Kelsey Bock – School of Physician Assistant Studies. Paper 216. 2010

Background: Many people suffer from alcoholism which can be a debilitating disease. With only three medications on the market to treat alcoholism, research to find new pharmaceuticals is important. The recent publication of a book promoting baclofen, a GABA agonist normally used to treat spasticity, as a treatment for alcoholism, has brought public attention to the topic. For potential patients who have read the book and clinicians who treat alcoholism, this systematic review examines claims that baclofen decreases alcohol cravings and has a possible clinical use in the treatment of alcoholism.

Methods: An exhaustive search of available medical literature, published in English, was conducted using MEDLINE, Evidence-Based Medicine Reviews Multifile, and CINAHL with the keywords “baclofen” and “alcoholism.” A bibliographical search of the literature was done to find further articles and information. Each study needed to evaluate both abstinence and craving for alcohol. Due to the fact that there is limited research available on the topic, all available articles were included.

Results: The search yielded 2 random controlled trials, 2 open label studies, and 3 case reports. Both random controlled trials (RCT) showed statistically significant results in increased abstinence and decreased craving in baclofen versus placebo group. Both open label studies showed decreased craving with baclofen use, and one showed increased abstinence, while the other showed a decrease in alcohol consumption. All three case reports described accounts of severe alcoholics whose alcoholism was successfully treated with higher doses of baclofen. Minimal to no side effects were seen in all trials and no patients described craving or euphoric effects from taking baclofen.

Conclusion: Even with the need for more research on the topic, baclofen should be considered as another medication to try in the treatment of alcoholism. Patients with intense cravings for alcohol may have greater benefit in cessation of alcohol use as baclofen significantly and quickly decreases cravings. Both the high safety and low side effect profile make baclofen a reasonable option to try. Since the amount of research on the topic is minimalminimal, clinicians need to use their judgment and may want to try baclofen only after first attempting other treatment options. The duration and dosage of baclofen is uncertain and will need to be adjusted on a patient by patient basis.

The efficacy of baclofen in reducing alcohol consumption

baclofene,Dépendance à l’alcool, stopper l’alcool, alcoolo-dépendance, stopper l’alcool,arreter de boire, baclofène, baclophene,problème avec l’alcool, je suis alcoolique, sevrage alcoolique, traitement de l’alcoolisme, alcool besoin d’aide, alcool information, Alcool: comment trouver de l’aide, aide sur alcool, alcool,dépendance, sos alcool, l’alcool détruit ma vie, besoin d’aide pour arrêter l’alcool , traitement de l’alcoolisme, médicaments pour arrêter l’alcool, Je bois trop d’alcool , Stop-Alcool, je bois seul, je bois en cachette

James C. Garbutt, Alexei B. Kampov-Polevoy, Robert Gallop, Linda Kalka-Juhl, Barbara A. Flannery – Alcohol Clin Exp Res. 2010 Nov;34(11):1849-57. doi: 10.1111/j.1530-0277.2010.01273.x.

Background: Recent clinical trials and case-reports indicate that baclofen, a GABA_B agonist, may have efficacy for alcohol dependence. Baclofen has been shown to enhance abstinence, to reduce drinking quantity, to reduce craving, and to reduce anxiety in alcohol-dependent individuals in 2 placebo-controlled trials in Italy. However, the clinical trial data with baclofen is limited. The purpose of the present study was to test the efficacy and tolerability of baclofen in alcohol dependence in the United States.

Objet : Les éudes récentes et les “case report” indiquent que le baclofène, un agoniste du GABA-B peut être efficace dans la dépendance alcoolique. Il a été démontré que le baclofène pouvait  améliorer l’abstinence, réduire le craving, réduire la quantité de boisson  consommée, et réduire l’anxiété dans  la dépendance alcoolique dans les deux essais contrôlés par placebo en Italie. Cependant, les données des études cliniques concernant le baclofène sont limitées. L’objet de cette étude est de tester l’efficacité et la tolérance du baclofène dans l’alcoolo-dépendance aux états unis

Methods: The study was a double-blind, placebo-controlled, randomized study comparing 30 mg/d of baclofen to placebo over 12 weeks of treatment and utilizing 8 sessions of BRENDA, a low-intensity psychosocial intervention. One hundred and twenty-one subjects were screened to yield 80 randomized subjects (44 men) with randomization balanced for gender. Percent heavy drinking days was the primary outcome measure with other drinking outcomes, anxiety levels, and craving as secondary outcomes. Tolerability was examined.

Méthode : L’étude est en double aveugle, contrôlée par placébo, compare une dose de 30mg/jour de baclofène à un placébo durant 12 semaines de traitement  en ajoutant 8 sessions de BRENDA, un programme psychosocial. Sur 121 sujets, 80 sujets ont été répartis (44 hommes) avec une répartition équilibrée par sexe. La mesure principale était le pourcentage de jours de consommation abusive, le niveau d’anxiété et de craving étaient des résultats secondaires. La tolérance a été examinée

Results: Seventy-six percent of subjects completed the study. No difference by drug condition was seen in percentage of heavy drinking days where on-average rates were 25.5% (±23.6%) for placebo and 25.9% (±23.2%) for baclofen during treatment (t₇₃ = 0.59, p = 0.56). Similarly, no differences were seen by drug condition in percentage of days abstinent, time to first drink, or time to relapse to heavy drinking. Baclofen was associated with a significant reduction in state anxiety (F_1,73 = 5.39, p = 0.02). Baclofen was well tolerated with only 2 individuals stopping baclofen because of adverse events. There were no serious adverse events.

Résultats : 66% de sujets ont complété l’étude. Aucune différence n’a été observée dans le pourcentage de jours de consommation abusive, 25,5% (± 23,6%) pour le placébo et 25,9% (± 23,2%) pour le baclofène pendant le traitement. De façon similaire, aucune différence n’a été observée en pourcentage de jours d’abstinence, en terme de prise dupremier verre, ou en terme de recommencer à boire de façon excessive. Le baclofène a été associée à une réduction significative de l’anxiété. Le baclofène a été bien toléré avec seulement 2 personnes arrêtant le baclofène en raison d’événements indésirables. Il ya eu aucun événement indésirable grave.

Conclusions: Baclofen, a GABA_B agonist, represents a possible new pharmacotherapeutic approach to alcohol dependence. Despite encouraging preclinical data and prior positive clinical trials with baclofen in Italy, the current trial did not find evidence that baclofen is superior to placebo in the treatment of alcohol dependence. Additional clinical trial work is necessary to establish whether baclofen does or does not have therapeutic efficacy in alcohol dependence and, if it does, what factors are predictive of response.

Conclusions : le baclofène, un agoniste du GABA-B, représente une possible approche médicamenteuse dans la dépendance alcoolique. Malgré des essais pré-clinique positifs en Italie, cette étude n’a pas pu démontrer la supériorité du baclofène versus placébo dans le traitement de l’alcoolisme. Une autre étude est nécessaire pour établir si oui ou non le baclofène a une efficacité thérapeutique dans la dépendance à l’alcool et quels sont les facteurs prédicifs de la réponse.

Olivier Ameisen – Alcohol & Alcoholism Vol. 42, No. 5, p. 506, 2007

I wish to propose a hypothesis that could help explain some of the effects of baclofen in alcohol dependence that are described in Dr. Bucknam’s case study (Bucknam, 2007) and in my self-case report (Ameisen, 2005). At a behavioural level, alcohol, baclofen and GHB all share sedative/hypnotic effects in humans. Clinical trials have shown baclofen to reduce anxiety in alcoholic (Krupitsky et al ., 1993; Addolorato et al ., 2002) and non-alcoholic (Breslow et al ., 1989; Drake et al ., 2003) patients alike.

GHB deficiency in alcohol dependance

Déficience en GHB dans l’alcoolo-dépendance

baclofene, baclofen,arreter de boire, stopper l’alcool, en finir avec l’alcool, baclofene, baclofen, baclophen, sortir de l’alcoolisme, dépendance, médicament pour arreter de boire, traitement alcoolisme, je veux arreter de boire,alcool, alcoolisme, déni alcoolique, craving, arret alcool

Psychopharmacology (2003) 167:221–224 – Giancarlo Colombo · Giovanni Vacca · Salvatore Serra · Giuliana Brunetti · Mauro A. M. Carai · Gian Luigi Gessa

Recent studies demonstrated that treatment with the g-aminobutyric acid (GABA)B receptor agonist baclofen reduced alcohol intake in selectively bred Sardinian alcohol-preferring (sP) rats tested under the home-cage, two-bottle choice regimen.

Objectives: The present study investigated the effect of baclofen on the appetitive, rather than consummatory, aspects of alcohol ingestion in sP rats.

Methods: Rats were trained to lever-press for oral alcohol (10%, v/v) or sucrose (3%, w/v) under a fixed-ratio schedule of 4. Once self-administration behavior was established, alcohol intake averaged approximately 0.7 g/kg over the 30-min session. Subsequently, the effect of the acute administration of baclofen (0, 1, 2 and 3 mg/kg, i.p.) on the extinction responding for alcohol and sucrose (defined as the maximal number of lever responses reached in the absence of reinforcement and used as index of motivation to consume alcohol and sucrose) was evaluated.

Results: All doses of baclofen produced a marked suppression of extinction responding for alcohol. Conversely, only the 3-mg/kg baclofen dose significantly affected extinction responding for sucrose. A separate open-field test indicated that baclofen (0, 1, 2 and 3 mg/kg, i.p.) did not affect spontaneous motor activity in sP rats.

Conclusions: These results suggest that baclofen may specifically reduce the motivational properties of alcohol; further, these results are in agreement with the recently reported anti-craving potential of baclofen in alcoholics.

Baclofen suppresses motivation to consume alcohol in rats