What is baclofen?
Baclofen is a medication which has been used in medicine for over 40 years to ease muscle spasms in patients with conditions such as paraplegia and multiple sclerosis. In 2004, a French doctor Olivier Ameisen, suffering from alcohol addiction, discovered the anti-craving and anti-anxiety effects of baclofen by treating himself. He published a book on his experience, The End of my Addiction, which sparked widespread interest amongst alcohol addicted patients in France. There has been a steady increase in the number of patients on baclofen for alcoholism, France being the frontrunner with around 100,000 patients being treated. The french experience has led to increasing use of baclofen in other European countries with an estimated total of 350,000 patients in France and surrounding countries. In the UK and the USA, as in Australia, baclofen is not yet widely used but there is growing interest and demand for this treatment.
How does baclofen work?
Baclofen is a synthetic molecule which was designed to imitate GABA, a natural brain chemical or neurotransmitter. Both GABA (the natural one) and baclofen (the synthetic one) attach to the GABA B receptor on neurons (nerve cells) to calm the activity of parts of the brain, especially in areas which control cravings for drugs. In general terms, this is how it calms down cravings for alcohol and also calms anxiety. Exactly how it does this is not well understood.
Who benefits from baclofen treatment?
By dramatically reducing cravings for alcohol, baclofen gives alcohol addicted patients the choice about whether to drink alcohol or not.
It’s important to understand that doesn’t make patients stop drinking; the patient still has to be motivated to succeed. But it is much easier to stop when cravings and anxiety are reduced.
The older anti-craving medications, acamprosate (Campral) and naltrexone are not effective in most people, only helping around 1 in 10 people treated with them. Baclofen helps around 1 in 2 people treated so is much more effective and helps many people who have not been helped by other treatments.
How is baclofen treatment given?
Baclofen is given as tablets taken 3-4 times a day. This is because it’s effect only lasts 4-6 hours.
The dose of baclofen needed for the full effect on cravings varies widely between patients, from 30-300mg/day. Baclofen is started at a very small dose and this is steadily increased until the patient feels that the cravings are well controlled or gone. Sometimes the cravings gradually decrease as the dose rises but for other patients, there is little effect on the cravings until a certain dose is reached and the cravings suddenly “switch off”. There is no way to predict in advance what dose of baclofen will be needed for a patient.
What problems can occur with baclofen treatment?
Side effects – baclofen can cause a wide range of side effects. They generally happen at two stages of treatment. At the start of treatment, there is often tiredness, nausea, headaches or dizziness but they only last 2-5 days then disappear. They tend to occur when the dose is going up quickly, especially at the start.
Other types of side effects appear when the dose is in the higher range, usually over 100mg/day and are often strange such as tingling in arms or legs, hallucinations and joint pains. They can be very unpleasant but are harmless and disappear when the dose is reduced back down or kept at the same level.
Stopping quickly – once a patient has been on baclofen for more than 2-3 months, there will be nasty withdrawal symptoms if it is stopped quickly, much like alcohol withdrawal. To stop baclofen treatment, the dose should be decreased slowly over 1-2 weeks.
If a patient becomes ill, injured or has surgery, the baclofen must be either continued at the same dose or decreased slowly until ceased. For patients concerned that no-one will know they are on baclofen, a Medic Alert bracelet should be worn to inform caregivers of the baclofen treatment and not to stop it abruptly.
Facing life without alcohol– alcohol addiction can take over large parts of life to the exclusion of usual activities such as work, relationships, social interactions, hobbies etc. Stopping alcohol opens up time and energy for these again. For alcohol addicted patients who still have personal and professional networks in place, baclofen treatment usually leads to a rapid improvement in life. However life without alcohol can be very challenging for people whose alcohol addicted lives are empty and lonely. Filling the space created by sobriety with social contact with other people and worthwhile activities is as important as the baclofen treatment itself.
Who cannot take baclofen?
Very few people cannot try baclofen treatment. Because there are severe health consequences from alcohol addiction, it is rare that baclofen treatment would be more risky than continued heavy drinking.
A true allergy to baclofen is very rare although baclofen can cause a transient rash which may be mistaken for an allergy.
There are a couple of conditions in which care must be taken:
Baclofen can cause a worsening of Bipolar Disorder (Manic Depression), causing mania.
Baclofen can also worsen epilepsy in some patients, especially when given in high doses.
Using baclofen treatment in alcohol addicted patients with bipolar disorder or epilepsy may well be justified despite the potential problems. This is because often the alcohol problem causes poor adherence to medications and other treatments for the epilepsy/bipolar disorder. Baclofen treatment undertaken with close supervision will generally improve both the alcohol addiction and the epilepsy/bipolar disorder with great benefits for the patient’s health and well being.
Baclofen is excreted from the body by the kidneys so patients with kidney failure need to be closely watched while on baclofen treatment.
Baclofen can be used in patients with even advanced liver disease such as cirrhosis.
How long will I need to take baclofen for?
As long as required. Essentially there is no time limit but it doesn’t have to be forever. It is sensible to aim for at least one year of treatment. The need for ongoing treatment can be tested periodically by slowly decreasing the dose and seeing if the cravings re-appear. The length of treatment is likely related to the brain pathways related to addiction and how strongly formed they have become during the time of alcohol addiction. Being sober will allow these pathways to wither away from disuse. Logically, the longer the alcohol addiction has endured, the longer that baclofen treatment will be needed.
Is baclofen expensive?
No. Baclofen is an old medication and there are cheap generic brands available. It’s on the General Schedule of the PBS so there are no restrictions on the conditions which it can be used to treat. This means that concession card holders will pay the standard concession price, currently $6.30, for a bottle of 100 tablets of either 10mg or 25mg tablets. Others will pay the full PBS amount of $15-25 for 100 tablets of 10mg and $28-38 for 100 tablets of 25mg: discount chemists have the cheaper prices. The actual cost for each patient depends on the baclofen dose needed but it is modest, especially compared to the cost of alcohol.
Can I drink alcohol while taking baclofen?
Yes. The initial phase of treatment involves continuing usual levels of drinking while the baclofen dose is raised. As the cravings decrease, the patient has the choice to decrease and then stop alcohol.
Some patients do not want to aim for abstinence but rather occasional or social drinking. This is possible on baclofen because of the strong anti-craving effect but is not suited to all patients.
Does baclofen help other addictions?
It looks like it might help stimulant addictions like methamphetamine and cocaine. There is only preliminary research available but some patients report it being very useful for stimulant cravings. It doesn’t appear to be helpful for cannabis addiction. There are variable reports about baclofen’s effect on cigarette smoking. It appears to help some patients reduce or stop but has no effect in others.
Where can I find more information?
The Baclofen Treatment for Alcoholism website (baclofentreatment.com) has a wide range of information, resources and links to other baclofen websites. Or simply search the internet with “baclofen alcoholism”.