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Baclofen and Alcoholism

Posted Jun 02 2009 4:41pm 28 Comments

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.

SD

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I came across the Baclofen and alcoholism 'cure' by mistake, or perhaps, serendipity!

I have read Olivier Ameisen's book "The End of My Addiction" and spent a lot of time researching Baclofen. I have been sober for nearly 4 years with a relapse lasting 4 days approx 4 months ago.

Luckily, I have a doctor who was willing to prescribe it for me and we are utterly amazed at its ability to suppress cravings.

Fiona

I have battled alcoholism most of my adult life and have tried every treatment known, even a month's stay in the Priory Clinic. Always, eventually, I fell back into the same old destuctive pattern. My last plunge into the abyss found me weighing less than 75kgs, unable to dress myself, unable to wash and unable to eat. I retched blood every morning. In desperation my wife begged my GP to prescribe Baclofen and, reluctantly he agreed.

Nine months later and I cannot believe the miracle that has occured. I am now indifferent to alcohol; my preferred drink is bitter shandy these days! Baclofen has lifted the terrible mill-stone from my shoulders. I cannot begin to describe the feeling of freedom this drug has brought to me.

Baclofen can CURE alcoholism. 

"anybody can do an ‘uncontrolled’ study– and such studies are worthless"

"no real evidence that baclofen works– only rumors"

 You make a lot of bold statements that reveal that you, as with most physicians, don't understand the nature of evidence--whether you consider it "scientific" or otherwise--and don't know that you don't know it. 

What do you call the experience of your own patient? Just a rumor? Worthless? And what about your own clinical experience? Trash talk?

The emminent psychopharmacologist, Stephen M. Stahl, describes the value of the information that you dismiss and desparage in a nutshell:  "anecdotal and empirical evidence of safety and efficacy from uncontrolled use in clinical practice."

Try reading his book, go to his CMEs, and take your blinders off.  NOT everybody can do an uncontrolled test that yields useful information. NOT all medical evidence comes from "controlled studies."

 Stahl also provides enlightening discussions of the limitations and defects in clinical trials and the difficulty in translating their results to clinical practice.

Contrary to your dim view, the universe of information is not simply black and white, and mostly black. 

 

I am a Family Physician. I have started 4 patients on baclofen. The dose range is 60-100 mg in divided doses in these 4.The longest one on it is about 4 months. They all report no cravings or serious side effects. These were all desperate people who had tried AA and rehab programs in the past and failed. They agreed the potential risk was worth the potential benefit given the limited clinical data available. I cannot help but be impressed with this drug and will continue to prescribe it carefully. There is a controlled double blind study coming soon out of Univ of North Carolina testing baclofen plus naltrexone vs naltrexone alone. Unfortunately they are using only 30 mg of the baclofen in that trial.

I, too read the Ameisen book. I wonder why the NIH isn't "all over this"

Interestingly the people in AA don't want to talk about this approach! It is apparently against their "religion". As a result many people are discouraged from using anything other than meetings and the "Big Book". Hopefully this will change if the data becomes more compelling

all the best

Dr N.

Healing Words,

Which study are you referring to?

 Your link is to The Rose of Newport Beach. Does this mean that they have adopted baclofen therapy? It would be consistent with their use of other modern, but less effective drugs such as Vivitrol. 

Regarding the North Carolina studies, unfortunately these are run by Dr. James Garbutt  who seems to have a seething resentment of Dr. Olivier Ameisen, the discoverer of high-dose baclofen therapy. As a result, Dr. Garbutt's studies of baclofen are lamentable for using arbitrarily low doses of baclofen, and seem designed to show little effect. 

 Dr. C.

Dr C,

Are you using baclofen on patients? What has been your success if so? I am quite interested in knowing of "case studies" as there does not seem to be any long range studies at the higher doses my patients are needing.

Healing words,

Withdrawal symptoms are not synonymous with addiction. Yes, baclofen must be tapered very slowly if at all. This is an inconvenience but not a reason not to take this very beneficial drug for alcohol dependence. There are many centrally acting drugs which must be tapered slowly such as certain hypertension drugs, benzos, and antidepressants.

 

Dr N.

Lacking fair-minded well-designed studies, despite widespread enthusiasm for the baclofen 'cure' for alcoholism, this may well be a "self-selection" effect, both of the people for whom it seems to work (or who want it to work), and this includes prescribing physicians -- with a jeopardy that adverse drug effects (ADEs) are underreported and even suppressed by the mechanism of group pressure.

Looking at studies and case reports where the patients were being treated for spasticity issues (before the alcohol 'cure' was touted), the reports of unacceptable levels of ADEs are much more numerous. The seriousness of these effects is magnified by the fact that withdrawal from baclofen must be very gradual, often entailing the use of other dubious drugs (e.g. benzodiazepines) to blunt the otherwise potentially extreme withdrawal effects from baclofen. Some of the more vulnerable populations would include people 60+ years, previous diagnosis of a primary anxiety disorder, agitated depression or a bipolar type II tendency.

I am of course happy for those for whom baclofen has done miraculous things, but need to caution that cases where baclofen has caused significant and lasting distress are likely under-reported.

Perhaps the placebo effect (suggestion, self-fulfilling prophesy) is more powerful than generally thought, which can be a good thing if it results in abstention from alcohol, but overall I think we are in for a disappointment when the hysteria dies down and long-term follow ups and large sample controlled studies are done; it is all too common to wish for a "magic bullet" reductionist solution that ignores the patient's underlying psycho-social and biochemical individualities.

vicjoe,

In defense of your otherwise indefensibly dour, sneering, hauty, and nihilistic tone, at least you didn't tout the wonders of AA. 

 

You talk about ADEs, but in an alcoholic patient, such effects must be compared to the alternative: The extremely adverse effects of alcohol abuse. Compared to alcohol, baclofen's worst effects are truly a stroll in the park. 

 

I can verify from personal experience that baclofen is not a magic bullet for everyone, but it actually is for many. And this is a magnificent leap in alcoholism treatment--in fact the first leap at all. 

 

My theory is that there are various flavors of alcohol addiction. Ones that are primarily driven by anxiety will respond well to baclofen. An early indicator, at relatively low doses, is whether baclofen acts as an anxiolytic, as evidenced by relief of a broad definition of anxiety to include a range of adverse neurological activity beyond just anxious thoughts, or fear and worry, including relief of symptoms like insomnia and bruxism.  

 

Ameisen blazed the trail that many have followed--many who had tried and failed with numerous and repeated attempts at other medications, residential rehab, and AA. 

 

vicjoe, you say you are happy for those for whom it works, but your words ring so hollow it's painful to read them. You diminish the evidence that exists, albeit less than mathematically perfect, but then counter it with your own wholely baseless speculation and failure of reason. 

 

For those who want to break this deadly addiction, baclofen is well worth a good strong try.

 

Dr. C.

Dr C.,

We are not as far apart as you might think. When you write of my "sneering, hasty [sic], and nihilistic tone", and later how "painful" it was to read what you regarded as hollow words about my being happy for those for whom baclofen works -- I truly meant that, and herein lies a problem with textual communication: namely that without other cues such as gestures, tone of voice, etc., one's imagination as to the intent of the writer may not be accurate, asynchronous text such as in a forum like this being what McLuhan called a "cool" medium, rife with possibilities of subjective interpretations.
I'd better stop and lay out my background. Originally a medical sociologist (emphasis in social psychiatry, a sub-specialty that has since gone the way of the dodo), a sociological social psychologist (another sub-field of a field [sociology] that is not widely followed these days, based upon the Pragmatists like Peirce, Dewey, Mead, and to some extent Wm. James). Later in my life I did post-grad work in Communication at the New School on the social psychology of the Internet (hence my comments above on asynchronous communication). I also completed pre-med and 1st year medical school (until it was discovered I was also a grad student in medical sociology doing participant observation, and the grant-funded program I was attending on was pulled), so I have had some direct clinical experience. During my working life (in government) I also received advanced clinical training to counsel people in the corrections system (forensic psychology). In addition, my other passion and graduate minor was in the philosophy of science, particularly research design, objectives, measurement, etc. Add the sociology of science to that and I am quite sensitive to what constitutes genuine science vs. that which is self-serving, career-advancing, simply myopic, etc.

I agree with you absolutely that alcohol dependency (thank heavens you didn't say something perforative like "alcohol abuse" or "the disease of alcoholism") is multifaceted and often driven by anxiety. BTW, I did not tout AA as it is except for short-term personal support, basically worthless IMHO. I <i>did not say or imply</i> that baclofen could not be effective in some cases. What I was trying to get at was that I suspect there are more adverse reactions that are anecdotally reported due to self-selection bias in online forums and unstructured clinical observations. In short, the people who do badly on baclofen are likely to blame themselves and not come forward with their "failure" and we should open the door so such reports can be incorporated into study designs to counter distorting halo effects of the "magic bullet" type. I simply think those who have had serious ADEs have blamed themselves and not come forward (nor have their embarrassed off-label prescribers likely been forthcoming), and we are the poorer for not having those reports, so that therapy can be more accurately targeted or contraindicated as the case may be.
What is needed is a larger well-funded placebo/double-blind cross-over study by researchers with no axe to grind -- alas, since most drug research is funded by the Pharma companies these days, baclofen being an out-of-patent drug makes this unlikely. Until then, the precautionary principle applies, including a risk/benefit ratio that is empirically known (or as at present, scientifically unknown).
What is being messed with here are very intricate brain neurophysiological functions, so, especially given the lengthy history of psychoactive drugs' causing under-reported misery over the past 4 decades, it behooves any partisan of a particular nostrum to proceed with caution and open-minded integrity, so that the truth will out, whatever form it takes.

I now have 5 patients on baclofen. All are doing well. They have all reported total abstinence and the range of dose is as low as 30 and as high as 100 mg.

The last patient I put on it was having limited success on campral but still binge drinking. She had some mildly elevated LFTs. She was having anxiety about the possibility of drinking too much. She even had dreams about overindulgence. She is only on 30 mg and without being prompted volunteered that she noted a decrease in anxiety. She has been on it just one month.

As a practicing physician I do count on the placebo effect. I would be a fool not to be a cheerleader for any appropriate drug including this one. I also am obliged to advise patients of the potential side effects and alternatives. Out of an abundance of caution I prepared a 3 page information document which I ask them to read and sign. They take a copy home and have my cell phone number. I am that concerned about the off label use. I see the patients regularly while they are on it.

Placebo effect notwithstanding I am convinced there is more to this than placebo. The experiments with rats showed a dose dependent effect on their ethoanol intake. This is probably not a placebo effect. Also I would imagine AA having a high placebo effect and yet there are so many failures. Three of the people I have seen have failed at AA and rehab centers where there would have been expected to be a very high placebo effect. That is why this is such a remarkable phenomenon to me and it is forcing me to rethink my assumptions about alcohol addicted patients. I now believe even those who have failed at rehab and AA were really trying. At least the 5 out of 5 who kept at it and got into my clinic seem very motivated to be cured and all are now free of cravings. Interestingly 3 of the 5 are going to AA meetings now and are able, sober, to get the benefit of the group support.

Obviously it is the last thing you tried that worked so there is that but for me 5 out of 5 is pretty compelling.

If any doctors out there have a protocol I'd love to compare notes some time.

Dr. N

I recently remarked to my GP that Baclofen was probably bad news for the very lucrative business of the private Alcohol Rehabilitation Clinic. After all, here was an incurable "disease" and patients so desperate to find some sort, any sort, of help with their addiction that they would sell every possession they had, cars even their family home to be able to afford the extortionate fees charged by some clinics; and relapse was pretty much a certainty for most of them. Then along comes a cheap drug, which is comparatively easy to administer and suddenly, the end of the once seemingly inexhaustible gravy train looms large on the horizon!

No wonder we are seeing references to "essential treatment centres" creeping in here.

I still maintain, through my own experiences and remember I was once a patient of the Priory Clinic, that Baclofen is a major breakthrough in the treatment of alcohol addiction. When you consider the deaths, terrible social consequences and the dreadful strain and expense placed on the Health Services caused by alcohol addiction then Baclofen is, potentially, only some little way short of a being a miracle.          

Healing Words,

You clearly have a commercial interest in this thread. I disagree that the alcohol addict always needs a rehab specialist or treatment center. 4 of my 5 patients had failed at rehab centers more than once but succeeded with baclofen plus family support and a caring relationship with their family doctor (me). 3 of them continue to go to AA for social support 2 do not. I believe the key to cure for alcohol addiction in many cases is craving suppression which is exactly what baclofen does.

The anxiety and depression generally lift when the drinking stops. If they continue those may be treated as seperate issues.

 All the best,

Dr N.

 

I am familiar with the journal but am having a hard time finding the article. Would you kindly give a full citation (year, issue, name of article, etc.). Thank you,

Dr N

Dr. Olivier Ameisen's book (Amazon link below) includes in its appendix the full text of several important papers, including ones originally published in A&A, and several more as abstract only. This should be regarded as the basic textbook of baclofen therapy for alcoholism. 

http://www.amazon.com/Heal-Thyself-Destroyed-Alcohol---Personal/dp/0374532206/ref=sr_1_3?s=books&ie=UTF8&qid=1278967656&sr=1-3

 Google Scholar is a good search tool. For example:

 http://scholar.google.com/scholar?hl=en&q=baclofen+alcohol&as_sdt=2001&as_ylo=2010&as_vis=0

 

Thank You, Bernard C.

I have been an alcoholic for sixteen years and have begged on countless occasions to be sent to rehab. I was treated as insane to even think this could be a possibility. (Why is it impossible to get into rehab? Or is this just the case in Scotland?) Every time I went to my GP to ask for help, I was sent home with Librium for an at home detox on my own. The most I was finally offered, (after twelve years), was six days in an Edinburgh Mental Health Hospital, but once again, a short course of Librium was the treatment. (Two weeks this time, one week on previous occasions.)

I recently came across an article in a newspaper about Olivier Ameisen's work with Baclofen and asked my new CPN, (I haven't had a CPN in years), if there was any way I could try the drug. Incredibly, she said she knew what I was talking about and that there was one doctor in my county who was allowed to prescribe the drug for alcoholism. My CPN duly referred me to this doctor, who arranged for me to go into the same hospital as before, but this time to be treated with Baclofen. That was at Christmas last year and I have been sober ever since.

I must point out, however, two interesting features of my treatment. One is that I have been treated with a very low dose - 30mg daily, taken in 10mg doses at 8am, 1pm and 10pm. This low dosage has worked for me, but I can't help feeling that it would be better to start at a higher dose and gradually reduce, rather than start at such a low dose and risk it not working, thus running the risk of it failing and then being dismissed as ineffective.

Secondly, I found that the bedtime dose brought on a mild, (relatively), asthma attack every night. I have been diagnosed with asthma, bronchitis and the beginnings of emphysema, but apart from one full blown asthma attack, I have never felt that I suffer from these illnesses - no trouble breathing, no coughing fits, etc., but these bedtime attacks had me scared to go to bed. Once I tied them in to the Baclofen, I stopped taking the evening dose and took it instead at 4.30pm. This seemed like a much more appropriate time to take it anyway, as this would have been my critical time of day to start drinking. The asthma attacks stopped, but my breathing in general is affected in a way that wasn't the case before. So I would warn anyone who is prescribing, or being prescribed, Baclofen, that they should take into consideration any lung conditions, and not take Baclofen before going to bed. However, if you don’t have lung problems, taking it at bedtime knocks you out, thus eliminating that dreaded insomnia.

Another point I'd like to mention, which may be an indicator of whether or not Baclofen will work for you, is the fact that I was a lone drinker at home. I would like to know if the other people it works for were also lone drinkers. I wonder if it would work for people who enjoy drinking socially, in the pub, having a laugh with their alcoholic friends. This line of inquiry could reveal some interesting results.

One last thing:  my alcohol doctor who prescribed the Baclofen in the first place; a hospital consultant; a psychologist and an occupational therapist have all said to me that it is me who is doing it, not the Baclofen. In other words, all of them, including the very person who prescribed it, are saying, indirectly, that Baclofen for alcoholism works as a placebo! They clearly don’t know me, or they would know that I am an utter sceptic and that I don’t believe anything works until it proves to me that it does. To summarise, Baclofen for alcoholism has transformed my life and I would be willing to put up with almost any side-effects to achieve this abstinence which I have craved for sixteen years and for which the only treatment I have received in all these years has been Librium. I’d recommend it to everyone. No, make it compulsory!

 

Veronica F.

  

Veronica,

Baclofen for alcohol dependency must be started at low doses and slowly increased as needed to achieve consistent abstinence. this is because of the side effects which occur in many people in even low doses. A recent study in France showed there was an effective dose range of from 15mg/d to 300 mg/day with the average dose needed being 145mg.

This is not a placebo effect! It works on lab animals as well as humans. I don't think the rats are trying to please the scientists!

 I am a family doctor and have 6 patients on this drug. The dose range is from 15-240/day. All but 1 are abstinent and the one is much improved. We are adjusting her dose and treating another condition which may be interfering with 100% success. these are people who had bee through rehabs, meetings, other drugs etc. 

There is always a decision on the patient's part and I don't discount the value of that. The fact that you continued to try to dry out indicates your sincere commitment to recovery. The drug blocked your cravings so you could use your good judgment and quit.

That is how it works.

Dr N 

There was someone who emailed me from Australia via this board. I attempted to respond but the mail was returned. Not sure why. It may have been identified as spam. Please try again to contact me and give me your email in the contact info so that I may try again to help

Dr N. 

William,

History has taught us that most people's first trip through rehab is far from their last. (That's why we have such a lucrative, if ineffective rehab industry.) So if you're like most people, you'll have another chance to try pharmacutical therapy, although I hope you won't need it.  

Dr. C

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