approved naltrexone for alcohol dependence and then four years
later for opioid dependence.
Still,
medication-assisted treatment has yet to form the basis of mainstream treatment
of substance abuse disorder. And it won’t, according to Marjean Searcy, until
the way we look at the condition changes.
“So
long people have seen it as a moral issue. Or a criminal issue. We need to
shift it into a medical model,” Searcy, the project director for the Central
Rockies Addiction Technology Transfer Center, told Foundations Recovery
Network.
The
12-Step Program Monopoly
The
battle is an uphill one. As Glaser has demonstrated in her reporting, world of
addiction is one that has long been monopolized by the 12-Step program
approach.21
It’s
difficult to track the effectiveness of either Alcoholics Anonymous or its
sister-program Narcotics Anonymous. Part of this, she notes, is the inescapable
result of the anonymous nature of AA/NA. 22 Without any
sort of information collected on who attends these meetings, it’s difficult to,
for instance, compare trends over time, be it in the case of an individual or an
entire country.
By comparing outside studies going
back to as early as 1966, however, one group of researchers was able to
circumvent this problem in part and evaluate the effect of AA and the 12-Step
approach in the lives of a little more than 3,400 people. Based on this, the researchers concluded
that “no experimental studies unequivocally demonstrated the effectiveness of
AA or [12-Step facilitation] approaches for reducing alcohol dependence or
problems.” 23
Neither
is Glaser alone in the push away from the AA model toward one she sees as
committed to viewing addiction as a disease—not a moral failing. Dr. Mark
Willenbring is the former director of the National Institute for Alcohol Abuse
and Alcoholism, where he says he saw tax-supported research in favor of new
drug and behavioral therapies for treating drinking problems pour in. 24
“But
nobody was paying attention.” Willenbring, who now operates a private
rehabilitation clinic in Minnesota, attributes this in large part on the fact
that, unlike other fields of medicine, in the world of addiction, when
treatment fails, the patient is blamed. 25
But
even in those cases where physicians and rehab specialists are aware of these
drugs, trepidation abounds. For one, removing the ability to feel high or drunk
does not necessarily remove a person’s reasons for drinking, be it anxiety,
depression, chronic pain, social anxiety or something else entirely. This was
the case for Billy Webb, who at one point attended 110 AA meetings in 70 days
in his search for sobriety. Webb had first started drinking in his teens to
help his social anxiety. By the time he was in his mid-20s, he was downing 20
to 25 drinks a day. For years he was in and out of treatment before he was
introduced Willenbring’s clinic, where he was prescribed naltrexone. Almost
immediately, he was able to limit his drinking to two to six drinks a day. The
difference, he says, lay not in the taste but in the effect. “I didn’t get that
same rush in my head.” 26
And
for a few months, it looked like Webb had found the solution to his drinking
problem. But it didn’t stay that way. Ultimately he missed feeling intoxicated
so much that he stopped taking the drug. “I missed feeling like myself.” These
days, he is on a new drug—gabapentin—and still meeting with a therapist.
Included in the mix again: AA. 27
Best
of Both Worlds
True,
baclofen and others like it may not represent a kind of cure-all, at least not
for everyone. But there is one thing that is certain, and that is something
needs to change—and fast. From heroin to pain relievers, death by overdose is
on the rise, in some cases multiplying by six-fold within a 13-year span, as in
the case of the heroin. 28 Meanwhile, excessive alcohol
use claims an estimated 88,000 lives each year, amounting to 2.5 million years
of potential life lost between 2006 and 2010 alone. 29
If
we are to effectively combat this trend, Searcy says an approach like the one
Webb most recently settled on—attending AA and taking
baclofen—is critical. This, she says, is the one-two combo that, more than
12-Step programs or medication alone, often knocks addiction off its feet.
In this
way, Searcy says addiction is very similar to our approach to mental health.
Not very long ago, depression and other mental illnesses were deemed a personal
failing, something to snap out of. “As medications got better and we realized
you could do things with medication to change a person’s brain,” that changed.
Searcy
believes this shift is happening again, only this time with addiction. As
evidence, she points to a recent acceleration in research regarding
medication-assisted treatment for addiction, a trend she calls “really
exciting.” According to Searcy, “We’re changing the way we look at substance
use disorder. We know it’s a disease.”
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