As our problems evolve – or persist, as the case may be – so do the scientific and pharmacological community’s efforts to ease our pain. Such has been the pattern for years. And some might say, rightly so. After all, we shouldn’t suffer needlessly. And, if there are medications available that show promise in helping to remove barriers to a more balanced, normal existence that is free of troubling symptoms, they should generally be considered. In that vein, we have seen new interest in the potential medical uses of cannabinoids to treat seizures and other neurological disorders. Similarly, there has been a lot of research interest lately surrounding the use of ketamine in treating severe depression.
Exploring the ways in which certain compounds, chemicals, or even plant extracts can have beneficial applications in improving quality of life is the tradition of modern medicine. And if certain medicines have the possibility of helping break long-standing patterns of addiction, we should have an open mind and a spirit of optimism about them. As long as those medications are safe – and not addictive or problematic in and of themselves. And, as long as they don’t promise to eliminate the need for any work on our part to get better. Because if they do that, they just may be too good to be true.
Consider the case of baclofen – a drug traditionally used as a muscle relaxant to treat muscular disorders. In the last 15 or so years, due to evidence that it can reduce anxiety and promote a feeling of well-being in alcoholics, it has been a hot topic in recovery circles. And it has inspired a lot of evangelists who see baclofen as a wonder drug – a long elusive “cure” for their addiction.
Never mind that baclofen was never meant to treat alcoholism. Instead, this derivative of gamma-aminobutyric acid (GABA) is a muscle relaxer, meant to treat spastic movement disorders like cerebral palsy or Lou Gehrig’s disease.
Promise in a Pill
But a growing body of evidence suggests it also offers relief to alcoholics by inhibiting both withdrawal symptoms and cravings. That was exactly what French heart specialist Olivier Ameisen found when he experimented with baclofen to treat his own alcoholism. Dr. Ameisen went on to write a book about his experience, The Last Glass, which was published in 2008 and inspired numerous alcoholics to follow his example. Like him, they started taking big doses of the medication, which has been around since the 1970s and is marketed under the brand names Kemstro, Lioresal, and Gablofen.
“The symptom of the disease is the irrepressible longing for a drink,” said Dr. Ameisen. “If you put an end to the symptoms, you put an end to the disease.” The doctor first prescribed baclofen to himself in the early 2000’s. And he passed away in 2013, suggesting that he had never again experienced an alcohol craving since having found the right dosage of the drug.
Some baclofen loyalists claim that they have been “cured” within a month. Even more striking, some patients say they can still drink, but moderately. The dream of any addicted person.
But the path to liberation is full of pitfalls. Doctors who agree to prescribe the drug to alcoholics are rare, since technically speaking, it is against the law to recommend baclofen as a treatment for anything other than muscle spasms.
With Relief Come Risks
A number of health authorities have warned that “the benefits of baclofen for the treatment of alcohol addiction has not yet been proven” and strongly encourage alcoholics not to use the drug. Of particular concern are the dosages alcoholics are suspected of taking. Doctors recommend adults take no more than 100-120 milligrams of baclofen per day. But most who have experimented with the drug to stop drinking, like Dr. Ameisen, claim they have needed on average at least 150 milligrams – sometimes 200mg plus – per day for the drug to effectively suppress their cravings. And some patients, pleased with the initial results of the medication, just stop following any regular dosage regime altogether.
People in favor of using baclofen to treat alcoholism have formed communities on the Internet and are lobbying hard for health authorities to begin allowing doctors to prescribe it freely. Ameisen’s colleagues in the medical community have mixed feelings about the drug. Some agree that it should be broadly available, if nothing else so that doctors can at least monitor the use of a medication patients are finding ways to obtain anyway. But others are steadfast in refusing to prescribe it, in part out of fear that they might open themselves up to possible malpractice suits, but also because Baclofen’s use as an alcohol addiction treatment has simply not yet been studied enough. “We are in a delicate position,” says Dr. Stéphanie Geiger- Boicot, an addictionologist in the Quatre-Ville hospital in the French city of Saint-Cloud. “If someone files a complaint, we are not protected.”
Mixed Findings on Efficacy
And the research that has been conducted has been mixed, or inconclusive. Preliminary open-label studies from Italy demonstrated the effectiveness of baclofen in reducing alcohol use among the alcoholics. In addition, results from a clinical study conducted by Brown University show alcohol-addicted participants receiving baclofen were able to abstain from drinking for longer periods of time than those who didn’t receive the drug.
However, similar clinical study involving participants who drank at moderate levels showed little difference in abstinence rates between those who took baclofen and those who didn’t. These findings generally point to the need for more research to better pinpoint baclofen’s effects on the brain at different stages and degrees of alcohol misuse.
In general, addictionologists tend to be suspicious of a pill that would so quickly eliminate any feeling of dependence. Especially since baclofen, which patients take continuously, is not without side effects: drowsiness, dry mouth, cramps, sometimes depression and manic episodes are relatively common and can be severe. Dr. Michel Craplet, a psychiatrist and expert in alcohol addition, say the drug has a psychological downside as well. He describes alcoholics who self- medicate with baclofen as lonely – and jaded.
“They lived for a while with what they thought was a miracle drug: alcohol,” he says. “Today they think that another miracle drug, baclofen, will save them from their illness. One illusion replaces another.”
Is baclofen a mere illusion? Or a super-placebo? Or a truly effective aid in the treatment of a deadly disease? More will be revealed…