In a small, frightening room in the psychiatric hospital where my wife had recently incarcerated me, I explained to the staff psychiatrist about Olivier Ameisen and the drug baclofen. Ameisen and I share an American publisher, and my editor, who knew about my battle with the bottle, had sent me an early copy of his book. The psychiatrist surprised me by saying: ‘Let me look into it, but I’m willing to try it.’ He was, he told me, a child psychiatrist, which immediately seemed both inevitable and desirable. I didn’t joke with him about it, however. No joking of any kind with the psychiatrist. He had just told me he thought I could leave in a few days, much sooner than most. I didn’t want to take any chances.
Ameisen, a cardiologist, claims there is a pill that cures alcoholism. In The End of My Addiction, he tells the story both of his own plunge through the many circles of alcoholic hell and, by way of research he did on the web, his almost immediate recovery.[*] Like many others, Ameisen argues that addiction to alcohol – what we have come to call alcoholism, since it entered the Western vocabulary in 1852 (in German) as Alkoholismus – is the consequence of sustained self-medication for, generally speaking, anxiety. As Seneca reports, even Cato ‘soothed his mind with wine when it was worn from the cares of state’. On this account, alcohol is like Xanax: Xanax perfected through millennia of human effort and experimentation, and therefore with lots of benefits that Xanax doesn’t have, but also several menacing side-effects that it doesn’t. (Xanax, incidentally, like Klonopin and Ativan and other benzodiazapines, is widely used in the treatment of alcoholism.)
The silver bullet Ameisen discovered is a drug called baclofen, which has been used since the 1950s for treating seizure disorders and similar conditions. After failing with rehab, Alcoholics Anonymous, Cognitive Behavioural Therapy and all other conventional treatments for alcoholism, finding himself at what AA calls ‘rock bottom’ feeling he had nothing left to lose, Ameisen began doing research on addiction online, and stumbled on baclofen. He was so broke he couldn’t afford to buy the articles (his institutional subscriptions from Cornell and NYU had been cancelled when they fired him), so he made do with the abstracts. Baclofen had been used experimentally to treat alcoholism before, with mixed results, but only in low dosages. Ameisen found a graduate student’s paper which showed that rats addicted to heroin, when treated with very high doses of baclofen, not only lost all signs of addiction but even seemed to display a curious aversion to the drug. Gradually increasing his own dosage, Ameisen worked his way to the levels being used to treat the rats. On day 37, he found, ‘on 270 mg/day of baclofen (3.6mg/kg), I experienced no craving or desire for alcohol for the first time in my alcoholic life. Even in a restaurant with friends, I was indifferent to people drinking … At the end of my ninth month of complete liberation from symptoms of alcohol dependence, I remain indifferent to alcohol. Alcohol thoughts no longer occur.’ Five years later, he is still taking baclofen (now at a much lower dosage), shows no signs of alcohol addiction and claims even to be able to drink an occasional glass of wine without experiencing any subsequent craving.
There are two basic theories of addiction: the ‘possession’ theory and the ‘tragic’ theory. Like most alcoholics, I prefer, but am suspicious of, the possession theory. This story goes that the addict is like any other poor Christian, but he’s been taken by the devil. His addiction is not something he could choose (after all, it certainly isn’t something he would choose), and therefore he can’t be blamed for it. Unsurprisingly, some finessing of the notion of blame often takes place here: the possessed addict may have chosen a lifestyle that lends itself to possession – he may have hung around with unsavoury people, made a variety of unwise choices and so on. But the basic point remains: he was taken by his addiction, he didn’t take it. He is a victim. This is Ameisen’s view. The alcoholic has a disease, plain and simple: we should no more blame him for the booze than we would blame Kafka for his tuberculosis. For Ameisen, however, our usual understanding of disease doesn’t apply here. The disease of alcoholism is the product of the symptoms of alcoholism. You eliminate the symptoms and you have cured the disease.
As a child I visited my older sister in a psychiatric hospital, but I hadn’t been inside one for 30 years. Then, on 1 January this year, at about 11 o’clock in the evening, my wife found me, feet kicking, dangling from an improvised rope – a twisted yellow sheet – about a metre off the ground in our bedroom closet. Our two-year-old daughter was in the bed, sleeping, just a few feet away. Somehow the proximity of a child to the parent’s suicide, as with Sylvia Plath’s little children in that lonely London flat, increases the suicide’s shame. I was at the end of a binge. I was also at the end of three years of secret drinking, of hiding bottles and sneaking away to bars while my wife thought I was living as I had promised her, as a sober man.
When I was released from the hospital I had prescriptions in my pocket for lithium carbonate (bipolar disorder), Lamictal (mood disorder, alcoholism, depression), Klonopin (anxiety) and, in the hopes of a miracle, baclofen. I had never taken a psychiatric drug before. When I collected the pills, I thought: two bottles of red wine a night, or this? How could any rational person – any rational person who doesn’t own stock in a pharmaceutical company – seriously believe that this was climbing the ladder of health?
At 6 p.m. the same day I drove to my first AA meeting. I was in such a hurry that in the parking lot outside the church I drove my car into a concrete pylon. The smashed indicator is still there today, 90 days later: like the 90-day AA coin in my wallet, a reminder.
Alcoholics Anonymous are the leading champions of the tragic view of addiction. Theirs is also the most popular and most successful treatment for alcoholism. They, too, claim that alcoholism is a disease, but the claim is disingenuous, or at least inaccurate, because AA also insist that the only treatment for the disease is a moral or spiritual one. Every AA meeting opens with a reading, ‘How It Works’, from what is known as ‘The Big Book’. This is a cautionary tale about how it doesn’t work, followed by the method itself, the justly famous 12 Steps. The cautionary tale warns that there are ‘men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average.’ I find it depressing, and telling, that the meetings begin with this little meditation on failure and self-deception. When I first heard these lines, I thought: what if I am lying to myself about the fact that I am capable of being honest with myself? After all, isn’t that precisely how it feels, that at the very moment you think you are being honest with yourself you discover a new layer of your own fraudulence? The problem gets worse still when you have to be honest with others, and particularly when you have to be honest with others about yourself, the source of the problem of dishonesty in the first place.
As I looked around the room I thought: yes, I am officially a loser; I am drowned in this understanding. These were people who were living half a life. And that’s guessing on the high side: most of these folks looked as though they were squeezing 10 per cent of the juice from a day. I don’t mean to say that drinking is the other half of life: it’s more fundamental than that. It’s what Nietzsche means when he discusses the ascetic ideals: the ideals of self-denial destroy creativity, power, even sex. These are the ‘last men’, the nihilists, the hopeless ones: Vladimir and Estragon without their sense of irony. They read the 12 Traditions, they say their serenity prayer, they hold hands, they chant in a circle, they ask for the intervention of a Higher Power, while pumping each other’s hands: ‘Keep coming back, it works if you work it!’ They are life’s beaten-down and broken, they are afraid, they settle for less, for as little as you ask, for nothing at all if you insist. Some of the people in this ring of vinyl chairs have 10, 15 years under their belts. You can see it in the greyness of their skin, the glaze in their eyes.
‘And you still come to meetings?’
‘Of course. Got to preserve my sobriety. Anything you put ahead of your sobriety, you will lose.’
They celebrate their AA birthdays. Thirty days. Sixty days. Ninety days. Six months. A year. Stretching out. In one of his poems – later echoed by Matt Dillon in Drugstore Cowboy – Charles Bukowski complains about the terror behind the thought of tying one’s shoes every morning, of brushing one’s teeth. The AA meeting room in this defeated old church stank of that terror. I took my 24 coin, the red one, plastic, out of my pocket, and looked at it in the palm of my hand. I imagined spinning it playfully on a bar, smiling at the bartender, and ordering my third vodka tonic.
On Ameisen’s version of the possession view, there is a complex interaction between muscular tension and psychological anxiety, and while we don’t yet know if one is the cause of the other – he recommends the question be thoroughly studied – baclofen, happily, treats both: it relaxes your muscles and soothes your anxiety. 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. After reading the book and discussing his results with Ameisen, Jean Dausset, the winner of the 1980 Nobel Prize for Medicine, said: ‘Olivier Ameisen has discovered the treatment of addiction.’ There are now many small studies of baclofen and its effects on alcoholism underway, and one hopes that larger, government-sponsored studies will follow. It is estimated that in the UK alone 15,000 people die each year from alcoholism and alcohol-related diseases, at a cost of £25 billion to the health services.
The theory behind baclofen’s effectiveness, briefly, is that the drug may increase the amount of the neurotransmitter GABA (gamma-aminobutyric acid) in the brain. When stimulated, a particular subset of GABA receptors seem to reduce our desire for many addictive substances. Normally these receptors are sufficiently stimulated by naturally produced GHB (the notorious date-rape drug), but GHB is insufficiently produced in the brain of the addict. GHB taken as a supplement has been shown to help with alcoholism; unfortunately, it is highly addictive. Crucially for Ameisen’s hypothesis, alcohol stimulates the same subset of GABA receptors. Baclofen does the same thing as alcohol and GHB, Ameisen proposes, but without the consequences of dependence and other side effects. The demon that drives the alcoholic’s destructive behaviour turns out to be an absence. When the brain is fed the food it needs, the demon flies away.
On 200 mg a day of baclofen, in an important meeting with several associate deans of my college and three new department chairs (I was made chair of my philosophy department just a few weeks before I tried to commit suicide), I fell asleep with my head on the conference room table and, for 40 minutes, everyone was too embarrassed to wake me. Somnolence is the most obvious and inconvenient side effect of baclofen. I reduced my dosage to 100 mg a day, and started taking it only at bedtime. A few days later, a colleague asked if I had changed my medicine. ‘Yes,’ I told her. ‘Why do you ask?’ She is German, an analytic philosopher, and therefore very direct: ‘You are drooling less than you were.’
On this reduced dosage, I found that my craving for alcohol, while still significantly reduced, returned. Round about four in the afternoon the thought of a cold beer would start popping up in my brain.
Herbert Fingarette, the best contemporary philosopher of self-deception, has also written a book on alcoholism. Heavy Drinking: The Myth of Alcoholism as a Disease (1988) argues the opposite case to Ameisen’s. For Fingarette, the view that alcoholism is a disease that can be cured actually contributes to the addiction, by providing the alcoholic with the false, self-deceptive and self-destructive belief that he cannot control his own drinking. In this short book Fingarette conducts a remarkably comprehensive survey of the literature on alcoholism – something Ameisen doesn’t attempt – to show that no study convincingly demonstrates that alcoholism is anything more than heavy drinking that has become progressively worse. ‘Heavy drinkers’, as Fingarette chooses to put it (for him the word ‘alcoholic’ is both stigmatic and an impediment to recovery), 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. This was music to my ears when I read it: the notion that I could slowly drink my way back up out of the cave of my worst abuses of the drug not only strongly appealed to my need for alcohol, but also seemed to make practical sense. You don’t ruin a marriage overnight, in most instances, nor do you rebuild one in a day. Baby steps into hell, baby steps back out again. That sort of thinking.
Unfortunately, if there is a telltale sign of self-deception it is precisely this: I happily find myself believing precisely what it is I wanted to believe in the first place. The more attractive a belief sounds, the more carefully it ought to be examined. (An interesting counter-example is a case like Othello’s, where the self-deceptive process leads one to believe precisely what one most wants not to believe. Jealousy often works this way.) Contrarily, there is something about the hard work of AA that has the pain of truthfulness about it. As Rilke said to his young poet, if you want to know the right course of action, just ask yourself: what is the hardest thing to do? It’s not a hurricane lantern, but in this dark and windy land, it might be a better candle than most.
About 40 days in, I found myself growing more and more depressed. I felt as though there was no corner small enough to hide in, and blamed the Ativan (I had switched from Klonopin to Ativan on the advice of a friend, who similarly found that Klonopin increased his depression). Ill-advisedly, and against my wife’s protests, I quit the benzos cold turkey. ‘I can’t take this chemical-y feeling any more,’ I told her. ‘I want my own brain back.’ Within a few days it was as though I was exploding from the inside, like John Hurt in Alien, except that instead of having one alien embryo about to burst from my chest I had thousands. I was in a state of constant claustrophobic panic and could barely get out of bed. My wife called our family doctor, Dr J., who is also a friend, to ask about my drugs and dosages. She said: ‘At this point, your guess is as good as mine.’ When my wife told me this, I said, dismayed: ‘Well, the difference between Dr J. and my psychiatrist and the other people I’ve seen is that she trusts us enough to tell us the truth.’
So, like Ameisen, I went online. I discovered that diazepam (Valium) is commonly used to treat the effects of Ativan withdrawal; I emailed Dr J. She wrote back: ‘I need to do some research.’ Soon I had a prescription. Within hours of taking my first pill I could breathe again. Now, for me, Valium is what two glasses of wine used to be. I feel as though I stand balanced on this little orange pill, and I count out my five doses of five milligrams each very carefully throughout the day. I even save them up for a five o’clock happy hour when I can, and take two or three between five and seven, when the day is easy. The truth is I am still drinking. I’m just drinking something else, and, you might say, I am drinking with some measure of control. My dosage of Valium is going down rather than up: I was on six a day a couple of weeks ago, and plan to go down to four a day at the end of the month. I don’t mention my Valium at my AA meetings or with my sponsor, not wanting to risk what they might say. Thus goes the life of ‘rigorous honesty’.
Nevertheless I have noticed that, somehow, for reasons that remain mysterious to me, the AA meetings are helping. Another philosopher, a friend who knows a lot about self-deception, said to me recently: ‘But isn’t AA just another version of psychoanalysis? Why not just go to a therapist?’ My psychiatrist, who is mildly hostile towards AA, has the same view. I told my friend: ‘You know, when you get your coin every 30 days, they ask you to explain how you did it. When I got my 60-day coin, I said: “I think it was from starting to learn how to listen.” That’s the difference.’
How did I get here? I have been struggling with overdrinking since I was 16, but things turned vicious after my second daughter was born. My wife and I decided we should drink at the weekends only – standard alcoholic strategy – and during an engagement party we held for some friends from her law school I drank several bottles of an excellent Ribera del Duero (the party was Spanish-themed) I had found at a good case-price. I remember eyeing my wife as she sat on our couch next to a handsome young attorney. She was fingering the hair by her ear. I woke up the next morning fully dressed and alone in bed. My right hand – which has two broken fingers from a past drunken effort to punch through a brick wall – was hurting, and my missing wife wasn’t answering her cellphone. The baby was gone too. I walked, still drunk, to the hotel where I knew she would have stayed. In the hotel room I wept and promised I would never have another drink. She wore extra make-up to law school for the next few weeks to hide the bruises to the left side of her face, her jaw, her cheekbone, the skin around her eye.
It was the first and last time I have punched a person I love. I tried to quit, failed, tried and failed again, and soon my drinking went underground. At a certain point in this process my wife, who pretended not to know about my secret drinking but must have had some idea (to this day, she insists she really believed I was largely sober; when obviously drunk I would tell her I had taken a large dose of cold medicine), ordered Days of Wine and Roses from Netflix. It came while she was at school, and I watched it that afternoon, lying in bed with a hangover. I put it back in the mail the same day. I couldn’t let her see it. When she asked me about it, saying that our account showed it had been mailed and returned, naturally I lied. Three years of secret drinking continued and finally ended – I hope – with that sheet tied around a pipe in our closet.
Alcoholism is so common an addiction that it has its own ism, unlike, say, heroin or cocaine or sex. And although my experiment with baclofen is ongoing, I’m not sure Ameisen has made, as some well-credentialled enthusiasts have exclaimed, ‘the dazzling discovery of a cure that could soon be within reach of all’ (David Servan-Schreiber). I think it is going to take more than a drug to cure me. While this is not as exciting a conclusion as one would like, it seems to me that what I have been calling the tragic and the possession views of addiction can be reconciled with one another – or at least that their solutions are, if you will, two sides of addiction’s algebraic equation. I do believe that baclofen is helping with a chemical imbalance in my brain; that Valium is alleviating my anxiety and satisfying a craving I have for relief at the end of the day; and that AA is holding my hand through the process, helping me to understand the psychology of my addiction, the interactions between plot and character that have put me where I am (yes, as any alcoholic will agree, it is pleasant to be the hero of my own tragedy). There may well be a kind of biofeedback relationship between the neurochemical imbalance in the addictive brain and the kinds of behaviour he or she engages in. I was predisposed to be an alcoholic, but it took years of practice to get really good at it.
The crucial, and perhaps most helpful, point of agreement between the tragic and possession theories is that in neither account is addiction understood as a moral failing on the part of the alcoholic. While the AA view seems to smuggle moral blame into its account – the process of recovery is characterised as a moral process – the alcoholic’s problem, even when he relapses, should not be understood in moral terms. The one dominant theme of contemporary literature on the problem of addiction is that the alcoholic, the junkie, the crack addict, must not be accused. How they are to be helped is, as we have seen, a tricky business.
But as of this writing, I have not had a drink. My green 90-day coin is in my wallet now, where the first red one-dayer used to be. To be as honest as I know how to be on the subject, I don’t even want a drink. Is it the 100 mg a night of baclofen, the AA, the combined (placebo?) effect of the two? Count each of them on one finger, I guess, and cross the two of them for me.
[*] Little, Brown, 352 pp., £11.99, March, 978 0 7499 4225 0.