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


1 Comment

billy · May 13, 2009 at 7:12 am

I have been taking baclofen since early January for alcohol dependence, and it has been pretty miraculous. I have gone from drinking 6-12 drinks daily to having a single glass of wine 2-3 times a week.
I have absolutely no desire to drink anymore, and I will happily have a single drink during social situations without fear that it will trigger a craving. I simply have no desire to drink a second glass.
Anxiety management seems to be crucial for how this drug works. I would previously start to feel anxious and jittery every afternoon, and if I couldn’t get hold of a drink by 5 or 6 o’clock, I would feel exceedingly ill at ease. All of that is now simply gone.
In addition, I feel absolutely no craving for baclofen itself – I have to consciously remind myself to take the drug, since I am prone to forgetting about it.
I started at 20mg daily of Baclofen, steadily increasing the dosage every three days, and I found my therapeutic dose at 150mg. Sleepiness and slight cognitive fuzziness was a problem at that high of a dose, but after one or two days at 150mg I felt something “click,” and I simply had no desire to drink (my alcohol craving was slowly lessening with every increase in baclofen dosage, but it wasn’t until the 150mg level that I suddenly felt a total absence of craving).
After maintaining the 150mg dose for several weeks (side effects got better but were still somewhat of a problem), I began to reduce the dosage in order to find the optimal maintenance dose. With a reduction in dosage (I’m now at 75mg daily, with an additional 25mg as needed), the side effects became negligible – the only remaining side effect is grogginess in the morning, and a simple cup of coffee takes care of that nicely.
The dosage regimen is the same one as described by Ameisen in his book and journal article on the subject, and as followed by Buckman in his related article (searching on pubmed brings up both these articles – I think they were both published in Alcohol and Alcoholism).
Ameisen reported having to go all the way up to 270mg before being able to reduce dosage, but it seems to vary from person to person.
Unfortunately the drug is out of patent, so clinical studies will be difficult to fund, but hopefully Ameisen’s book will get something going. I’ve heard rumors that the French government is going to fund a study, but I haven’t seen anything concrete about that.

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