Posts tagged baclofen

Dr. Levin Has Good Luck with Baclofen

 

 

Drug Could Offer Respite for Alcoholic

Dr. Fred Levin is an Associate Professor of Clinicial Psychiatry and Behavioral Sciences at Northwestern University. He’s also Rebecca’s prescribing physician, and for the past several months, he’s coached her and others through the recovery process.

He only began prescribing baclofen recently. Like Rebecca, he read an account by a French cardiologist named Olivier Ameisen, who used the drug to treat his own alcohol addiction. In the past year and a half, Dr. Levin has treated as many as 300 patients who were addicted, many of whom have gotten better.

Baclofen has been used safely for decades as a muscle relaxant. It’s believed to stimulate a neural receptor called GABA-B, which consequently leads to a reduction in the release of dopamine, a neurotransmitter associated with the brain’s reward system. Doctors who prescribe baclofen for addiction argue that this reduction could lead to a suppression of craving. And it may not be limited to just alcohol. Dr. Levin believes the drug could treat a variety of addictions, ranging from heroin, to cocaine to alcohol.

But not everyone agrees. Dr. Dan Angres is the Medical Director of the Resurrection Addiction Services Program and a Clinical Associate Professor of Psychiatry at Rush Medical College. He believes there isn’t sufficient data for him to begin using it in his practice. “I think we always have to be careful for any kind of quick fix for something as complex as addiction,” Dr. Angres cautioned.

Baclofen isn’t FDA approved to treat addiction, and the recommended dose for muscle spasms is lower than what addicts are prescribed. While doctors are able to prescribe medications for symptoms they weren’t approved for – which is called off-label use – the few randomized controlled trials assessing baclofen’s efficacy have shown mixed results. And questions still remain over the long term effects of baclofen in high doses. A large clinical trial set to begin at the University of Amsterdam may shed light on baclofen’s ability to treat alcoholism, but until then, physicians like Dr. Levin remain convinced, “How could I see 300 people and only have two failures? Come on, that doesn’t make any sense at all.”

 

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Back to Baclofen

Here is an article from The Guardian on Dr. Olivier Ameisen and baclofen: “The little pill that could cure alcoholism”. From the article:

“It’s not that there is much argument over how baclofen might work. Recent advances in brain imaging have increased knowledge of the function of the pleasure and reward systems, and suggested that addiction interferes with the balance of the neurotransmitters dopamine, glutamate and gamma- aminobutyric acid (GABA). “What baclofen does is stimulate the GABA-B receptors, and you see the release of dopamine and glutamate is slowed, so the reward system is normalised,” says Ameisen. It is even widely accepted that baclofen in low doses treats withdrawal from alcoholism, though no more effectively than several other medications. What proved more controversial was Ameisen’s theory of the “threshold dose”, which he says is “needed to break the cycle of addictive craving, preoccupation and obsessive thoughts” and which moves baclofen from treatment to cure.”

A couple of years ago, Scientific American ran a series of stories on “self-experimenters”, including this one on Dr. Ambeisen. There is good information in the story. We have also written here before about Dr. Ambeisen and his use of baclofen to treat himself. What is as interesting as the story itself, is the comment section. There are a couple of nice snippets of AA dogma, including this gem below, which I thought I would highlight for those in need of a daily chuckle:

“It is regretable [sic] that AA did not work for this man. From my experience, he could not get out of self long enough to let it. Ego is the main target of alcoholismn [sic] and and the only remeidy [sic] I have ever seen is true spiritualism. Unfortunately, you have to get out of self long enough to gain the proverbal [sic] high ground perspective of spiritual intervention. I guess this is the reason that AA is not for everyone. Some sorry souls are so wound up with self, they cannot alter their perspectives, even momentarily. I feel very sadened [sic] for this man and can only think of the quote, “heal thy self physician.” This must be true for anyone who will not let God do it.”

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We are often asked to post alternatives to AA, or what our opinion is in terms of treating  addiction, beyond simply quitting. My opinion of using baclofen to treat alcohol addiction is no different than it is of naltrexone, campral,  CBT or any other treatment option. Subject it to proper, scientific, peer reviewed research – and if it shows to be effective in treating addiction, it should be looked at as a possibility for treatment. If it is unwilling to subject itself to the scientific method, and is unwilling to change or improve upon itself (as is the case with AA); or, if it has shown itself to be ineffective by objective research (also AA and Twelve Step Facilitation) – then it is most likely snake oil.

I have no idea whether or not baclofen is an effective treatment for alcoholism. I read Dr. Ambeisen’s book, and would recommend it to anyone interested in the subject of addiction recovery. My guess is that it most likely is effective, but my opinion is not what matters, which is the beauty of science. What does matter is what the science says, and there is currently research being done on the effectiveness of baclofen, including a study at the University of North Carolina on the use of baclofen in conjunction with naltrexone. These are controlled, double-blind studies on which science thrives, and AA avoids like the plague.

No Research?

Inspired by Speedy and his ideas (Yah, um, Speedy?) I have been poking around on the science blogs, wondering if anyone in the skeptic community has AA on their radar – not so much. A little, but not too much. Today, I ran into an interesting post about the publication of the book called The End of My Addiction by Olivier Amiesen – the cardiologist who cured himself of his chronic, debilitating alcoholism with a drug called baclofen. If you’re up on the addictions news, I’m sure you’ve heard of it. I haven’t read the book, but I’ve read a lot of comments about it on different forums: variations on the theme that alcoholism is a spiritual problem and no pill can cure that, and even if it could, they wouldn’t take it.

The post focused on the fact that research is not forthcoming – and it oughta be. What was especially interesting to me about the ensuing conversation in the comments was that there were no AAs present. It is a heated discussion, to say the least, but it never turns “spiritual.” However, there is no one there to point out that perhaps the reason that research has been stymied is that curing alcoholism without God or steps (and the ever pre$ent revolving door) is not in the best interest of the treatment industry. I’m not coming down on either side of the debate about whether or not the drug could work for people, but rather on the side of research. Why no research?