Baclofen for Alcoholics

Baclofen is a muscle relaxant most often prescribed to treat multiple sclerosis. But it can promote a sense of well being in recovering alcoholics, too.

Multi-use medicine.

I was coming up on my third year sober in AA and miserable. Then baclofen changed my life.

A pharmaceutical brought me to a place the program couldn’t. Finally I was at home in the world. A year later, that’s still the case.

Baclofen is a muscle relaxant most often prescribed to treat multiple sclerosis. In 2008, Dr. Olivier Ameisen, a noted cardiologist, published a book, The End of My Addiction, claiming to have cured himself of alcoholism with high doses of baclofen.

Ameisen, who died in 2013, had the kind of credentials that made it hard to dismiss him. He’d been a member of the esteemed cardiology team at New York-Presbyterian Hospital as well as the official physician to the prime minister of France, and taught at Weill Medical College of Cornell University.

The book was controversial. The upshot saw baclofen officially sanctioned as a treatment for alcoholism in France. Elsewhere, an untold number of alcoholics desperate to stop drinking started popping baclofen in copious amounts. But covertly, I came to the little white pill another way and for another reason.

In 2015, Dr. Markus Heilig published a book The Thirteenth Step: Addiction in the Age of Brain Science. Let’s pause a moment as we collectively smirk at the title.

As clinical director of the National Institute on Alcohol Abuse and Alcoholism, he led a large, long-term study on the relation between stress and cravings in the sober alcoholic. Surprisingly, Hazelden gave him an award for his work developing a pharmaceutical treatment for alcoholism.

I’d been sent the book in my professional capacity. It was dense with language I couldn’t penetrate, documenting major advances in the neuroscience of various addictions. Only a neuro-nerd would find this a page-turner. But Heilig briefly referred to a drug in development that would promote a sense of well-being in recovering alcoholics.

He got me with that.

One of the shares that stayed with me through countless AA meetings came from a member known to intellectualize even the most basic insight into obscurity. This time he was straightforward.

“I took that first drink and I felt well. Entirely well for the first time in my life.”

It was a moment of penetrating recognition for me. The times I drank for enjoyment were few compared to how often I drank to feel complete and able to cope. Coping was essential to me, a higher level of being.

The discordance was that the same drink—the first drink—guaranteed to render me useless, was also the only way I knew to get to well.

Now, almost three years sober with one horrendous five-week relapse, I emailed Heilig. I knew it would be years before a drug in development would be sprung from his lab, but did the doctor know of any medication currently available that might help even in small measure?

Heilig replied there was “reasonable support” for baclofen, though not in “the crazy French mega-doses.” In the book, he goes further, calling the results of a study testing baclofen on severely liver-damaged alcoholics “very promising.” To me, he suggested 30 mg daily was safe and well-tolerated.

As for those French mega-doses? Ameisen found his switch, the threshold dose at which he became “indifferent” to alcohol, at 270 mg. Currently, the French health authority caps the recommended daily dose at 300 mg.

Over time, Ameisen titrated down to 120 mg and lived free of cravings for the rest of his life. A possibly correlated development was that the pronounced, sometimes disabling, anxiety that had plagued him from childhood vanished.

This is where my story with baclofen begins.

I came into AA a binge drinker on my knees, determined to stay sober whatever it took. I’d certainly managed it before. Earlier in life, I’d quit drinking and spent 15 years comfortably sober. No AA and no cravings.

I now had to work for my sobriety, but I was entirely willing. Indeed, I worked so hard eventually I was ground down by my determination. My higher power either wasn’t all that powerful or was busy helping other members find parking spaces.

Simply put, I wasn’t finding the relief I needed in AA. At some point in that third year, I took a drink. The first time I emptied the wine glass, I was shocked at the letdown. My tepid reaction wasn’t at all what I had in mind.

Even so, I couldn’t stop. There wasn’t a good moment in the five weeks I fought to get sober. I was desperately trying to manipulate my alcohol level to the point where I could detox at home. When I finally got there, I put out the call for help.

This time, though, I had to live sober with an awful knowledge. There was no way out. Alcohol no longer delivered on its promise.

Quick, fast, I was back in the rooms, once more a member but perhaps not in as good standing. I was pressured to start the program again as a newbie working through the steps. I just couldn’t. The promises were always elusive. Now they just seemed taunting.

That was my mind frame when I started using baclofen. I don’t know what exactly I was expecting, but I got so much more. As we in the program say, baclofen did for me what I could not do for myself.

I’d been completely unaware that pervasive anxiety was the deciding factor in my makeup. That it shaped my days and determined my life. Other baclofen users I’ve encountered online say the same. They just didn’t know.

The first I became aware that a change was underway was when I told a friend, also in the program, that I had informed the bureau of grim determination I was no longer accepting assignments.

Before baclofen, each morning I would formulate my strategic assault on the day. I attached such urgency to everything I was incapable of prioritizing. Daily tasks, like picking up my dry cleaning, pressed as heavily on me as a work deadline.

I had to get everything done and I had to get it done now. But my list was inexhaustible. Even so, I kept adding to it, demanding more and more from myself, incessantly strategizing how to overcome any obstacle I could bring to mind.

Anticipating obstacles was my true calling and almost a second job. Whether it was a boss making another unreasonable demand or a lesser inconvenience, I had my often elaborate strategy in place. Meanwhile, I all but vibrated with tension on a perfectly ordinary day.

There were no small matters in my life. And that was so sad. If I didn’t have to be with me, I would have made a run for it. After years of therapy and so many meetings, this is who I was stuck with.

All of it was the anxiety expressing itself. A close friend told me she was unaware that I was living in a constant state of preparedness. There were no tells, no giveaways. That I wasn’t aware either astonishes me now.

Inevitably, though, I would wear thin. I never outright craved a drink, but as my low-level misery deepened into despair, I had to find the means to cope. I don’t know why I bothered pouring wine into a glass. Better to pop a straw into a bottle and be done with it until I reached for the next one.

It took several months to find the effective dose of baclofen. Titration was slow and there were side effects, daytime somnolence and nighttime wakefulness being the most persistent. My doctor helped me find a way around both until I found my sweet spot at more than 30 mg, but way less than a mega-dose.

I’m being coy about my dosage for a reason. Everyone has to find their own way without a preset number as a destination. Treatment is highly individual and sometimes complicated. For instance, at times I conflated the effects of living without anxiety with those produced by the drug.

On baclofen, I sometimes feel euphoric. I used to worry I was on an induced high. There’s no denying that at the outset I definitely had a couple of chemical moments. I remember my eyes seizing on a neighbor’s garden as the day faded. The flowers were just so beautiful.

Still, the euphoria grounded in my new outlook persists. It seems I’ve finally found my gratitude. I’m able to take simple pleasure in my much calmer days and find more of life effortless. Not that I haven’t been thrown by certain events in the past year. I’m still capable of mounting a full-scale panic.

My work life was indeed misery making, so I cautiously switched things up. Then I received word I had taken a financial hit in another quarter with no way to recoup. I wish I had handled the news with grace, but I didn’t.

But I’m not drinking, not even tempted. And I’m not steeped in self-pity. There’s no longer a trap door I plunge through to hit another abysmal bottom. I somehow know that even though I might not like what’s coming, essentially I’ll be all right. That’s an entirely fresh approach for me.

Possibly the most important insight I’ve harvested is that my alcoholism is a medical condition and needs to be treated as such. I could have twelve-stepped my way into eternity and still not have experienced this changed life.

The other night when I mindlessly missed two doses of baclofen, I felt the anxiety try to claw through. My former self was shadowing me, worrying every detail. I urged the subway to go faster, then sweated over the menu as if the fate of nations rested on my choice of entrée.

I took my medicine when I got home and went to bed cradled by the thought I would wake up a different person. Someone I can live with.

Sarah Charles is a pseudonym for someone who has been a journalist for 30 years and an alcoholic for almost that long.