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Bump for alb:nutso: I take pride in my humility :nutso:
:what?:
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Graph of My Drinking From July '09 to January '10
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Baclofen for Alcoholism and Other Addictions
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BUMP, BUMP, BUMP.
This should SOOOO be stickied at the top of the meds thread, please, whomever has the power. This is a list of PUBLISHED STUDIES regarding baclofen and alcohohism . . .
No one's experiences, no one's beliefs. Significant scientific data that I believe should be easily available to EVERYONE considering baclofen."Wherever you are is the entry point." --Kabir
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RedThread12;1100164 wrote: BUMP, BUMP, BUMP.:nutso: I take pride in my humility :nutso:
:what?:
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Consolidated Baclofen Information Thread
Baclofen for Alcoholism and Other Addictions
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Red,
I sent a report to the Forum Moderator.
That was the wrong medium, unfortunately. I hope I don't get into trouble for it.
It is to be used for spam, etc.
But I did send another one asking how we go about getting this thread made sticky.
Hopefully he/she will respond.
CindiAF April 9, 2016
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Thanks, Cindi:
Actually, I just looked back through the whole thread and it did . . . well . . . disintegrate from it's original very succinct intent of putting the scientific publishings concerning bac in one place.
Probably what should be stickied are the early posts where that information is put forth. Don't know exactly how to do that.
Moderators, if you're reading this, please know that we'd be happy to drop off anything that doesn't refer people to published material regarding baclofen and alcoholism and addiction. :thanks:"Wherever you are is the entry point." --Kabir
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A new review published in feb 2011 with many references.
http://www.baclofene-alcool.fr/index...download&id=90
Florie
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a clumsy English translation (pdf crammed by me into google translate) of the above article
http://www.baclofene-alcool.fr/index...ownload&id=90:
Alcohol treatment by baclofen
Baclofen for the Treatment of alcoholism
R. Beaurepaire
? Springer-Verlag France 2011
Summary
clinical data and evidence of Patients who show an efficacy of baclofen in treatment of alcoholism have increased during past two years, but many prescribers are still very reluctant to use it. Yet alcoholism is a fatal disease for which no treatment truly effective, outside of baclofen. In this article, the author relates his experience of prescriber baclofen, with an analysis of potential barriers may limit its effectiveness. An approach biological mechanisms which could act baclofen is also proposed.
To quote the magazine: Psychiatr. Sci. Hum. Neurosci. 9 (2011).
Keywords
Addiction ? Anxiety ? Indifference ? Drowsiness ? Tonsil
Abstract
Clinical data and patients' accounts Have Provided Accumulating evidence Supporting the Efficacy of baclofen in The Treatment of alcoholism. However, alcohologists Remain Reluctant to PRESCRIBE baclofen. It Should Be Remembered That Alcoholism Is A Lethal Illness efficacious for Which No Treatment exist except baclofen. The author of The this paperwork on historical experience With The limitation of baclofen, and analyzes The Potential Barriers That May Limit Efficacy icts. A Biological Approach Of The Mechanisms Which May act by baclofen est aussi Proposed.
To cite this Newspaper: Psychiatr. Sci. Hum. Neurosci. 9 (2011).
Keywords
Addiction Anxiety ? ? Indifference ? Drowsiness ? Amygdala
Alcoholism is a devastating disease that kills about 60 000 people per year in France, making 120 people per day. Mortality related to alcohol includes both cirrhosis that traffic accidents caused by alcohol. In terms of health economics, the cost of alcoholism is enormous. In terms of psychological distress, individual and family, the cost is equally great. There are several diseases other than alcoholism which are also widespread and costly, for example diabetes or schizophrenia, but these diseases can be cured, they have specific and effective treatments. However, there no treatment for alcoholism. That we do not tell us there are effective treatments for alcoholism, it is not true. A drug such as naltrexone may have a small short-term efficacy in some patients, but its effectiveness in the longer term, one year for example, is zero [7]. "The therapeutic nihilism applies equally well to acamprosate "said Stahl, the current Pope of psychopharmacology [15]. This does not preclude the existence in France huge infrastructure to support alcoholics. They are gradually introduced during the past 40 years, with the centers of Food Hygiene and other counseling centers, a specialty Medical - alcohology - alcohologists physicians, associations funded by many organizations, treatment centers, centers for aftercare, techniques multiple ownership, learned societies, schools, newspapers, conferences, committees, relationships, careers, etc.. to the insignificant results. A huge machine, oiled, institutionalized, branched, purring, gain for some and very costly to society. Quite justified given the number of alcoholics in France, the enormity infrastructure appear perfectly proportional the enormity of the request. But in terms effectiveness? We may feel that the enormity of infrastructure is mainly proportional to their inefficiency in therapeutic terms. It tells a little bad faith, they could be there only to do as if. As if we were able to cure alcoholism. We do is not.
And then came a drug that cures alcoholism. Nobody was waiting. And it soon became obvious that nobody wanted it. As if effective treatment could jeopardize the big machine to treat alcoholics serves only pretend.
The drug called baclofen. It is a muscle relaxant sold in 1972 to treat spasms muscle that is observed in some diseases neurological, such as multiple sclerosis. A drug well known to neurologists, who have even developed a form that can be injected directly into the brain, form intrathecally. We therefore injected baclofen direct contact with the brain, and apparently it does poses no major problems of tolerance (but it exposes to infectious complications, so that this path is rarely used). Thus neurologists prescribe baclofen for nearly 40 years, commonly in children, sometimes directly into the brain. Neuroscientists have also observed that to have a real impact, it was often give baclofen at doses well above those recommended (in the authorization of placing on the market or MA, France, the maximum doses are recommended 75 mg / d as outpatients and 120 mg / day in people hospitalized). Baclofen is prescribed by neurologists to increasing doses, until the antispasmodic effect. Gives neurologists and commonly long and baclofen at doses of 200 or 300 mg / day, without anyone find fault [14].
Therapeutic effects of baclofen in alcoholism
The therapeutic effects of baclofen in alcoholism was discovered by a French doctor, Ameisen [2]. For story of this extraordinary discovery, the reader is referred Ameisen the book, The Last Glass, published in France in 2008 [4]. Briefly, Ameisen was addicted to alcohol and he found in the literature of articles showed that when one gives a rat made baclofen addicted to drugs, this dependence ceases [13]. The drug dependence in rats at doses of stops about 3 or 4 mg / kg baclofen, or more than 200 mg a man of 70 kg, and Ameisen ceased to be dependent alcohol at 270 mg / day of baclofen. At this dose 270 mg, Ameisen realized he had become totally indifferent to alcohol. It would have been only one case clinically isolated, but that did not. Since then, dozens doctors reported a similar effect, indifference vis-?-vis alcohol, some say the abolition of craving (but we will see later that this is perhaps not the exact phrase), in patients to whom they have prescribed baclofen dose gradually increasing, unbounded higher. Several hundred cases are now reported (Not all published but mainly reported here or there on Internet forums, or through communications Ameisen personal and myself).
Ameisen and I have published a short series of 60 cases of patients followed for three months [5]. We have since treated a much larger number of patients, but statistically, the numbers have not changed. Colleagues who are currently sets dozens of patients have told us they also found similar figures. The figures in our published study, which could therefore be fairly representative of larger series of patients, are as follows (three months). Close 90% of patients experienced the effects of suppressors baclofen on the desire to drink. Most have totally stopped drinking, or drink a glass of time time, usually without finishing the glass. However, a number of patients who said the experience clearly Suppressive effects of baclofen on their desire to drink, have been much more difficult to stop drinking, and some do not stop drinking, even if their consumption overall alcohol decreased significantly (decrease of more 50% compared with consumption before baclofen). We have a lot of thought and discussed the case of this group of patients we have termed "demigu?ris . It seems that these patients were unable to stop drinking for three main reasons: motivation inadequate, a concomitant psychiatric disorder and intolerance to side effects of baclofen.
A real motivation to stop drinking appears as a prerequisite for the Baclofen is effective. A fairly large number of patients we cared we were "led", not say "pushed" by a spouse, or parent, or colleague or an employer or social services, while Just as the desire to stop drinking was not at all clear patients themselves. It appeared that alcohol could have a function in some terribly important people. Often a function of identity, such as some people gave the impression that they "exist plus if they stopped drinking. Sometimes a function antidepressant, some people say they do could emerge from a state of deep sadness, or retreat complete itself, thanks to alcohol. Or a clearly hedonic, perhaps not far removed from the function Previous antidepressant, but still different where patients say they love the festival, live only to Day, for "fun" find unbearable boring life without alcohol. For others, alcohol is clearly transactional function vis-?-vis certain relatives, often the mother, where the taking of alcohol is destructive an expression of suffering, denial, immaturity, some might say an unresolved Oedipus, in a systemic blocked. It might give other illustrations these features that make it ineffective alcohol effects of baclofen in reducing craving for alcohol, that is to say that make many patients may not have enough motivation to stop drinking, Alcohol intake is too important not to say "Vital" at home.
More than half of patients who were prescribed the baclofen were mentally ill. In general, patients knew their psychiatric illness and were followed by a psychiatrist. Anxiety disorders and depressive were the most common diagnoses, many of patients had bipolar disorder, and we diagnosed many cases of personality disorder. Most patients were receiving treatment corresponding their disorder, most often they brought a order. We have not changed any treatment or even advisable to change. Our attitude has always was to say that treatment with baclofen is totally independent of other treatments (psychiatric and somatic) and that under no circumstances, not even by suggestion, we intervene in ongoing treatment. Nevertheless, we always read with each patient information note specifying the precautions baclofen, among whom were interactions potential of baclofen with some psychotropic drugs. We have also consistently called on doctors informing them of the requirement of baclofen. Analysis Results showed that the existence of psychiatric illness could be correlated with reduced efficacy of baclofen (highly statistically significant). One could expatiate length on the reasons for this correlation. We remember that there is undoubtedly a transverse dimension "disease of the will" in all diseases psychiatric. We have seen that to obtain an optimal effect of baclofen, it was essential that patients are motivated to stop. The motivation of patients with disorders mental can be reduced for whatever reason or circumstances: for reasons intrinsic to disease ("disease of the will"), by type of illness (Anxiolytic effect of alcohol in anxiety or antidepressant among depressed), due to disorders associated personality (eg, alternating idealization / disqualification of baclofen in BPD) of because of adherence (known to be particularly mentally ill patients in general) or because of secondary gains related to alcoholism (Exposure of suffering to mobilize entourage etc..). In these circumstances it is perhaps not very surprising to have observed a lower efficacy of baclofen patients with mental disorders.
Side effects of baclofen were another obstacle to its effectiveness. In the aforementioned study on on 60 cases in three months, we reported that more than 80% of patients reported side effects. With a decline of nearly two years and several hundreds of cases analyzed, this percentage remains approximately the same. Although these side effects of baclofen are All benign (that is to say, never put into play the prognosis life), some because of their intensity, have led patients stop their treatment, or not to increase enough doses to achieve a therapeutic effect. The Fatigue is the most common side effect of baclofen. This fatigue can be very embarrassing when it is intense. It sometimes takes the form of true sleep attacks, and may be accompanied by dizziness and discomfort. The baclofen at low doses sometimes produce statements subconfusionnels that may worry many patients. At high doses, we observed several cases of real confounding syndromes, but whenever the high doses baclofen were associated with the consumption of high doses of alcohol and benzodiazepines, so he been difficult to incriminate the only baclofen. An epileptic was also observed in a patient who had not a history of epilepsy. Some patients have a incontinence, others repeated vomiting, and in two patients, persistent diarrhea. These events Adverse very annoying (diarrhea, vomiting, incontinence, epilepsy, confusion, fatigue, attacks sleep) were concerned that a small minority of patients, but they have led some to quit baclofen. However, these adverse events are manageable rule. The Most are accessible to a specific treatment (diarrhea, antiemetic, etc..), but mostly they are manageable in adapting the conduct of treatment with baclofen. It is rare that these side effects occur immediately, decision the first tablet of baclofen. They occur in good standing a degree, in increasing doses levels. When an adverse event occurred very annoying attitude is recommended to provide the patient lower doses of baclofen, while ironing lower tier dose, who did not produce side effects, and maintaining a while at this dose. Then rates increase again very slowly and cautiously, by example of one tablet per week. It usually happens and to pass the course a lot of side effects, who do not reappear when growth slows doses. It is well known that many side effects baclofen (it's mentioned in Vidal) are related to too rapid increase in dose. In patients stop their treatment on the grounds of adverse events, the question of their motivation to stop drinking arises an obvious way. We also observed patients who discontinued treatment for purported effects reactions that seemed very minor. Otherwise words, the patients' motivation to stop drinking is at issue in these cases. Patients adequately motivated not discouraged for an adverse effect, if embarrassing as it is, and follow carefully the suggestions they are made to reduce the dose for a while and try again increased very slowly doses. It is also notable for introducing the paragraph Next, we observed no addiction baclofen (except perhaps in two patients, but addiction baclofen was questionable at home in the sense that they were virtually all addictive psychotropic scope).
(continued on next post)
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Mechanism of action of baclofen
Baclofen is an agonist of GABA-B receptors (there are in the two types of brain GABA receptors, GABA-A and GABA-B). Baclofen and benzodiazepines differs used in alcohol withdrawal, which are mainly receptor agonists GABA-A. There is no other agonist GABA-B on the market. With the exception of GHB (gamma-hydroxybutyric acid) not marketed in France, but sold in other European countries, therefore potentially available France illegally. The problem is that GHB has side effects that may be dangerous, it is a anesthetic, a stimulant, some athletes use it to doping, and it is addictog?ne. His fame comes mainly of what the "drug rapists." GHB exists naturally in the body in small quantities, and has specific receptors in the brain. It was showed that GHB reduces the craving for alcohol man [6]. Its physiological effects in animals resemble much to those of baclofen, and activation it occurs in various brain regions like much to that of baclofen, particularly in the hypothalamus and amygdala [16]. In 2007, Ameisen proposed the hypothesis that alcoholism may be related to a lack of endogenous GHB [3]. The argument of Ameisen based on the following: activity agonist of GHB on GABA-B receptors, its effect anticraving well demonstrated, and the fact that GHB is a sedative, anxiolytic and muscle relaxant, may have a therapeutic effect specific key symptoms of dependence, which are insomnia, anxiety and muscle tension. The exogenous baclofen can thus, according this hypothesis, the lack of sufficient endogenous stimulation GABA-B receptors by GHB. Unlike GHB, Baclofen selectively act on the GABA-B receptor, which are not involved in the development of a dependence, while GHB has many sites of action, some of which are likely to participate in the development establishment of an addiction.
It is therefore in France only one selective agonist GABA-B receptor on the market, baclofen. This agonist suppresses the urge to drink among alcoholics, which logically implies that the desire to drink in alcoholic goes through the GABA-B receptor (a defect of stimulation of this receptor). This raises the question of the relationship biological, and differences between the desire to drink and craving. Indeed, we note that, oddly enough [16], baclofen has no activating effect in the brain region that is typically the most involved in the craving system dopaminergic m?soaccumbens pleasure, which is the site of action of all substances that have properties addictive. This would imply that deletion of the desire to drink produced by baclofen, or indifference alcohol is the result of its action on an independent system dopamine system of pleasure. What may be a surprise in the sense that neurobiologists consider Usually this system has a position of fun central to the physiology of alcohol dependence and its treatment [11]. It was on this system appear to act as naltrexone and acamprosate. We know however, that the establishment of the dependence passes through several stages, the first involving specific m?soaccumbens the dopaminergic system, and steps consisting of following the so-called "transition addictive system, "which is the desire to obtain substances becomes largely dependent on other structures brain such as the amygdala interacts with certain regions of the medial prefrontal cortex (cingulate and orbital). Once implemented, the system would be based on addictive two biological systems, a modified system of pleasure (Especially with changes in dopamine receptors D2 in the striatum, responsible for the craving) and amygdalocortical system modified in its reactivity (And responsible for other aspects of addiction). This system is known to be involved in memory experiences of pleasure or pain and in their recall in the presence of environmental cues that have relationship with these experiences. The presence of receptors GABA-B in the amygdala leads to raise the hypothesis which would be acting at this level that baclofen exerts its therapeutic effect in alcoholism. And it is Interestingly, in this context to note that the memory is largely dependent on glutamatergic mechanisms in the amygdala, and that baclofen, acting on receptors GABA-B triggers a cascade of events leading to inhibition glutamatergic [12].
The amygdala is a region of the brain most involved in anxiety. GABA-B receptors in the nucleus basolateral amygdala has a role in controlling anxiety states. Whatever drug treatment they used (outside of baclofen), patients have stopped drinking due to treatment and willingness relapse in the year in 80% of cases (percentage comparable to that obtained with placebo). It is quite commonly accepted that anxiety, stress and stimuli packings are the most common causes of relapse [9]. On the neurobiological level, chronic intake alcohol would have a stimulating effect on the GABAergic system and inhibit glutamatergic systems, and relapses are related to an imbalance between these two systems during withdrawal of alcohol, where GABAergic systems are insufficiently challenged and where glutamatergic systems become hyperactive. The Relapses may occur long after weaning alcohol because of packaged memory responses, which involve the GABA and glutamate in the amygdala. The circumstances are exposure to a number of situations, Such an index of alcohol consumption in the environment, or distress associated with conflict, or a feeling of abandonment and loneliness, which reactivates a lack of suffering and produce a need impulsive eating. Anxiety is the center of the relapse, always closely linked to an imbalance between these two neurotransmitters. Studies also show it's more the presence of contextual clues consumption alcohol (and the need to calm the anxiety associated with these indices) that the phenomenon of craving itself is associated with relapse. In these circumstances it might be more appropriate to report the effects of baclofen in its anxiolytic effects and its ability to render indifferent to alcohol, an effect that "suppressor of craving. Anxiety could have the consequence of coercion, or concerning (Anxiety implies that it is pathologically affected by something), phenomena that would more central to relapse than craving. The effect of baclofen would produce a state of non-concernment for alcohol and its contextual cues, ie indifference vis-?-vis alcohol, anxiolytic effect of a contemporary. The question to resolve is whether the baclofen makes indifferent to alcohol because it has effects anxiolytics, or if its anxiolytic effects are independent its ability to render indifferent to alcohol. Otherwise words, to understand the mode of action of baclofen, it will be necessary to dissect the different mechanisms, or various components involved in relapse, which are craving, anxiety and the phenomena of indifference / concernment vis-?-vis alcohol.
Anxiolytic effects of baclofen were found in some forms of anxiety in humans, particularly states in post-traumatic stress [8] (we do not find a publication showing that baclofen would therapeutic effect in other forms of anxiety). Home animals, the anxiolytic effects of baclofen are contrasted and not always obvious (for review see [10]). In series of patients we treated, the anxiolytic effects baclofen were evident in many patients, but not all. Some have even reported to feel worse, more anxious and irritable, with baclofen. These patients are nevertheless a minority. The majority of patients experienced a feeling of wellbeing by baclofen, many have spoken of serenity, some showed obvious symptoms of mild euphoria (Or hypomania). In this context of mood disorders, It should also be noted that some patients experienced depressive symptoms (which is difficult to say whether they are attributable to baclofen or other elements from these Patients often have a long history of depression). What emerges from these clinical data rather mixed, is that the effects of baclofen are very different from one topic to another in terms of anxiety and mood. In But what has always been constant is the setting establishment of an indifference vis-?-vis alcohol (even if interindividual differences were observed, as described earlier in this article). So that what might to unite in the effects of baclofen is more state of indifference vis-?-vis the alcohol effect anxiolytic. The amygdala is known to be involved in anxiety, but also to create a state of nonreconnaissance, or indifference, towards making naturally afraid. A bilateral lesion of the amygdala, as in the Urbach-Wiethe disease, produces anomalies recognition of facial expressions, with non-recognition of socially frightening stimuli [1]. A state of indifference vis-?-vis the frightening stimuli can be interpreted as a form of anxiolysis. But is certainly also worth distinguishing anxiolytic and indifference. A wide field of research is opened by Baclofen: its ability to create a state of indifference vis-?-vis alcohol is it related to its action on the amygdala? What is the role of other brain regions known to be involved in anxiety and in which there are receptors GABA-B (raphe, bed nucleus of the stria terminalis, hypothalamus)? Is it true that baclofen does not act on the system fun (some experimental data tend to show that he is acting on this system)? What links between anxiolysis and indifference? What is the role of GABA-B receptors in the amygdala in this indifference? And many other issues.
Conclusion
Baclofen appears clinically as a drug extraordinarily effective in the treatment of alcoholism. Alcohologists that like it or not, he will have one day they prescribe. It is very interesting to analyze the reasons that baclofen is effective total in more than half of alcoholics, but in a good third of them the therapeutic effect of baclofen, even if real, remains incomplete. Cause analysis these "half-success" shows that all patients dependent alcohol are not for the same reasons, and that some of these reasons may be obstacles to effectiveness of baclofen. The study of biological mechanisms by which baclofen acts potentially opens a considerable number of questions, which put demonstrate the complexity and multifaceted phenomenon dependence.
References
1. Adolphs R, Tranel D, Damasio AR (1998) The human amygdala in Social Judgement. Nature 393 (6684) :470-4
2. Ameisen O (2005) Complete and Prolonged suppression of Symptoms and consequences of alcohol-dependence using HighDose baclofen: a self-case report of a physician. Alcohol Alcohol 40:147-50
3. Ameisen O (2007) Gamma-hydroxybutyrate (GHB)-deficiency in alcohol-dependence? Alcohol Alcohol 42:506
4. Ameisen O (2008) The nightcap. Deno?l, Paris
5. Ameisen O, de Beaurepaire R (2010) Remove dependency to alcohol and consumption of alcohol by baclofen High dose: One open trial. Ann Med Psychol 168:159-62
6. Caputo F, Addolorato G, Lorenzini F, et al (2003) Gammahydroxybutyric Maintaining acid versus naltrexone in alcohol abstinence: an open randomized comparative study. Drug Alcohol Depend 70:85-91
7. Chick J (2002) Naltrexone for 3 or 12 months in addition to psychosocial counseling Did Not Reduce drinking alcohol in dependence. Evid Based Ment Health 5:80
8. Drake RG, Davis LL, Cates ME, et al (2003) Baclofen Treatment for chronic posttraumatic stress disorder. Ann Pharmacother 37:1177-81
9. Everitt BJ, Robbins TW (2005) Neural systems of reinforcement for drug addiction: from actions to habits to compulsion. Nat Neurosci 8:1481-9
10. Frankowska M, Filip M, Przegalinski E (2007) Effects of GABAB receptor ligands in animal tests of depression and anxiety. Pharmacol Rep. 59:645-55
11. Heinz A, Beck A, Gr?sse SM, et al (2009) Identifying The Neural circuitry of alcohol craving and relapse vulnerability. Addict Biol 14:108-18
12. Pan BX, Dong Y, Ito W, et al (2009) Selective gating of glutamatergic excitatory inputs to neurons of amygdala by Presynaptic GABAB receptor. Neuron 61:917-29
13. Roberts DC, Andrews MM (1997) Baclofen suppression of cocaine self-administration: demonstration using a discrete trials proceedings. Physiopharmacology (Berl) 131:271-7
14. Smith CR, LaRocca NG, Giesser BS, Scheinberg LC (1991) High-dose oral baclofen: experience in patients with Multiple sclerosis. Neurology 41:1829-31
15. Stahl SM (2008) Stahl's Essential Psychopharmacology. Cambridge University Press, New York
16. Van Nieuwenhuijzen PS, McGregor IS, Hunt GE (2009) The distribution of gamma-hydroxybutyrate-induced Fos expression in rat brain: Comparison with baclofen. Neuroscience 158:441-55
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The link comes up blank. If you give me a good one I can add it:nutso: I take pride in my humility :nutso:
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Baclofen for Alcoholism and Other Addictions
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Lo0p;1102260 wrote: The link comes up blank. If you give me a good one I can add it
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Great post Terry, thanks. A lot of interesting stuff in there, some of which ties in nicely with stuff already mentions on this forum.
Sometimes/often my google translate won't work or works sporadically due to my slow internet connection. Loop, if its possible to link to the translated version, it would be preferable I think.Started Baclofen 3/9/10 Hit my switch at 250mg on 21/11/10 Present maintenance dose of 50mg : started drinking after 1 year, upped dose to 80mg and stopped: Tapered to 30mg, started 6 months of drinking, upped dose to 240mg to stop 12/7/12
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Forgive me if this has already been posted (I?ll delete if it has). These recent articles from Paris Match may be of interest.
de Beaurepaire, scandale, baclofène, alcoolisme - ParisMatch.com Interview with Dr de Beaupaire
"After 1 year, 50% drink moderately or not at all, another 30% have mostly reduced alcohol consumption and feel better. The rest still drink excessively due to a lack of motivation or an underlying psychiatric disorder." [My translation]
Olivier Ameisen, baclofène - ParisMatch.com Interview with Olivier Ameisen
If you use Chrome you can load a Google Translate extension, which allows you to translate a page at the press of a button, rather than cutting and pasting text.
The unexamined life is not worth living
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