Please help me

There are so many people who feel like the person who wrote to me today. I remember that feeling so clearly– that there was no solution– but now I see that there is another life, and that some people will find it. And tragically, some won’t.
There are many different levels of ‘insight’– it isn’t the case that I now ‘have it’ and before I didn’t have it. I will always have blind spots– some large, some small; some short-term, and others that will last a lifetime and that I hope won’t trip me up again. I will do my best to share the insight that I have gained with the person who wrote to me– today, and going forward. I don’t know if I will be able to help or not.
Dr Junig;
It is XX am on Sunday, November 29th, 2009. I am supposed to be at a XXXXX party for XXXX.  I am frozen with fear, I have nothing to say, and I have been drinking my wine to numb the fear.
I so wanted to be the one to break this alcoholism….but find myself as I am aging, becoming my Mother!
Please, if you can, tell me how to get control of my fears and the drinking to numb the fears.
Thank you, in advance, for any help you may have for me.
My reply:
The first step is to realize that the drinking is not ‘medicine’ for anxiety or help for your fears, but rather that alcoholism is a progressive, predictable disease that makes everyone feel the same way.  The standard pattern is for the alcoholic, or addict, to shift from one state of personality to another, back and forth–  one believing that the problem is not that significant and that it can be ‘fixed’ on one’s own with a little bit more will power, and the second feeling horribly shameful, alone, and hopeless.  The problem that I face as a psychiatrist is that a person will call when at that low state of mind, finally realizing that he/she needs help and will do anything to be free from the misery.  But the next morning, the other personality wakes up and convinces herself that everything is fine—decides to throw all the pills or booze down the drain and do the ‘right thing’ next time.
The truth is that both personalities are wrong.  The trick comes in recognizing that your insight will only keep changing back and forth, back and forth, until you do something to change the pattern.  The progression of addiction causes the person to feel worse and worse until finally getting to a ‘rock bottom’ where there is NO way to kid yourself anymore.  We need to get you to that ‘rock bottom’ sooner if we can, so that you can stop the torture.  The challenge for you is to remember how you are feeling now, or when you wrote this message—and keep THAT memory alive for days, weeks, a lifetime.  I can help you with that, but only if you can manage your part- which is to drop the insistence on seeing it how you have always seen it.  I need you to see the alcohol as the PRIMARY problem—not a consequence of something else, like fear.  You also will need to understand that some medications, especially the Valium/Xanax/Klonopin medications, do the same thing as alcohol.
When we first met I suspected this was going on;  I am, after all, in recovery, and I have had the exact same feelings that you are having now.  I still remember when and where the ‘realization’ came to me that I was seeing things wrong, and that I needed to open my mind to the thought that everything I was thinking needed to be dropped and replaced by a new way of thinking.  The change after that moment was remarkable;  I realized that I needed to do drastic things in order to live, and so when I was told I needed to go to an AA meeting, I simply went—there was nothing to argue about and nothing else to say.  If you can get yourself to THAT point, Deborah, we can do wonders to improve your life.  But even if you are not completely there, consider coming in to discuss the situation.  There IS a better life out there—I promise.  But you can’t find it by doing the same things just a little differently;  if that were the case, you would have found it by now!  Consider dropping EVERYTHING and letting go.  Come in soon if you can.
Take care XXXX,
Jeff J

Baclofen and Alcoholism

I had a follow-up visit today with a patient who is being treated for anxiety and alcoholism.  He has attended AA in the past and he has no problem with the message, but at the same time the message has never really grabbed hold of him in a significant way.  His use of alcohol and anxiety are related to each other, as is typically the case.  As with other patients I have treated, he sees alcohol as treatment for his anxiety; giving up alcohol is a frightening idea when he thinks about the interactions with the public that are necessary as part of the business that he owns and runs.  From my perspective when working with such patients, I know that they will be much better somewhere down the line when they have been sober for a few months.  The hard part, though, is getting them there!
This particular patient contacted me awhile back about something he saw on TV one morning– a doctor who had written a book about using baclofen to treat alcoholism.  The patient asked if we could try that approach.  After doing some reading, I found that there are anecdotal reports describing positive results with baclofen, but no controlled studies.  In other words, there is no real evidence that baclofen works– only rumors.  And in medicine, there are ALWAYS rumors– and most of them are garbage.  Still, the risks of taking baclofen are low, and the medication is readily available and not terribly expensive.
I recently wrote about supplements and nutrients, and about how I consider taking supplements to be a waste of time and money.  Moreover by delaying more appropriate treatment they increase the chance that a person will have more negative consequences to his/her illness.  I am a skeptic about things that don’t have the support of CONTROLLED studies (anybody can do an ‘uncontrolled’ study– and such studies are worthless).  So while I did go ahead with the baclofen treatment, I certainly didn’t talk in a way that would add a positive placebo response.  If anything, I did the opposite;  I said that we could try it, but that it probably wouldn’t do anything positive.
I was pleasantly surprised to hear today that the patients has been sober for the past three months, while taking baclofen at a dose of 80-100 mg per day!  He reports that he feels more relaxed than he has felt in a long time, and that unlike his experience with AA, he has little in the way of cravings or thoughts about alcohol.  He said “this is no ‘dry drunk’;  I feel like I don’t need alcohol at all anymore.”  This is a person who has higher than average insight into his thoughts and feelings, and I trust his comments about his subjective experience with baclofen, anxiety, and cravings.
I don’t think this is a placebo response for the reason I mentioned, and also because it has lasted for several months with no ‘wearing off’ of effectiveness.  Placebo responses tend to fade over time.  I think about the tense muscles, anxiety, and insomnia experienced by many alcoholics in early sobriety, as if their systems are revved up a bit too much;  there is none of that with this person.  He appears to be calm, relaxed, and comfortable.  He is sleeping well;  he takes three doses of 20 mg of baclofen each during the day, and 40 mg at bedtime, and the bedtime dose helps him to fall asleep.
I don’t know if baclofen is for everyone, but it seems to be helping this individual.  I’d love to hear your experience with baclofen if you have used it for alcohol dependence.