Sunday Herald – November 17, 2008

Doctor rocks medical world with claim pills cured his alcoholism. Book sparks clamour for clinical trials into effect of muscle-relaxant drug.
From Hugh Schofield in Paris

THE MEDICAL world is sharply divided over claims made by an eminent French cardiologist that he has discovered a cure for alcoholism.

Dr Olivier Ameisen, who at 55 is recognised as one of France’s leading heart specialists, weaned himself off his own crippling dependency on alcohol by self-administering doses of a well-known muscle-relaxant called baclofen.

He has how written a book about his experience – called Le Dernier Verre (The Last Glass) – in which he urges immediate clinical trials to test his hypothesis that baclofen suppresses the craving for drink.
Widespread media coverage of his book in France has led to a rush of demands from alcoholics for similar treatment, and some doctors have reported unexpected successes after prescribing it.

But other specialists are sceptical about his claims, arguing that alcoholism is a complex condition with psychological as well as physiological causes. Many say they fear the consequences if sufferers come to believe a cure is a mere pill away.

A child prodigy on the piano – virtuoso pianist Arthur Rubinstein even encouraged him to make a career in music – Ameisen instead opted for medicine in order to please his parents. After qualifying in Paris, he moved to New York in 1983 where he became associate professor of cardiology at Cornell University.

Further success followed in 1994 when he opened a profitable private practice in Manhattan, but it was at this point that the doctor’s demons began to emerge. Stricken by an overwhelming feeling of inadequacy – he says he felt like « an impostor waiting to be unmasked » – he found relief in prodigious quantities of whisky and gin.

« I detested the taste of alcohol. But I needed its effects to exist in society, » he says in Le Dernier Verre, which is published in English next month.

Ameisen tried every known remedy to end his dependence, including psychotherapy, acupuncture, hypnosis, Alcoholics Anonymous meetings and detoxification cures. Between 1997 and 1999 he spent a total of nine months confined in different clinics. But nothing worked.

Fearing for his own patients, he eventually gave up his practice and returned to Paris. It was there in 2000 that he read an article in the medical pages of the New York Times about an American man who was treated with baclofen for muscle spasms and found that it eased his addiction to cocaine.

Further investigation uncovered research showing that the drug worked on rats to cut addiction to alcohol or cocaine. But strangely Ameisen found that baclofen – though widely used in other fields of medicine – was virtually unknown to specialists on dependence.

In March 2002, he began treating himself with daily doses of five milligrammes. « The first effects were a magical muscular relaxation and baby-like sleep, » he says. Almost immediately he also detected a lessening in his desire for drink. Gradually he increased the daily dosage to a maximum of 270mg, and found that he was cured. Today he continues to take 30mg to 50mg a day.

« Mine is the first case in which a course of medicine has completely suppressed alcohol addiction, » he says. « Now I can have a glass and it has no effect. Above all, I no longer have that irrepressible need to drink. »

With its eye-catching message, Le Dernier Verre has been an autumn bestseller – prompting thousands of recovering alcoholics to ask why they cannot have similar treatment.

« We are in a real fix because of this book, » alcohol specialist Philippe Michaud told Le Monde. « We’re being bombarded with phone calls demanding a course of baclofen. »

The trouble is that baclofen is not authorised for treating alcoholism. Some doctors have decided to ignore this detail, and report exciting results. « I prescribed it to two alcoholics who were really at the end of the road. To be honest, it was pretty miraculous, » said Dr Renaud de Beaurepaire of the Paul-Guiraud hospital at Villejuif near Paris.

In Geneva, Dr Pascal Garche put 12 patients on baclofen, of whom seven came through reporting marked improvements. « I have never had reactions like this before. We cannot ignore findings such as this – the book is going to set the cat among the pigeons, » he told Le Monde.

Ameisen believes that baclofen works by stimulating the creation of neurotransmitters which regulate the desire for addictive substances. However, some alcohol specialists – while not doubting the honesty of his account – question its relevance to the problem as a whole.

« Treatment of alcohol dependence can never be based simply on medicine. It’s a multi-cause condition with strong social and psychological components, » said Michaud, of the French Alcoholism Society.

One thing Ameisen and his opponents agree on is the need for clinical trials to asess whether baclofen is truly effective against alcoholism. The trouble is that the molecule is no longer protected by patent, so the drug’s original developer – the Swiss-based Novartis – has no financial incentive to perform the necessary study.

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