The misuse of alcohol is one of the greatest risks to health worldwide. It causes 20-30% of esophageal cancer, liver disease, epilepsy, car accidents, homicide, and other purposeful injuries. For a long time, the main treatments for alcohol use disorder (AUD) have been psychological therapy and social counseling. But that has had limited success.
A large proportion of people with AUD have no response to the treatment, and those who do respond, do not tend to stay alcohol-free for the long-term. Baclofen could play an important part in the treatment of alcohol use disorder.
Baclofen is a muscle relaxer and is usually taken to relieve muscle spasms. It is used for pain and stiffness caused by multiple sclerosis, spinal cord injuries, and other spinal cord disorders. It acts on the central nervous system to produce relaxing effects.
Baclofen gained widespread use due to the information revolution. Forums and social media collect and circulate information from patients related to treatments that are not being promoted by drug companies.
The patients themselves are encouraging the growth in baclofen use, even against the efforts to slow its acceptance by pharmaceutical companies and skeptical doctors. Patients are getting information from press releases and internet searches. People who want to try baclofen search for willing doctors or buy it over the internet.
Although internet chat groups can’t replace clinical testing, they provide information on how a medication works in “the real world.” Plus, you get a “first-person” report of a patient’s experience with the medication.
Patients reported that baclofen freed them from constantly craving and thinking about alcohol. They could be present with alcohol without it triggering them to drink.
It has a higher success rate than Naltrexone or Acamprosate in attaining abstinence or low-risk drinking.
Naltrexone and Acamprosate have shown only a 10% rate of improvement over a placebo in studies done. Controlled trials of heavy daily drinkers showed a 42-49% improvement over the placebo.
One of the major differences between baclofen and other alcohol addiction medications is the way it became widely used. Newer, effective treatments are propelled into widespread use faster because it’s the patients that are driving the process. This process was seen in the 1980s with HIV medications during the AIDS epidemic and is depicted in the 2014 film, Dallas Buyers Club.
The story of baclofen for alcohol addiction has turned the process upside down. People demanded it and pushed it, not pharmaceutical companies.
The goal of baclofen treatment is to entirely suppress cravings for alcohol and exchange the compulsion to drink with a choice. There are cues to drink literally everywhere. This includes Advertisements, sports events, drinking in TV shows, and pubs and bars on every street.
Non-alcoholics hardly notice, but the alcohol-addicted brain observes the surroundings constantly, thinking about alcohol, and planning how to get alcohol.
Resisting the drive to drink alcohol demands constant energy and willpower to resist. Patients say that baclofen stops that constant thinking about alcohol. Triggers are still around, but now choice replaces compulsion.
Baclofen is a strong anti-anxiety medication that is helpful for patients with alcohol addiction. Alcoholics with severe anxiety are difficult to treat because they tend to medicate their anxiety with alcohol. Alcohol is an effective anti-anxiety medication because it is quickly effective, cheap, easy to get, socially acceptable, and legal. Most of today’s society use alcohol occasionally to de-stress, relax, or enhance social relationships.
For patients with chronic anxiety, the relief they get from alcohol is a trap. Many become dependent on the effects in a short amount of time. After a while, they need more alcohol to get the same effect and become addicted. For people with an anxiety problem, stopping the alcohol produces withdrawal. Withdrawal symptoms can feel like bad anxiety, and it reveals the underlying anxiety problem. This double jinx makes it had for anxious alcoholics to maintain sobriety.
Naltrexone and acamprosate, the currently popular treatments, are started after detoxification. A period of 3-10 days of being alcohol-free is needed before starting the medication. The strong anti-craving effect of baclofen means that patients don’t need to go through detox before they can begin baclofen treatment. This is why baclofen is especially good for outpatient treatment.
Drug and alcohol specialists are necessary for some patients, primarily those who need detox or rehabilitation services. However, a lot of alcoholics with underlying anxiety seem to “slip through the cracks.” They need a rehab with dual diagnosis services and can see the interrelated nature of mental health and substance abuse and treat both at the same time.
Baclofen can be very easily started when an alcohol addicted patient suddenly stops drinking and goes into withdrawal. The patient can be started on a dosage without slow adjustments. This reduces the severity and length of withdrawal. It also gives the patient the confidence that the baclofen can help them. This encourages them to stick with the increase of baclofen dosage until it completely suppresses the cravings.
Baclofen is cheap. The cost to the patient depends on the person’s dosage, but it is more economical than most other medications. Because it has been used for 40 years, it isn’t protected by a patent, so it can be manufactured and sold by any pharmaceutical company. This keeps the cost low at about 25 cents a tablet. It is prescribed in bottles of 100 tablets of 10mg or 25mg. The costs drop by using fewer tablets per dose. Up to 5 refills can be given.
There is no restriction on how long a person can stay on baclofen treatment. Patients with neurological problems have been using baclofen for 40 years of long-term treatment and have shown no side effects or toxicity.
We all know how damaging alcohol is to the liver. Baclofen is 80% processed by the kidneys. About 15% is processed int the liver as an inactive substance. This is important because it makes it safe for patients who have extreme liver dysfunction from alcoholism or other problems. Naltrexone and acamprosate can cause problems in patients with liver dysfunction.
A study of patients with cirrhosis of the liver showed the effectiveness of baclofen with no troublesome effects. However, since baclofen is excreted by the kidneys, patients with kidney impairment need to be careful.
Treatment with baclofen is usually begun with the patient still drinking alcohol in his typical amounts. The dose of baclofen is regularly increased over time, and the desire to drink alcohol decreases until the patient can stop drinking.
Some patients find that the loss of the urge to drink is gradual, and for others, it occurs suddenly when the perfect dose of baclofen has been reached. Most patients will detach themselves from alcohol gradually and have no withdrawal symptoms.
Other patients stop their drinking quickly. Since baclofen is effective for easing withdrawal symptoms, these individuals rarely suffer any.
Patients should be aware that baclofen therapy for AUD is an “off-label” prescription and requires medical monitoring. Especially at higher doses and with patients who have a coexisting physical or psychiatric condition.
We all know there is nothing perfect in this world, so it is no surprise that there are some possible side effects from baclofen. You may be allergic to it and will need emergency treatment if any of these effects occur:
Common side effects include:
Taking baclofen with other medications that slow your breathing or make you sleepy can cause dangerous side effects or death. Be sure to tell your medical professional if you are taking any of these drugs:
There are other over-the-counter medications, herbal supplements, and prescription medications that can cause a reaction. Include these when you talk to your doctors.
Baclofen is a selective agonist. It activates the GABA-B receptors in your brain. GABA-B receptors are involved in anti-anxiety effects, pain-relieving effects, appetite suppression, and some anticancer effects. Some scientists support the idea that baclofen acts as a substitution for alcohol in the GABA-B receptors.
Treatment with baclofen produces a feeling of indifference towards alcohol. This happens by gradually increasing the dose until the indifference occurs. There is the concept of a threshold, and above that threshold, the GABA-B receptors (the receptors involved with addictions) are deactivated. How and why remains a mystery. The links between GABA-B receptors and the elimination of craving and indifference to alcohol are not fully understood.
Unfortunately, no. It is a very promising and progressive treatment for alcohol use disorder. You will still need an assessment by a medical professional. But you may be one of the lucky ones who can be treated with a baclofen protocol.
You will still need medical supervision during detox, withdrawal, and rehab. At LA Detox, we don’t practice a “one size fits all” approach to treatment. You will get the most effective treatment and therapies designed for your recovery. Contact us to get yourself on the cutting edge of evidence-based treatment.
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