New article on Baclofen in the London Review of Books

[billyb]

Here's an interesting article about one person's experience with baclofen in the new issue of the London Review of Books.

LRB ? Clancy Martin: Diary

It has some really chilling details in it, but it's well worth a read. He is quite enthusiastic about baclofen, although somewhat hesitant to call it a "miracle cure." He found relief through a combination of baclofen, Valium, and AA.

So far most media attention has either hyped up the book or viewed the claims skeptically, but this is the only first-person account I've seen published so far (other than Ameisen's book, of course). It should be great publicity for getting the word out about baclofen!

I'm interested to hear what people think about the article...

[Cinders]

New article on Baclofen in the London Review of Books

A really good read. I think I shall buy the book.

Thanks, billyb!!

Cindi

[louise]

New article on Baclofen in the London Review of Books

Interesting article. Thanks for posting it. I do wonder if he had split his doses up if he would have had less problem with baclofen. I'm sure a two pronged approach (medications and AA) is very useful to help break both the physical and psychological issues.

[Long Road]

New article on Baclofen in the London Review of Books

Cinders
Did U have a previous name? No need to disclose. I think I know U

[Evie.Lou]

New article on Baclofen in the London Review of Books

Thanks Billyb, Another book to add to my collection about how to really begin the recovery process !!!
You're such a blessing. Thanks for being here !!!

[Zman]

New article on Baclofen in the London Review of Books

I dont get it. He says "And indeed, once I started taking the drug, I not only lost my craving for alcohol, I soon developed an aversion to the very thought of a drink. The idea of sitting in the sun with a glass of Gevrey-Chambertin turned me off. This from a man who used to own a wine bar."

So what went wrong? He doesnt properly explain. Was it that he couldnt maintain the 200mg dose? Did he titrate up in a proper granular fashion? It appears that Bac did work for him, at a certain dosage level.

I'm a lawyer, and I'm used to coherent cause and effect arguments. This article, and its description of the author's struggle and various treatment regimes, does not make logical sense; mainly because it appears that he had found the "cure" and then inexplicably abandoned it.

[billyb]

New article on Baclofen in the London Review of Books

Cinders;657953 wrote: A really good read. I think I shall buy the book.
As far as I know, he's only written the single article I linked. I know the name "London Review of Books" makes it sound like there should be a book associated with the article, but they also publish a number of stand-alone articles as well.

louise wrote: I do wonder if he had split his doses up if he would have had less problem with baclofen.

Zenstyle wrote: I was amazed that he was taking a daily dose of Baclofen in one fell swoop. Where was his Physician?

Yes, to me it sounds like he had success at 200mg because he was doing it correctly, but when he reduced to 100mg, he decided to take his dose all in the evening before bed. Considering that the half-life is only 3-4 hours, the majority of it is out of his system by the time he wakes up in the morning. It's no surprise that he feels a craving the next day at 4pm.

It seems to me that he's using the Valium in place of a more consistent baclofen dosing schedule. That crushing anxiety he talks about when he quit Ativan sounds more like the effects of baclofen withdrawal as it leaves his body during the day (which was masked by the Ativan). Valium is effective for baclofen withdrawal, so it's no surprise that it helps take the place of the Ativan.

I hate to second-guess his dosing schedule, but it does seem like he would have more success with a better dosing schedule, which would probably enable him to eliminate the Valium.

What I liked most about the article, though, was his insightful examination of the different "possession" and "tragic" theories of alcoholism, and his analysis of the role of self-deception. Considering he's a philosopher whose primary interest lies in self-deception, it's no wonder that he would have some good insights there.

[billyb]

New article on Baclofen in the London Review of Books

Zman;658617 wrote: This article, and its description of the author's struggle and various treatment regimes, does not make logical sense; mainly because it appears that he had found the "cure" and then inexplicably abandoned it.

He says that he reduced his dosage because of sleepiness, but when he did so, he also went to an unusual dosing schedule.

I suspect that he had good supervision with his psychiatrist at the institution (who had read Ameisen's book, it seems), but when he was released he may have gone about it a bit more haphazardly.

I don't doubt that he titrated up correctly, and that he just skipped over that part because it makes for a boring article. But, I do suspect that he might have reduced his dosage in a less systematic way.

Again, I suspect he's using the Valium in place of a more consistent baclofen schedule, since he must be feeling baclofen withdrawal in the afternoon, which would contribute to his anxiety, and also give him cravings for alcohol.

This demonstrates what is so frustrating about the lack of awareness among doctors about baclofen!

[louise]

New article on Baclofen in the London Review of Books

billy, I too found his philosophical discussion interesting, but am at a loss of how to discuss it intelligently. I'm still not even sure what I think about it as a "disease". I do know I've tried the moral approach (rationale recovery) and just ended up feeling weak. But I think baclofen may help me make up my mind.

[oliveoyl]

New article on Baclofen in the London Review of Books

Liked the article.... but he never seems to make his point a bit like my philosophy teacher at university ( also a drunk ) all over the shop i spose it comes with the trade ( philosophy) to much time to think too little to do!!!!!! by the way im a philosophy major .. dont know wether to run... sH###T ...or go ..blind me self somtimes !!!!

[beatle]

New article on Baclofen in the London Review of Books

I think this guy made a lot of the mistakes that many (maybe most) of us here have as we try to find our own way out. If the doctors only bothered to know more about it and could help guide us, we might not even have to seek our way out on our own. But since almost no doctors seem to know anything about alternatives to AA (even substance-abuse specialists adhere to the 12-step rehab, at least in my experience), we all have to do our own research and make our mistakes by trial and error.

I also agree that this guy's reasoning doesn't make sense (as Zman said, no cause and effect argument here). The part of the article where he approaches the problem "philosophically" is very interesting, though.

[veritas]

New article on Baclofen in the London Review of Books

I found the philosophical side of the article very interesting and very pertinent. I think that moral assumptions about addiction have often stalled research and meaningful discussion.

I do think that a "one size fits all" approach does not fit addiction. I tend to agree that addiction is a symptom not a disease. I wonder whether genetics won't one day identify many genes that may lead to a addicted lifestyle.

I tend to look towards a genetic approach. If one looks at a genetic approach, there is the assumption that we have a specific blueprint that we cannot change. It is neither good or bad, there are no moral undertones, it is just there.

Genetics also takes into account that there needs to be some trigger, enviromental or emotional, which triggers of the active renegade gene.

If I take red heads as an example. They all have the gene for skin cancer, but they need to be exposed to a toxic dose of sunlight to set the rogue cancer cells working. This interaction between many factors needs to be explored in more depth.

Yes, as an addict, I often feel as though I have been taken by some demon possesion. It is so contary to my usual nature and my ideals of honesty. I often struggle with my own search for truth and try to face elements of self deception, but none of these pose adequate answers to what is a many faceted dilemma.

To my mind, what baclofen has done is shifted the focus onto physiology. I welcome this.

[billyb]

New article on Baclofen in the London Review of Books

Here's my understanding of Clancy Martin's article:

Two common ways of looking at alcoholism are 1) the "possession" or "disease" theory in which alcohol possesses us like a disease, making us do things against our wills and better judgments; and 2) the "tragic" theory, according to which some people are afflicted with a tragic, morally-tinged weakness of will, and that the only way to cope with this tragic flaw is to sacrifice their vitality of life in a kind of ritualistic appeal to a higher power that leaves them living a kind of "bare life" existence. Certainly a considerably less-rosy outlook.

He argues that Ameisen subscribes to the disease theory, and that his interesting innovation is that it is symptom-driven disease. Ameisen talks about this in his book, and it is pretty compelling.

Martin then goes on to say that AA gives lip service to the disease theory, but in actuality it subscribes to the "tragic" theory: that alcoholics have a constitutional tragic flaw, and their only hope is this kind of bare existence given over to a higher power.

He then discusses a book by Fingarette on Alcoholism. Fingarette argues that when you call alcoholism a disease, you create a cycle of self-deception - you start to believe that you are a helpless victim, and powerless to stop by your own accord (hence the appeal to drugs or a "higher power"). This contributes to a self-destructive attitude that blocks recovery by making people think they are unable to do anything about it themselves. Fingarette argues that in fact "heavy drinkers ... have slowly dug themselves into a pit from which they now may laboriously climb out again, perhaps by quitting entirely, or perhaps by gradually and deliberately moderating their drinking." [those are Martin's words, not Fingarette's]

And then, in a brilliant reversal (this is his best insight, as far as I'm concerned), Martin shows that Fingarette's theory also fosters the same self-deception it claims to overcome: Martin readily latched on to Fingarette's theory because it gave him a way to continue drinking (albeit moderately) while pretending to himself that he was working on a cure.

I think his larger, more implicit point (and I hope I'm not reading too much into the article), is that all theories of alcoholism rely to some degree on self-deception. That people cling to this or that theory of alcoholism and this or that method of recovery because of their own psychological drives and unwillingness to be honest with themselves - even if, and this is crucial, they are being dishonest with themselves to a certain extent precisely by being thoroughly honest. That all "methods" are in some sense a kind of self-deception, however, doesn't mean that they are ineffective - as we well know!

Finally, Martin concludes that both "possession" [disease] and "tragic" [lack of will] theories of alcoholism are two sides of the same coin. That baclofen helps with the disease portion, and AA helps him with the more psychological barriers of will.

The conclusion strikes me as remarkably similar to what we have been discussing here: that baclofen is crucial for getting rid of the physical need for alcohol, but that there remains some psychological work to be done in breaking the habit.

This is to me a very solid conclusion, and one that I fully endorse.

My concern, however, is that Martin is not getting the full benefits of baclofen. That, were he on a more consistent dosing schedule, he might discover, as many of us here have, that the psychological habit of drinking is far more manageable. For me eliminating that last habitual drink, even after I had no physical desire for alcohol anymore, was incredibly difficult. After I abstained successfully for a month, however, and with a continued and consistent baclofen dosing regimen, I can confidently say that I finally conquered my addiction.

Anyways, that's my reading of the article.

[billyb]

New article on Baclofen in the London Review of Books

Wow, just as I was typing the post above, I received an email from Clancy Martin!

I sent him an email earlier today with some of my concerns about his article, and I also told him about the My Way Out forums. He gave me permission to post his email, which I'm pasting below:



Thanks so, so much for this. Yes, I have started spreading out my baclofen, as you suggest, and it is helping more. I am going to ask LRB if I can post an update, at least on their website. And please feel free to post this email on the ongoing discussion board, which I will contribute too soon (working on a piece that is way behind deadline and under deperate time pressure at the moment). Like you, I think I didn’t give baclofen as much credit as it deserves, and want to give it more. It really is saving my life—though the valium (which I am taking less and less of, replacing it with baclofen) and AA are helping, too.

You don’t sound presumptuous, on the contrary, you are helping me!

All best, more soon,

Clancy

[billyb]

New article on Baclofen in the London Review of Books

All I've heard, other than the more empirical evidence about its potential for heroin and cocaine addiction, are the conjectures about its potential for anything from smoking to gambling to binge-eating (Ameisen even relates a story in his book about how it relieved his compulsive shopping for CDs).

As for moderating, I only know about the case report by William Bucknam, and my own experiences, and I'm getting increasingly hesitant to discuss it here, because I don't want to suggest it will work for everybody. After my month of abstinence, I now have a glass every once and a while (once or twice a week), and it works well for me, with no desire for a second glass. But I can't say it would work for everyone, and one of the nice things about the LRB article is that it highlights the effectiveness of the dual-approach of AA and meds together.