EPTPatients refer to it as "the switch." "It's where you reach a point where alcohol doesn't matter anymore."
"I have prescribed Baclofen to more than 135 alcoholics who were at the end of their rope, and the results are quite frankly miraculous.”
—Renaud de Beaurepaire, MD
Chief of Psychiatry and Director of the Psychopharmacology Laboratory
PAUL GUIRAUD HOSPITAL, VILLEJUIF, FRANCE
—Renaud de Beaurepaire, MD
Chief of Psychiatry and Director of the Psychopharmacology Laboratory
PAUL GUIRAUD HOSPITAL, VILLEJUIF, FRANCE
High-Dose Baclofen: A Cure for Alcoholism?
I've been following the recent studies on an incredible drug. Baclofen is an off patent GABA agonist and muscle relaxant, and has been used for more than 40 years to treat spasticity in patients with multiple sclerosis, cerebral palsy, etc.
In 2005, attention to the drug grew when a cardiologist and long-term alcoholic announced in a case report that high-dose baclofen had completely suppressed all of his cravings for alcohol, and effectively "cured" him of his alcoholism. After years of going to daily AA meetings, working with a sponsor, and taking all the FDA approved medications, nothing was able to put a dent in his addiction. Yet he was cured by taking a pill.
More and more case reports have been published stating that individuals have been cured of their alcoholism and all cravings after taking high-dose baclofen. Numerous trials have shown that baclofen is effective in treating addictions including alcohol, cocaine, nicotine, and heroin. In a recent trial to treat alcoholics with liver cirrhosis using low-dose baclofen, an incredible 71% maintained complete abstinence from alcohol for 12 weeks.
Past studies of baclofen for addiction showed mixed results, because researchers were reluctant to test a dose higher than 30 mg/day. However, neurologists have safely prescribed up to 300 mg/day for the treatment of spasticity.
As word has spread of this incredible treatment, whole online communities have been popping up dedicated to treating their addictions with baclofen. Their forums are filled with success stories and gratitude for this "miracle cure." Unfortunately, addiction-treatment providers have been reluctant to accept it...
+ Show Spoiler +
"At issue is the definition of treatment. In the U.S., successful treatment of addiction has traditionally been an all-or-nothing undertaking, involving complete abstinence — as promulgated by supporters of 12-step programs like AA — rather than a regimen of moderation. For many, that definition includes abstinence even from drugs that would help fight cravings. Indeed, for decades, experts have debated whether drug addicts who cannot or will not quit should even be offered ongoing treatments that would reduce harm related to their drug abuse. Although many providers have recently become more open to new options, the majority of American addiction treatment continues to use the 12-step abstinence model.
"But in many other countries harm reduction is a widely accepted treatment model. In Europe and Canada, government-funded antiaddiction programs routinely help alcoholic patients reduce drinking, even if they won't quit; in Sweden, health officials suggest that cigarette smokers switch to snus (smokeless tobacco), which, unlike smoking, is not associated with lung cancer or cardiovascular disease. American proponents of moderation also argue that by demanding complete sobriety, it is possible that we are missing the chance to improve the health of smokers or problem drinkers who cannot or are not ready to stop entirely.
"What's more, the abstinence-only model is far from foolproof: 90% of alcoholics do not get sober on their first attempt, and most rehab programs report a more than 50% relapse rate in their patients within months. First attempts to quit smoking cold turkey fail just as often. So, helping drinkers and smokers cut down, even if they can't quit immediately, may have significant value, says Teri Franklin, a professor of neuroscience at the University of Pennsylvania. "If you can prevent people from inhaling the 4,000 chemicals in just one cigarette, over 400 of which are carcinogenic, you can get a health benefit," she says, noting that she was only able to quit smoking by first cutting down."
"But in many other countries harm reduction is a widely accepted treatment model. In Europe and Canada, government-funded antiaddiction programs routinely help alcoholic patients reduce drinking, even if they won't quit; in Sweden, health officials suggest that cigarette smokers switch to snus (smokeless tobacco), which, unlike smoking, is not associated with lung cancer or cardiovascular disease. American proponents of moderation also argue that by demanding complete sobriety, it is possible that we are missing the chance to improve the health of smokers or problem drinkers who cannot or are not ready to stop entirely.
"What's more, the abstinence-only model is far from foolproof: 90% of alcoholics do not get sober on their first attempt, and most rehab programs report a more than 50% relapse rate in their patients within months. First attempts to quit smoking cold turkey fail just as often. So, helping drinkers and smokers cut down, even if they can't quit immediately, may have significant value, says Teri Franklin, a professor of neuroscience at the University of Pennsylvania. "If you can prevent people from inhaling the 4,000 chemicals in just one cigarette, over 400 of which are carcinogenic, you can get a health benefit," she says, noting that she was only able to quit smoking by first cutting down."
A person who wishes to remain anonymous donated $750,000 to Amsterdam university in the Netherlands to initiate a clinical trial of high-dose baclofen. The trial was scheduled to start sometime in 2011.
Facts about balofen:
It is non-addictive, doesn't produce cravings, and has been safely prescribed for more than 40 years.
The highest dose of baclofen ever recorded, 2 grams in a suicide attempt, did not lead to death, and eventually the patient recovered completely.
Tolerance towards baclofen does not seem to occur to any significant degree, allowing a dose to be effective for many years.
In a restrospective study of 112 patients taking high-dose baclofen, only 8 discontinued treatment. The primary cause for discontinuation was not side effects, but a lack of improvement in spasticity.
The most common side effect is drowsiness, which typically dissipates after a few days.
Baclofen is off patent, and is cheaper than an alcoholic's days worth of liquor.
The most serious concern of the drug is a sudden discontinuation after prolonged periods of use.
Discontinuation requires that the drug be tapered down. Sudden discontinuation can result in severe withdrawal symptoms, which are similar in nature to benzodiazepine or alcohol withdrawal.
Studies and Links:
Complete and prolonged suppression of symptoms and consequences of alcohol-dependence using high-dose baclofen: a self-case report of a physician
Time Magazine, "Treating Alcohol Addiction: A Pill Instead of Abstinence?"
Baclofen efficacy in reducing alcohol craving and intake: a preliminary double-blind randomized controlled study
Ability of baclofen in reducing alcohol craving and intake: Preliminary clinical evidence
Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study
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Q&A
If baclofen causes withdrawal, doesn't that mean it's addictive?
No. Addiction has many different criteria, and the majority are psychological in nature.
The American Society of Addiction Medicine has this definition for Addiction:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. This is reflected in the individual pursuing reward and/or relief by substance use and other behaviors. The addiction is characterized by impairment in behavioral control, craving, inability to consistently abstain, and diminished recognition of significant problems with one’s behaviors and interpersonal relationships.
In other words, baclofen does not exhibit any signs of psychological dependence. It doesn't produce cravings, it doesn't impair behavioral control, it isn't progressive, etc.
But isn't withdrawal listed in the DSM as a criteria for addiction?
Yes, but it specifically states that at least THREE of the criteria must be met in order to diagnose an individual as addicted.
(1) tolerance
NO
(2) withdrawal
YES
(3) the substance is often taken in larger amounts or over a longer period than was intended
NO
(4) there is a persistent desire or unsuccessful efforts to cut down or control substance use
NO
(5) a great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects
NO
(6) important social, occupational, or recreational activities are given up or reduced because of substance use
NO
(7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
NO
Following these criteria, baclofen has not been shown to cause addiction.
What happens after taking baclofen for addiction?
Usually, the patient will steadily reduce their dose once indifference to alcohol has been reached. However, below a certain threshold, referred to as the "maintenance dose," cravings for alcohol can return. This means that baclofen may be a life-long dedication, much like AA and fighting cravings is a life-long dedication for many alcoholics.
It is not known how effective baclofen in combination with cognitive behavioral therapy and 12-step programs can be. Perhaps baclofen can be used to achieve abstinence without going through withdrawal, and then baclofen can be substituted with standard addiction treatment methods. The point is, it is too early to tell what is either possible or necessary with this treatment.
Can't you "cure" alcoholism by choosing not to drink?
No. Abstinence is not referred to as a "cure," because the patient will still experience the symptoms of the disease, including life-long cravings for the drug of choice. Baclofen treatment has been referred to as a possible cure, because it is the only thing which has managed to eliminate the symptoms of addiction.
Does baclofen get you "drunk" like alcohol does, since it affects GABA receptors?
No, and yes. "Drunkenness" involves many different symptoms and has many different causes. Acting as an agonist of GABA receptors only produce a few of the symptoms of drunkenness.
Drugs that act as agonists of GABA receptors (known as GABA analogues or GABAergic drugs), have relaxing, anti-anxiety, and anti-convulsive effects. Alcohol also has these effects, but they are not the sole effects produced.
In other words, baclofen mimics the effects of drunkenness when it comes to the effects listed above, namely drowsiness, relaxation, anti-anxiety, and anti-convulsive effects, but no others. However, these effects usually subside after a few days at a given dose, except at significantly high doses, which differs for each individual.
If anyone has any other questions, feel free to ask. The more we can spread understanding and knowledge of addiction the better.
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