Can a drug used to treat muscle spasms make cravings for alcohol go away for good?

Published on Wednesday 24 June 2009 14:58

Dr Olivier Ameisen thinks so, even if the medical establishment seems reluctant to investigate his claims

SITTING OPPOSITE DR OLIVIER AMEISEN – the man who says he has discovered a cure for alcoholism – I am battling with my own prejudice. The middle-aged man, conservatively dressed in a grey suit with a blue shirt that sets off the twinkle in his eyes, looks healthy and well. He's very polite and very French. His voice is quiet and accented. There's a tiny red ribbon in the button-hole on his lapel, the symbol of the Legion d'Honneur, awarded to Ameisen for his achievements as a cardioligist.

So why am I struggling? I'm trying to imagine Ameisen slumped in the back of a taxi, drunk and bleeding, with no idea where he's been and already craving his next drink. It's quite a leap but that is what happened. Ameisen is an alcoholic.

For nearly ten years Ameisen, like a sponge in a trifle, was soaked in booze. As an associate professor of cardiology at New York's Cornell University and then with his own private practice in Manhattan, he was a high-flying and respected doctor. He had a life that many would envy. But beneath the glossy exterior he was paralysed by anxiety. He felt his success was a sham, that he would be discovered as the failure that he really was, and to cope with his fear, he drank. He slid into a spiral of binges and trips to hospital, sometimes the one where he worked as a consultant. It was humiliating and degrading and, Ameisen knew, it could well be fatal.

"I didn't fit in," he says. "The day I had my first drink I felt like a normal person. As Alcoholics Anonymous says, an alcoholic is a person with a big ego and low self-esteem. That's exactly it."

As Ameisen drowned his anxiety in drink, his life fell to pieces. He tried to talk to colleagues, to his then partner, he tried every type of therapy imaginable.

"You name it, I've tried it," he says. "Psychoanalysis, psychotherapy, cognitive behaviour therapy, self-hypnosis, homeopathy, acupuncture. I've tried all the medications for anxiety: Benzodiazepine, anti-depressants – all of them.

"I spent years begging doctors to help me get rid of my anxiety because then I knew my alcoholism would no longer be a problem. They told me 'stop drinking and your anxiety will stop'. It was pathetic."

Nothing worked and Ameisen ended up leaving New York and moving back to Paris where he'd grown up. He'd attended thousands of AA meetings, spent nine months in rehab and still he was drinking. Desperate, he thought about suicide, but always the same thing stopped him.

"I always felt that it was a biological disease," he says. "No one believed me but I knew it and I felt that if I killed myself, and I did think about that because my fear was that I would end up paralysed from falling while I was drunk, I was convinced that a treatment would be found and that pissed me off."

Ameisen struggled on. His days became a cycle of drinking and searching for signs that someone had found a cure for the disease that was ruining his life. He found nothing. And so he drank more.

"Alcoholism is such a humiliating disease because you're treated as a kind of low life, as someone who is self-destructive," he says. "I don't know any alcoholic who is self-destructive because if that's what you want you wouldn't choose alcohol, you'd shoot yourself. Alcoholics drink to feel better, not to feel worse."

But of course they don't feel better. As Ameisen binged a friend sent him an article she'd read in the New York Times about a man who'd been treated for muscle spasms with a drug called Baclofen. One of the side effects of his treatment was the suppression of his cocaine addiction. Ameisen seized on the article. He knew for him it was life or death. He then found a study which showed the drug worked on rats to cut alcohol and cocaine dependence. He also found that although Baclofen was used by neurologists to treat muscle spasms it was unknown to addiction specialists.

In March 2002 Ameisen prescribed himself Baclofen and began taking a daily dose of five milligrams, with the plan to increase the dose to a level where his own need to drink might be suppressed. He didn't know it was safe, but for him it was worth taking the chance. If things had gone wrong, he says, he'd be "dying with dignity". Eventually he ended up taking 270mg of Baclofen per day and with that he cured his cravings for alcohol. Ameisen became the first patient for whom a course of medication completely suppressed alcohol addiction.

"You can say that you have two categories of patients today: alcoholics with the disease who are going to suffer complications and death and those who like me walk around without the disease," he says. "I'm like you, I can have a drink of something, although I don't like to. If I were to see an addiction specialist today and I was to ask him whether I am an alcoholic, he would tell me, no. Basically you go from being a full-blown alcoholic to disease free."

Ameisen got his life back. As a doctor he decided he'd write a paper to be published in a medical journal which would spread the word about his experience with Baclofen. He sent his work to the chief editor of the journal Alcohol and Alcoholism, Dr Jonathan Chick, a consultant psychiatrist based in Edinburgh, and then he waited for the clinical trials of Baclofen to start. But they didn't. Not one.

Eyebrows may be raised at a physician who uses himself as a guinea pig in a medical trial for one, but Ameisen had reached his limit. He had tried every kind of therapy and treatment to no avail. He'd taken every prescribed medication, submitted to hours of therapy, spent months and thousands of dollars on residential rehab.

"It's a sham," he says of his stints in rehab. "The whole thing is a business. They hold their statistics completely secret and they tell you it works. I would've tried anything. I went to rehab religiously, believing that those guys had the solution and I relapsed the same day. And I'm not unique, it happens to 90 per cent of people."

When Ameisen finally realised that no one was going to take up Baclofen and embark on trials that would test out its efficacy and allow it to be prescribed to the millions of people who suffer from alcoholism, he decided to write a book. It was the only way to get the message out. And it has. Le Dernier Verre (The Last Glass) caused a stir in France when it was first published and there was further media furore in the US when it came out. The book is now out here too and although there has been some coverage, some interviews with Ameisen, it's been far from overwhelming.

Roughly ten per cent of people become alcohol dependent at some point in their lives and in Scotland excessive alcohol consumption is a national epidemic. Scotland has the eighth-highest level of alcohol consumption in the world. Alcohol accounts for more hospital admissions than heart disease and every year nearly 1,500 Scots die because of drink. In 2007/08 the public sector spent 30 million on alcohol services. Only six per cent of that money was used on preventative activities.

There are clinical trials of Baclofen taking place now, some four years after Ameisen published his original paper, but still, he acknowledges that the response has been muted.

"The resistance of some people is almost suspicious," says Ameisen. "You do wonder why."

He likens the reticence to investigate Baclofen to the discovery by Australian scientists, Barry Marshall and Robin Warren, that some stomach ulcers were caused by a bacteria and therefore treatable with antibiotics, research for which they won the Nobel prize in 2005.

"They were ridiculed," says Ameisen. "They were told the bacteria couldn't exist. They were antagonised by three main groups of people: the gastroenterologists who were making a living from carrying out endoscopies on patients with ulcers, psychiatrists who were making a living out of patients who'd been told they had a psychosomatic illness, and finally drug companies who were producing inefficient drugs, a huge business."

Ameisen's story is unsettling not simply because it shows how easy it is to slide into alcoholism, but also because it raises troubling questions about who controls the drugs patients can access. Baclofen, having been around for more than 40 years, is no long under patent and so offers little in the way of money-making opportunities. As a doctor, Ameisen acknowledges that the way medics prescribe is often influenced by "their training and the marketing of pharmaceutical companies". And if that sounds like a moral judgment, it's not. He writes: "It is a fact of modern medical practice created by increasing specialisation and by innovation in the pharmaceutical industry, both of which have been of great benefit to patients."

For their part, critics of Ameisen's claims about the use of Baclofen to curb addiction argue that claiming one drug can cure alcoholism is to ignore how complex a problem it really is, with social, physical and mental aspects. Ameisen understands the concern but his response is simple. "Scepticism is very healthy and people should be sceptical but dogmatism is not good and pragmatism is important," he says. "To the sceptics I say, just try it, what do you have to lose? I've yet to experience someone telling me they've tried it and it didn't work. It brings rapid, complete and effortless suppression of the diseases within weeks, once you've reached the dose of 100mg or so."

Ameisen also suggests that there are other, more subjective, influences on doctors when it comes to prescribing a treatment for alcoholism. "I think moral aspects intervene too," he says. "Doctors, like lots of people, probably think, well why should they get away with it? Why don't they have to pay a price?"

Ameisen knows about paying the price of addiction. He's taken the pledge, made the promise, tried with every fibre in his body to resist alcohol. But it never worked.

"Abstinent means – and I know this because I've been abstinent – that every minute you struggle against cravings. You are told by AA, and cognitive behavioural therapists, if you see a bar, cross the street; if you're invited to a party don't go. You don't have a life. When I was abstinent my life was run by dealing with the problem: how will I not drink today. It was my life."

There's no doubt that Ameisen is almost evangelical about the potential of Baclofen. And, given the transformation in his own circumstances, it seems reasonable. But he's also only too aware of the stigma attached to alcoholism.

"Breaking my anonymity was extremely hard," he says. "It was a tremendous sacrifice. But I thought, if I don't do it I will perpetuate this taboo. Ironically, I also thought others, other doctors, will do it after me, but none has, which shows how anchored it is and how pompous doctors are. They are just hiding. If you knew how many colleagues who have called me and I've treated, but they won't admit it publicly."

You might think Ameisen might be angry about this but he's not. In fact, there's something serene about him. Perhaps that's what happens when you're given a second chance. Knowing what he now knows, understanding that if he had taken Baclofen right back at the start he might have prevented his spiral into despair, does he wish it hadn't happened?

"I wouldn't change anything in my life," he says. "I have no regrets. My position now is higher than it was. I'm a visiting professor at the State University of New York based on my work around addiction. I had a good reputation as a cardiologist but had I died 10 years ago, nobody would've known who Olivier Ameisen was, except for my patients and a few friends. Now if something happens to me, the whole world knows. I feel like I've achieved much more in the field of addiction than I did as a cardiologist." SM

n The End of My Addiction, by Dr Olivier Ameisen, is published by Piatkus, priced 11.99.