Baclofen Efficacy Reversal

[WitsEnd]

Baclofen Efficacy Reversal

I too went on citalopram when I was titrating down to 80 mg baclofen (I experienced a huge return of anxiety at this dose). So citalopram at 20 mg did the trick and was brilliant at controlling anxiety BUT I have experienced a return of strong alcohol craving and have now gone down to 10mg citalopram daily ... don't know it this will work yet, but feel less craving for alcohol again. But watch out anyone out there: citalopram in my experience definitely reduces the efficacy of baclofen.

[JWHIII]

Baclofen Efficacy Reversal

Wow, it's been a year since I've been here... time sure does fly when one lives in a fog.

Though I continued counseling sessions on a bi-weekly basis and continued with 120 mg. of Baclofen daily, the cravings for alcohol resumed and persisted for several months after removing citalopram from the mix. I was completely at a loss as to why Baclofen had quit working it's miracle.

I had contacted Dr. A as well as Dr. B (whom I had obtained my first genuine script) in desperation. However, neither doctor ever replied. The psychiatrist I was obtaining a script from here locally, clearly knew very little about Baclofen in it's use as a craving suppressant.

It may just be that there are several other factors which must be considered when utilizing any medication. Circumstances are diverse with each and every one of us, and how any med works with an individual may well be assessed on such factors as past, as well as present circumstances.

I'm not trying to raise any hackles here, nor to offend anyone in any way... but it took me a while to figure out why Baclofen quit working for me. I know this group is founded on the term "problem drinker" as opposed to "alcoholic". But as much as I loathe the term, I must be an alcoholic.

I've had two stays in residential treatment when I was younger (18 and 25)... both of which proved to be a complete waste of time and money as the pre-existing issues that led to my alcoholism were never dealt with. 12 step ideology was crammed down my throat while all the other issues were left ignored. Now, how was I ever to stand a chance at "recovery"? I was doomed to failure!

I must admit that I now see how this can be explained as a "three-fold disease" of mind (negative thoughts), spirit (the emotions that follow) and body (the physical cravings that result from the misery thereafter, in an attempt to relieve the crippling discomfort and dis-ease of the current state).

I ended up firing my therapist and prescribing psychiatrist, and quit taking all meds (as they weren't working for me anymore). Then, I dived into a bottle of vodka for almost a year. I had only taken to vodka as beer didn't do it for me anymore. But then attendance problems at work arose, and I abandoned liquor for cheap, high ABV beer (12%). At this point, I'm at a loss.

I've started seeing a new counselor who utilizes EMDR therapy... had three sessions with her, but as these things go, time moves slow. It takes time to get acquainted with someone and the life events that have led up to where they are now. I've cut myself off from society and have been a recluse for over ten years now. This is the only format that I feel comfortable socializing in.

Things had gotten so bad with vodka use, that I started looking into residential treatment centers that specialized in duo-diagnosis (co-occurring disorders... i.e., social anxiety, depression, etc.). But even with insurance, I was looking at $4,000 out of pocket for something with no guarantee.

I agreed to an alcohol evaluation, and it was suggested that I undergo intensive outpatient treatment. I find this notion almost laughable, as I drink excessively on a daily basis. Plus, my work schedule (Wednesday-Saturday, 5:30 AM-4 PM) will simply not allow for such a commitment.

It seems as though I've tried everything, but I have yet to give up hope. I've tried hypnosis for suppression of anxiety/panic, but it did nothing to relieve these symptoms. Clearly, the root of my anxiety and depression must be surfaced and dealt with before I'll ever find relief from what ails me. I'm hoping to find this through EMDR. But if not, I guess I'll try meds again.

Anyway, I originally returned here to reply to tiptronic's bump up of this thread:

A bump and a request for further information, if anyone has it.

I'm talking to someone who is seriously considering bac, but has been taking Celexa for a long period. When in contact with Dr. L, he was told about possible interactions between bac & certain ADs. The indication was very much the same as we heard here - that it can potentially reduce the efficacy of bac.

One would obviously want to "set the scene" for a successful bac titration, so if it means tapering off Celexa 1st, there will be some planning involved.
This was the only pertinent information I managed to find...

Interactions between your selected drugs
baclofen ↔ citalopram
Applies to:baclofen and citalopram

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.
Baclofen and citalopram Drug Interactions - Drugs.com


From the exclusion criteria in a clinical trial study…

4. Concurrent use of any psychotropic medication including antidepressants, mood stabilizers, antipsychotics, anxiolytics, stimulants, or hypnotics. However, subjects who have been on stable doses of the antidepressants fluoxetine, sertraline, paroxetine, citalopram, ecitalapram, trazodone or venlafaxine for two months will be eligible. Subjects who have been taking benzodiazepines for alcohol detoxification will be required to have a washout period of at least five half-lives (approximately 5 days) from those medications before being randomized.

Efficacy and Tolerability of Baclofen for Alcohol Dependence - Full Text View - ClinicalTrials.gov

This clinical trial study seems to suggest that the introduction of Baclofen with concurrent use of Citalopram (Celexa) is not only deemed acceptable, but as a safe combination (save, the above interactions). Evidently, there hasn't been much research on the effectiveness of Baclofen in conjunction with other medications (such as SSRI's). But I'm all eyes with new information!

For future reference, here's a drugs interaction checker:

Drug Interactions

Hope you're all doing well,
John

[bleep]

Baclofen Efficacy Reversal

Hi John,

I'm unfamiliar with your story, but what is preventing you from trying baclofen again? As I understand it, you suddenly found it to be ineffective? Did you consider upping your dose at the time? Sorry if these are questions you have dealt with already.

[JWHIII]

Baclofen Efficacy Reversal

Hi bleep,

As I mentioned in closing, I've considered how meds may be incorporated into a treatment plan once again. As I've been seeing this new counselor with the intent of pursuing EMDR and possibly even hypnotherapy, meds have been a consideration as well (though not mentioned openly yet).

Out of all the meds I've tried, only two provided any positive results... Baclofen for craving suppression, and Citalopram for depression. I have yet to find a medication that has relieved my anxiety besides alcohol. But then, alcohol makes my anxiety (and depression) worse in it's absense.

If I were to agree to intensive outpatient treatment, one requirement would be total and complete abstinance from alcohol. Better said, the reason why I find this laughable is due to the fact that there's no way I'd ever be able to stop drinking again without Baclofen. But as my track record has shown me, Baclofen alone will most likely not be sufficient in allowing me to stop drinking.

The first two times I used Baclofen, I was purchasing it online without a prescription. Both times, it worked wonders for me... it gave me hope for a life without perpetual drunkeness. But as things go with customs, both times my orders were seized at about two months in, forcing me to discontinue Baclofen therapy abruptly. This is when I pursued a legal script from a doctor in Michigan.

But no sooner had I seen this doctor and had obtained the script when I was informed that he didn't feel comfortable with the long distance phone appointments. This was due to other issues I was having at the time (e.g. severe anxiety which produced an uncontrollable twitchy, shaking head).

This led me to pursue a local psychiatrist who would be willing to continue prescribing me Baclofen. I found it to be much more difficult at that point, to remove alcohol from my daily life. Thus, the effectiveness of Baclofen was a bit harder to guage. I actually had to make an effort that time around. It eventually worked it's magic, but I found myself feeling very empty and depressed.

But at about three months into Baclofen therapy (at my daily maintenance dose of 120 mg.), I started drinking again. It began as one or two beers on a Saturday night while at home alone, but quickly escalated into the extreme pattern I had known previously. This continued for several months afterwards despite maintaining my maintenance dose of 120 mg.

I tried increasing the dose back up to my ceiling "switch" dose last August to no avail. By that point, I was already in a mindset of pure misery. Needless to say, it didn't do any good.

For all those months, I did not divulge this information to my therapist, nor my psychiatrist as I was afraid they would remove Baclofen from the itinerary. But finally I came out with my daily drinking and tapered my dose of Baclofen down and eventually quit it's ingestion. I couldn't justify continuing to purchase it when it clearly wasn't working for me anymore. I cut my losses and gave in.

I still see Baclofen in my future (provided whomever I'm working with will agree to administering it). I truly don't see how I'll be able to ever stop again without it. There's just other deep-seated issues that must be dealt with. As I've learned, someone with a drinking problem cannot be force fed a program based on the 12 steps with any success without having every issue addressed.

They must treat the whole person, not just the symptoms. This is where much of my disdain for A.A. developed in the first place! I was 19 when I first entered a treatment center (with a six month stay at a halfway house after that). In both scenarios I encountered injustice based on the circumstances present at the time. For one, I was young. Those much older than me immediately developed their stigmas based on their pre-conceived notions as to who I was, based on the circumstances.

They saw me as a younger version of themselves when they never even knew me! Needless to say, I was treated as such for the entire duration. Once my year of probation was up, I embraced the freedom I found in absence of their suppression. To this day, I resent any 12 step organization.

Now a days, I'm 40 and my future is bleak. I live alone without friends or a significant other. I've lived right next door to the main A.A. clubhouse here in town for the last ten years and refuse to go over there for the reasons I've stated prior. In a nutshell, my day to day life is pure misery.

Baclofen is still very much a consideration, based upon the results I had with it prior. But there's clearly more involved here than just an overwhelming craving for alcohol. I have a lot of hurt, pain, anger and frustration inside, and Baclofen can only deal with the physiological (biological) aspects of this condition, not the mental (intellectual) or emotional (spiritual) aspects.

The entire person must be treated... not just the self destructive behavior that results from their chemical dependancy... that's only one aspect. I hope this makes sense coming from my fog.

~John

[ik1966]

Baclofen Efficacy Reversal

i found there is alink in sugarcravings ad alcoholcravings me too became an alcoholic after starting seroxat found on internet a big peace about it cannot put it on mwo it's on
www.nomorepanic.co.uk whe you type alcoholcravig and seroxat you will find it.....
or look o the baclofen forum...

[tiptronic_ct]

Baclofen Efficacy Reversal

John,

I'm sorry to hear that things haven't worked out for you.

No advice, really: just wishing you strength.

[Greg]

Baclofen Efficacy Reversal

Hi John, I've only just read some of this story, so apologies if I have missed important aspects, but what about bupropion (Wellbutrin) and baclofen as a new strategy against depression and drinking? Some say that bupropion is helpful with depression that hasn't responded to the usual serotonin-influencing antidepressants, including in people with alcohol dependence. The fact that it works very differently to SSRIs and most others could make it worth a go.

As for serotonin and increased cravings, I have found that L-tryptophan and 5-HTP both kick off intense cravings (for both alcohol and other drugs) in my particular case, but I have no idea why. I thought I was imagining it, since I didn't think it was possible. I have often thought it was due to serotonin levels being up and down a lot, due to not taking these supplements to a strict schedule, but that wouldn't seem to apply to anyone taking an SSRI regularly (and citalopram has a long half-life from memory).

People who feel rapid depression relief from alcohol, assuming it's not only during withdrawals, may respond a bit differently to it than most, since it's not widely acclaimed as a depression reliever by most people (some say it worsens depression). I had noticed such a quick and surefire relief from depression when I drank, even 20 years ago. I have not experienced similar effects from any antidepressant drugs or from baclofen either, but I have not yet tried bupropion. A theoretical reason why this happens could be that alcohol influences opioid receptors and endorphins, and this in turn is said to influence dopamine in the brain, and these effects are theorised to explain some peoples' greater attraction to alcohol.

As for alternative ways of achieving what alcohol does, opiates aren't really used as antidepressants currently, but bupropion does influence dopamine, without the addictiveness of opiates or stimulant drugs. Regarding therapy for deep seated issues, I'd say something more than 12 step oriented programs would be required.

I wish you all the best.

[bleep]

Baclofen Efficacy Reversal

A Dr Levin in Chicago is happy to prescribe baclofen over the phone, and is not afraid of high doses. Unfortunately I don't have his contact details, but I'm sure someone will PM them to you shortly. Let me know if that isn't the case, and I'll track them down for you. That should solve you baclofen side of the issue.

As regards your other issues, I completely agree that removing drink from the equation is only half the battle. I share your disdain for AA and the 12 steps, and don't believe it to be effective. How very unfortunate that the one AD that has any effect seems to block the effectiveness of baclofen. Perhaps discussions with Dr Levin will be able to shed some light on this issue, and he may be able to suggest an alternative?

At this point, I can only wish you the best, and hope you are able to find a solution.

[Seethepony]

Baclofen Efficacy Reversal

hi John, I remember when I was up to my nuts in nicotine and booze I used to imagine that by moving to another country I might magically leave my addictions behind, like stray socks. Then I would remind myself that the problem - me - would always be there, wherever I went...

Having said that, your general down-in-the-dumpsiness does sound like you could benefit simply from a change of scene. You seem to suffer from inertia of the soul. Why don't you just sell everything, move somewhere new, make a new life while making another assault on the booze with baclofen? The way you describe things right now sounds like you have nothing to lose.

I'm sorry if I'm making a naive suggestion and there are probably a million reasons such a move is impossible - or appears to be impossible - but maybe you should think about it nonetheless. Jump on a plane, tame camels in Alice Springs or something whacky. At least you'll get a story out of it!

[LadyLush]

Baclofen Efficacy Reversal

STP,
You must be very, very, short. A lot of nicotine in the US!

JW,
I am going to go back and re-read your thread. I personally have had a problem with Wellbutrin and Bac. Heart fluctuations and racing. They say that the Well speeds you up; the last thing I want is anxiety. I am cool on Bac alone when I take it when I am supposed to. I HAVE to monitor that or I get out of whack. It alone works if I stay in tune with doses.


LL

[JWHIII]

Baclofen Efficacy Reversal

Hi folks,

I know it's been a couple of months (though it seems longer), but I haven't been receiving topic reply notifications for whatever reason. Anyway, the therapist I've been seeing referred me to a doctor who, unlike others I've seen in the past, has been very open, honest, personable, compassionate, and knowledgeable. From our first meeting, armed with my history, she was able to make the assessment that Seroquel would benefit me in regards to my severe social anxiety and insomnia.

I started out with extended release Seroquel. And though this proved to be very beneficial in alleviating my head twitch/shake, it made me feel very tired and dizzy throughout the day. After a couple of weeks, I switched over to immediate release Seroquel, and this works brilliantly for me.

As I informed her that I had already tried Topiramate and Naltrexone with no benefits to report, she also prescribed Camprel. I started out gradually and am up to the maximum dosage, but have found no benefit in relation to craving reduction. Last night I did some research online and found that Acamprosate is not intended to help one stop drinking. In fact, I found that it serves no purpose until one has already quit drinking. So now I'm wondering why she prescribed it to me.

I've told her about the positive results I've had with Baclofen as a craving suppressant, but she evidently knows very little about it (if anything at all). The only reason I can say this, is due to the fact that when I've brought it up, she doesn't offer any dialogue concerning the topic. Usually, the subject moves elsewhere while Baclofen is dropped. But that's OK for now. I'm just grateful to have finally found something that actually alleviates my crippling anxiety in social situations.

I see her again in a little over a week. And as Dr. A himself instructed me a few years ago via e-mail, I'm going to give her a copy of his book in hopes that she will read it and reconsider. After seeing a few different doctors over the years, I know she is "the one". But if after all else, she is not willing to prescribe Baclofen to me, I will retain her services while seeking out another who is willing to write the script, as I know from experience that Baclofen is my primary hope in ever quitting the suds again.

Her goal is to get me stabilised enough to consult in a support group such as A.A. The main problem with this plan, is that I won't be able to stop as long as I have the overwhelming craving to drink. So one major trigger for my drinking has been effectively dealt with... that being extreme anxiety. Depression hasn't been nearly as much an issue for me as it had been. But then, Winter is just around the corner, LOL. But the usual cycle of anxiety and then depression has seemed to cease.

Anyway, just an update. Now to address your replies...

[JWHIII]

Baclofen Efficacy Reversal

tiptronic_ct:

John,

I'm sorry to hear that things haven't worked out for you.

No advice, really: just wishing you strength.
Thanks tiptronic, I appreciate your encouragement more than you may know.

Greg:

Hi John, I've only just read some of this story, so apologies if I have missed important aspects, but what about bupropion (Wellbutrin) and baclofen as a new strategy against depression and drinking? Some say that bupropion is helpful with depression that hasn't responded to the usual serotonin-influencing antidepressants, including in people with alcohol dependence. The fact that it works very differently to SSRIs and most others could make it worth a go.

As for alternative ways of achieving what alcohol does, opiates aren't really used as antidepressants currently, but bupropion does influence dopamine, without the addictiveness of opiates or stimulant drugs. Regarding therapy for deep seated issues, I'd say something more than 12 step oriented programs would be required.

I wish you all the best.

Thanks for your positive wishes Greg. I was taking Wellbutron back in '99 as part of a smoking cessation plan, but was also drinking daily while taking it (a definite no-no!). This is when I first began having panic attacks. What was worse, was that I had no idea what was happening to me. I wasn't familiar with what anxiety or panic was, so I was very confused at that time. My heart would flutter, my breathing became shallow, and I would feel frozen as a deer in headlights. All the while, I wanted to run out of the room.

I have to wonder if this isn't what started the downhill spiral for me. Granted, I had used a lot of hard drugs when I was younger. But this was a defining period for me in regards to anxiety and panic. It could be that the daily combination of Wellbutron, alcohol and pot did some damage to neurological receptors. But there's no real way of ever knowing.

Bleep:

A Dr Levin in Chicago is happy to prescribe baclofen over the phone, and is not afraid of high doses. Unfortunately I don't have his contact details, but I'm sure someone will PM them to you shortly. Let me know if that isn't the case, and I'll track them down for you. That should solve you baclofen side of the issue.

As regards your other issues, I completely agree that removing drink from the equation is only half the battle. I share your disdain for AA and the 12 steps, and don't believe it to be effective. How very unfortunate that the one AD that has any effect seems to block the effectiveness of baclofen. Perhaps discussions with Dr Levin will be able to shed some light on this issue, and he may be able to suggest an alternative?

At this point, I can only wish you the best, and hope you are able to find a solution.

Thanks bleep, I appreciate your warm wishes of encouragement.

I was so grateful when Dr. B was willing to see me and prescribe Baclofen to me. I was just in such a bad way by that point that he didn't feel comfortable in continuing the long distance Doctor/patient relationship. If I had only been on Seroquel at that time, a big part of the equation would've been resolved. To this day, I regret having broken Dr. B's confidence in effectively treating me, as he's a very compassionate individual.

I'll do some searches into Dr. L with the limited information provided. Perhaps I'll contact you privately. I have yet to check my inbox here, so maybe this info has already been provided me. Time will tell on that one, LOL. And yes, I've learned over the past few years that ceasing to drink is only the beginning in my case. It took me quite a while to figure that out. To be short, I have a lot of problems that stem from the hardships I've encountered throughout my life. That's where having a support group of some kind will be absolutely necessary for long term sobriety. But I'll need to learn how to trust again.

Seethepony:

hi John, I remember when I was up to my nuts in nicotine and booze I used to imagine that by moving to another country I might magically leave my addictions behind, like stray socks. Then I would remind myself that the problem - me - would always be there, wherever I went...

Having said that, your general down-in-the-dumpsiness does sound like you could benefit simply from a change of scene. You seem to suffer from inertia of the soul. Why don't you just sell everything, move somewhere new, make a new life while making another assault on the booze with baclofen? The way you describe things right now sounds like you have nothing to lose.

I'm sorry if I'm making a naive suggestion and there are probably a million reasons such a move is impossible - or appears to be impossible - but maybe you should think about it nonetheless. Jump on a plane, tame camels in Alice Springs or something whacky. At least you'll get a story out of it!
Hi STP,

This has been suggested by probably every therapist I've seen over the last 3-4 years now. The reason being, my job can be very stressful at times, and the schedule I must keep in itself, only adds to this stress. My motto in life for the most part, has always been "don't rock the boat". In other words, I'm not much into risk taking. There's so much uncertainty involved with making big life changes such as moving or taking on a new position. I've been with the same company for the last 16 years now, and so moving onto another company is almost terrifying to me. Especially in these uncertain times.

"Interia of the Soul"... I've never heard it put quite like this before, but I like it nontheless. Yeah, I feel "stuck" in my lot in this life, and would like to somehow break free from it all. But I'm not qualified to do anything else without a degree in something. I'd like to pursue creative or even technical writing as I think this would come naturally to me. But this cannot be attained without the appropriate degree. And as long as I must keep the schedule appointed me, there's no time (let alone energy) to take the classes.

On the other hand, I must continue working in order to pay for such classes. So it's sort've a catch 22... thus, why I feel stuck in my lot. Painted in a corner, living each day without hope of anything better to come, awaiting the end of my daily misery. But due to extreme attendance issues I've been having where I work now, I've been looking into other positions. I found one today online and spoke with a fellow I know who works there. Change is surely part of the answer, but to what extent is my issue.

Lady Lush:

STP,
You must be very, very, short. A lot of nicotine in the US!

I smoked a pack or more a day for 17 years, then went to dipping. I stand 6' 3 1/2".

JW,
I am going to go back and re-read your thread. I personally have had a problem with Wellbutrin and Bac. Heart fluctuations and racing. They say that the Well speeds you up; the last thing I want is anxiety. I am cool on Bac alone when I take it when I am supposed to. I HAVE to monitor that or I get out of whack. It alone works if I stay in tune with doses.


LL

Yes LL,

The whole point of an anti-depressant is to "pick you up". So naturally, if anxiety is also in the midst, this is definitely going to cause problems. At my lowest, my "then" doctor prescribed Effexor. I took it only one day as it made me feel like I had taken a handfull of white crosses. Once I made it home from work, I looked it up online and learned that it was basically speed! No wonder I was so anxious all day! That's when I fired my psychiatrist - ignorant b@$+@&>!!!

I've already went into my experience with Wellbutron, so nothing much more to add other than I'll never touch it again so long as I have say so in it.

Thank you all for your helpful and encouraging replies. Though I'm still searching for full relief, I haven't given up. I know the right combination is out there waiting.

Your friend,
John

[SlipperyPete]

Baclofen Efficacy Reversal

John, good to hear things are going better for you. I had been waiting for your update. I used to take Risperdal for anxiety, which is similar to Seroquel, and have good memories of it. I would imagine either of those combined with baclofen would make anyone anxiety-free, probably because they'd be comatose the whole time :H

[Otter]

Baclofen Efficacy Reversal

I think Baclofen should sort out your anxiety on its own if you take enough without gaps.

I started taking 10 mg a day for mild anxiety, shakes etc., not for drinking but through periods of intense stress I got up to about 160 mg a day. I found I had errant thoughts so I took propranolol which got rid of them. I am, I hope, coming out the other side of the stress I got myself into and am weaning myself off Baclofen. What I find is that it is very tricky and that when I go without for a significant period I get serious anxiety.

It seems to me that the anxiety comes from not taking it regularly or evenly. My guess is that if you take it in large individual doses you get a relaxation of anxiety and then a return as you come down from the spike in the the dosage. The key to this is to keep a high enough dose in your system at all times day and night to get rid of the anxiety.

It is also, now, my view that if Baclofen replaces a missing chemical in the brain so that one is no longer "alcoholic", then the idea of having to maintain abstinence is not necessary, other than to prove a point, or if one is ok with the idea of total abstinence. I think for a lot of people the change in lifestyle resulting from not drinking at all, or the loss of the other feelings associated with drinking probably leaves a big hole in one's life which nothing else will fill.

There is a "camp" emerging within those using Baclofen which aims at leading a "normal" life in which moderate drinking is permissible and not a problem.

I stopped drinking years ago and have demonized it for years now. I started drinking a bit recently, maybe a bottle in total over a month or so, nothing serious. I liked the taste and it chilled me out. I did not feel any need to continue drinking although sometimes I remember with some fondness, the days when I drank half a bottle of wine every evening with my dinner. I don't feel like going back to that because it was something I did to deal with stress, which I don't need to do now I have Baclofen.

The "experiment" of drinking again has allowed me to stop demonizing alcohol which is another step, I think, in the whole recovery process. Once you accept that alcohol is not the "cause" of alcoholism, but just a response to an anxiety condition, which becomes toxic if used to excess, then you may be able to adjust your use of it, if you cannot give it up, to a point where you feel comfortable.

The starting point, I still believe, is to get the dosage and frequency of Baclofen right and that is the big issue in Baclofen treatment now. Note what Drs. Chick and Nutt say about the need for research in this area. J Psychopharmacol. 2011 Jul 8. [Epub ahead of print]
Substitution therapy for alcoholism: time for a reappraisal?
Chick J, Nutt D.
Source
Health Sciences, Queen Margaret University, Edinburgh, UK.
Abstract
A number of compounds already in use as medications for various indications substitute for ethanol at clinically relevant brain pathways, in particular, at gamma-aminobutyric acid (GABA) receptors. Nevertheless, although substitute medications have been recognized for heroin and tobacco dependence, patients with alcohol dependence are rarely offered an analogous approach. Benzodiazepines may have paradoxical effects, and abuse and dependence are known.

Baclofen (GABA(B) agonist) has not been associated with dependence or misuse and has been effective in several trials in preventing relapse, although research is required to establish the optimal dosing regimen....

For a condition where existing therapies are only effective in a proportion of patients, and which has high morbidity and mortality, the time now seems right for reappraising the use of substitute prescribing for alcohol dependence.

Substitution therapy for alcoholism: time for a re... [J Psychopharmacol. 2011] - PubMed result

[JWHIII]

Baclofen Efficacy Reversal

Hi again all,

As though I wasn't under enough stress already, my situation at work had changed in more ways than one (to my utmost misery). When it became clear that my situation would prevent further progress, the doctor I spoke so fondly of prior; cut me loose quite uncompassionately.

She (like others during that time) was pushing me to go through residential treatment. But as it would've been $4,000 out of pocket before my insurance would pick up the rest, I couldn't justify such expense with no guarantee. Besides which, I've been through treatment twice along with 12 step programs three times with no benefit whatsoever.

I explained that given my experience, that wouldn't be a cost effective option. To which she eventually told me that alcoholics think they know everything because all they think about is themselves. Then she told me to call her to let her know what I decided. I was furious, as she filed me into a category based on my drinking problem, in conjunction with her perception of an average alcoholic... when she didn't even know me! This is exactly why I have resentments towards the organization of AA to this day.

I was 18 the first time I went through treatment, and lived in a halfway house for 6 months afterward. All the older folks had their preconceived notions about who I was based on my age and also themselves. But I was nothing like them. Like this doctor, they sized me up based on the circumstances I was in rather than who I really was.

Anyway, I had been introduced to Dr. L shortly prior to this, and had already begun titration of Baclofen. He informed me that Dr. A threw out the previous dosing regimen for an entirely new protocol (which retains the switch dose indefinitely)...

First day: 5 mg

Next 3 days: 5 mg/AM 5 mg/PM

Second week: 10 mg/10 mg/10 mg

Third week: 20 mg/10 mg/20 mg

Fourth week: 25 mg/20 mg/25 mg

...and so on. Of course, this more gradual method is to ensure minimal to no side effects (which seemed to be the case for me this fourth time around). But given the state I was in, I followed this incremental method with the exception of titration every fourth day as opposed to every seventh. It was otherwise too gradual and would've taken too long.

There have been many besides myself, who also found an unpleasant ineffectiveness of Baclofen as a craving suppressant at tapered dosages (hence, this topic thread). This is why Dr. A now feels that it's detrimental for the switch dose to be maintained indefinitely.

My three previous trials with Baclofen all proved my switch dose to be 170-190 mg. So I was deeply concerned when I was preparing to move up from 190 mg to 210 mg without having yet found indifference. Dr. L ensured me not to worry... that there is no constant in regards to a switch dose. I finally found blessed indifference again at 250 mg.

I presume this may have something to do with how folks in AA refer to alcoholism as a “progressive” disease. Meaning, it picks up where it's left off (regardless of how long it's left in remission). I don't want to shoot for a fifth titration (which could result in an even higher dose), so I'll maintain my new switch dose of 250 mg daily from here on out.

As I originally reported, Baclofen was no longer effective for indifference at my tapered maintenance dose of 120 mg daily. I thought the miracle of this “magic pill” wouldn't work for me anymore, so it was relieving to learn that I wasn't the only one this had happened to. I've been completely indifferent and drink-free since 11/13... unheard of just a couple months ago. Additionally, my anxiety symptoms and panic attacks are all but a memory.

Under stress albeit, self induced (i.e. cramming too many errands/priorities in too little time); I've actually thought about drinking a couple of times. Both times were manageable (while succumbing to drink was avoided). So per suggestion, I keep a couple .250 mg tabs of Xanax with me at all times (but have only resorted to it once).

Anyway, I just wanted to update this topic and to touch base. I plan to reply to another topic thread in this sub-forum soon... but want to have all my i's dotted and t's crossed before I do. My gratitude to all who have offered their kind and generous input.

Thanks,
John