Alcoholism 'cure' under scrutiny
Tuesday, December 16, 2008
By: RONAN McGREEVY
A claim that the drug Baclofen can 'cure' alcoholism has received mixed reaction
ELEVEN YEARS ago, Dr Olivier Ameisen realized he was an alcoholic. As a cardiologist based in Paris, who also had a prestigious sinecure as professor of cardiology at Cornell University in New York, he knew that it was affecting his career and resolved to do something about it.
He joined Alcoholics Anonymous and attended meetings on a twice-daily basis. Despite doing so for seven years, he was unable to stop his cravings for alcohol and ended up being hospitalized on several occasions, while also receiving nine months of treatment at a clinic.
He found such treatments could neither arrest the grip that alcohol had on him nor dissipate the feelings of worthlessness which most alcoholics feel.
In desperation, he turned to Baclofen, a generic drug used to control muscle spasms in patients with multiple sclerosis and spinal cord injury. It is in a class of drugs known as centrally acting skeletal muscle relaxants and is widely available in Ireland.
It had also been trialled on rats and found to have suppressed the desire to consume alcohol in selectively bred Sardinian rats, which were used to test alcohol suppressants.
Realizing that he had nothing to lose, Ameisen decided to self-medicate on high does of Baclofen. He also kept a clinical diary.
He realized that he was able to stay off alcohol without experiencing cravings and also return to drinking moderately, a luxury most recovering alcoholics indulge in at their peril.
Ameisen, who is one of France's best-known heart surgeons, has written a book about his experiences called Le Dernier Verre which will be translated into English next year.
The book is an account of how he was "cured" of alcoholism, a claim that is causing both excitement among alcoholics who have besieged treatment centres in France looking for it and consternation among medical professionals in his native country.
Ameisen has boldly stated that the course of medicine he has taken has completely suppressed his alcohol addiction.
Furthermore, he has stated that the drug worked where more conventional treatments of abstinence and addressing the underlying psychological causes that result in alcoholism have not worked for him.
His claim has refocused attention on the psychopathology of alcoholism and how the brain works in alcoholics.
It has been known for many years that alcohol releases a neurotransmitter called GABA (gamma-aminobutyric acid), which can create a sense of well-being and withdrawal symptoms when the alcoholic stops taking it, and that drugs can help arrest the craving process.
A study carried out in Italy of patients with liver cirrhosis last year found that Baclofen had a proven record in promoting alcohol abstinence.
Dr Conor Farren, a consultant addiction psychiatrist at St Patrick's Hospital in Dublin, says those working in the field of alcoholism have known for some time that Baclofen has been successfully used in limited trials.
However, he says there are several drugs which perform a similar function to Baclofen which are much more established in the treatment of alcoholics.
Farren says Naltrexone, which works on the body's natural opiate systems, and Acamprosate, better known as Campral, a drug that has been approved in Europe but not yet in the United States, have both proved to help suppress alcohol cravings.
He also says trials in the United States of the anti-convulsion drug Topiramate and Ondansetron, a drug given to patients undergoing chemotherapy, have also proved to be promising.
"There is quite a lot of pre-clinical evidence that Baclofen might be helpful, but what is lacking is real clinical evidence. The claims made about this drug are woefully premature," he says.
"Baclofen is not regarded in the research community as being there yet by any manner of means. The doctor's [Ameisen's] claims are far in advance of the field."
Farren, who is also a clinical senior lecturer in Psychiatry at Trinity College Dublin, says, contrary to Ameisen's belief, no drug can actually cure alcoholism which is a disease that has many complicated causes and particularly the feelings of worthlessness and powerlessness that cause people to become alcoholics in the first place.
"These types of medications are designed to get somebody through the first months of abstinence when cravings can be most prominent. They are not a substitute for the hard psychological graft of moving past the addiction and putting your life back together. To call any of these medications a cure is way over the top.
"The causes of alcoholism are multi-factorial and the physical dependence and craving for alcohol is just one aspect of it."
Public health specialist Prof Joe Barry, who is one of the foremost critics of Irish society's dependence on alcohol, says Ameisen would have been up before the Medical Council had he self-medicated in Ireland the way that he had done in France.
"I don't go for magic cures. By and large 'magic cures' turn out not to be so," he says.
Barry says Baclofen needs to be tested under scientific conditions with randomized controlled tests.
"On a more positive note, no possible method of improving matters should be rejected and the findings deserve proper scrutiny. It would be appropriate for the findings to be submitted to a journal for peer review. Also, if this works for alcohol, what about other drugs such as heroin or cocaine?"
Stephen Rowen, the retired former clinical director of the Rutland Centre and now an addiction specialist in private practice in Milltown, Dublin, also counsels against such a drug being used as a cure for alcoholism.
"Alcoholism is not just about alcohol. It is about an emotional and spiritual sense of loss. Having a chemical that blocks the cravings may be of great scientific and medical interest, but it is not a solution," he says.
"Alcoholism is fundamentally about the hole in the soul, the destruction of the human spirit, self-sabotage and broken relations. It might be of benefit for the few, but it won't help the many because it does not address these underlying problems which have to be addressed in a holistic fashion.
"I would be worried that many people, who hear about this drug, will decide that they can be normal social drinkers, but the reality is that would be catastrophic and life-threatening.
"Alcoholics can't drink socially and the only way they can live normally is through abstinence."
Baclofen would not be the first drug to have unintended uses.
The blood pressure drug Minoxidil, better known as Regaine, is now used to treat hair loss in men while Viagra was developed as a drug to treat blood pressure, but is now used to treat erectile dysfunction.
© Irish Times
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