Baclofen treatment - the next step

[Otter]

I thought I would start this thread after reading the Prescribing Guide which says that the most difficult work in baclofen treatment begins when sobriety is achieved. There two aspects to this; the first is dealing with other medical conditions which were previously masked/medicated with alcohol and may need additional pharmacological treatment, the second is the psycho-social aspect of sobering up to the train wreck of one's life.

Below is paragraph six from the guide:

"6 ? Baclofen:**Is it sufficient on its own?**Is there a place for other approaches
along with this prescription?
Baclofen is intended to eliminate craving and free patients from their addiction to alcohol. Olivier
Ameisen, having followed a large number of treatments and attended thousands of AA meetings
before taking baclofen, has written very clearly in his book (Le Dernier Verre), that baclofen had
allowed him to put into practice what he had learned during his cognitive behavioural
psychotherapy and his AA meetings. Baclofen gave him the space to reflect and to redirect his life.**
He was able to do this by applying all the strategies he had learned so far but could not use because
his cravings were too intrusive.
Many of us have been struck by the nature of consultations with patients on HD Baclofen.**Very
often, and certainly in the early stages, they are simply pharmacotherapy consultations during whichPrescribing guide for baclofen in the treatment of alcoholism*** Page: 7 of 10
Version 2**/ 03‐26‐2012*** DH**/ 08.15.2012
there is no mention of adverse side effects, doses of baclofen or variations of craving.**When the
effective dosage is reached at the cost of minimal adverse effects, many difficulties remain
particularly psycho‐social difficulties.**Baclofen, even when it is very effective, does not cure
solitude, the sheer pain of living, difficulties with interpersonal relations, or unemployment, but it
allows one to take one?s distance and face reality thus sometimes to suffer acutely as one becomes**
aware of the mess one has made of one?s life. **In this context, it is essential that the patients
continue to get support on their journeys towards their psycho‐social recovery.**And it is appropriate
at this stage to encourage and help patients to improve their psychological state, to overcome their
isolation or to find pleasure in life.**To do this, a multidisciplinary approach is essential.
In the presence of anxiety, depression, bipolar disorder, or borderline states where alcoholism is a
symptom, psychiatric treatment adapted to these conditions will be maintained. Baclofen does not
present contra‐indicated with the usual psychotropic drugs (benzodiazepines, hypnotics, SSRIs,
neuroleptics ...)
Psychotherapy, cognitive‐behavioural or not, and participation in support groups is of great help,
although this will be difficult for the group when patients have not chosen abstinence.***All this
remains to be developed.**The paradigm shift brought about by HD Baclofen treatment requires
rethinking the therapeutic methods for the whole field of alcoholism.
The value of baclofen consists in this new space that it gives patients, to rethink and reorganize their
lives.
As with any withdrawal, a period of moderate or severe depression occurs. The patient finds himself
facing his own reality which was hiding behind alcohol.***To accompany him on this personal journey
is part of the treatment plan.
The patient?s entourage, those close to the patient, must also move from an insistence on
abstinence with its attendant pressures to an encouragement to reduce consumption.***Some
prescribers will find it useful to establish systematic contact with the patient?s immediate family and
friends, even having them attend at their offices, so as to assist them with this change of attitude."

[RedThread12]

Baclofen treatment - the next step

I'll admit that I haven't thoroughly read the above, Otter, but I think I have the drift. And thank you for the thread and the topic. After all that has been said and done, I find myself landing fully in accord with Bill W's point of view . . . alcoholism is a spiritual disease. I certainly have no claim to understanding what "spiritual" is for any individual, except myself, of course One of the simplest definitions of "spiritual," that I've been working with lately, is simply this: I understand that there is something bigger than me.

That's it.

My own life seems to confirm Bill's understanding. When I was 31, I was starting to drink more and more regularly . . . during the day and some mornings. I was in an abusive relationship. My life sucked. I went to a therapist, and after a few sessions I said to her, "This is all very nice, but I can't imagine that this will work before one of us is dead."

Being multiply blessed in my life to even KNOW of another option, I undertook a very rigorous meditation training. From that time forward, I progressed in my life . . . work, relationships, personal growth . . . without alcohol or intoxicants of any kind, for more than a decade. It was hard work to put my butt on my meditation cushion every day for an hour or two, but the benefits were, and continue to be, profound. I never had to "end" that dangerous relationship. It (and he) literally just disappeared from my life. I never had to battle alcohol during that time, either. 6:00 am and the meditation cushion, along with the principals that I integrated into my life during that time, are just not compatible with alcohol.

It was many years later, after the traumatic end of my marriage, that I discovered that I am a "real" alcoholic. Of course, it's easy to see in my genetic lineage from both sides, but I actually did. not. know. because I was giving more importance to a regular "spiritual" practice than anything else. But I do not even have words to describe my gratitude for having had all of those years to cultivate skills for "living life on life's terms." I got sober the first time with some psych meds and AA. I got sober the last time with baclofen. Within 10 days of taking my first 10 mg, I was not only finished with drinking alcoholically, I was back to work, to life, to full-on, responsibly facing life . . . and even enjoying it!!!

So I guess, in my own way, I'm just agreeing with you. There's not drinking . . . and then there's not drinking. If there are no skills nor a foundation beneath the "not drinker," I can certainly understand that not drinking presents a whole new set of challenges. And I, personally - really, just IMHO, and IME (experience), think there are immense dimensions available for not drinkers in the realm of spiritual growth. Whatever THAT is for any one of us. AND, I do have downloads of a seminar held at Mayo Clinic (bfd medical institute here in the U.S.) during which multiple physicians, scientists, and Buddhist meditation practitioners presented the results of scientific studies ranging from fMRI's showing that meditation changes the structure of the brain toward the centers that are associated with contentment and well-being; to reduced inflammatory reaction in the immune system - it appears that inflammation may be the primary indicator of all diseases.

I'm not suggesting that everyone meditate . . . although just typing that makes me smile . . . but I do have an opinion that those of us who keep on seeking "something," unsuccessfully, with alcohol, might consider the possibility that not drinking is just our own, personal, doorway. I also think it's no coincidence that the evil drink is known as "spirits."

[StuckinLA]

Baclofen treatment - the next step

I shouldn't be weighing in on this, at least and definitely not right now, as I'm a little foggy and panicky and on my way over to my own thread. But caution to the wind , here goes.

I truly dislike, well, a lot of things, but the "spiritual disease" is for sure one of those things. Because we have an imbalance in our brains. Genetic? Maybe/probably. But many of us for sure grew up seeing a preview of what we would become. How on earth could we expect to have any idea of what "normal" is? For me as a child, normal looked like bringing 2 bottles of wine and a 1.75L of gin home after work every night. Taking them down to the basement and sitting on a ratty old couch in a small room, what used to be my dad's workshop, and drinking and smoking all night long, until Mom could, or could not, make it back up the stairs.

Is it much of a surprise that my drinking patterns became similar? Finding an early happy hour with a select few friends, then a later happy hour or evening out with a larger group, then grabbing a bottle from the liquor store on my way home. Is this a spiritual disease? Or the fact that I needed to be at a certain level of intoxication every night?

And it's also so much more than that. The fact that "happy hour" is ubiquitous. Every one I know goes regularly, though granted not daily. Look at our culture. Personally, I'm rather disgusted by American pop music, always but particularly right now. We have these club anthems with lyrics like "I brush my teeth with a bottle of Jack," and that's a woman singing.

With all this messaging, not only does it f-ck with us as diseased people, but if f-cks with the entire cultural perception of what AL is or should be. And of course we all want to be "normal," or even those of us who take great pride in not fitting in with "normal" are still basing whatever drop-out mentality we have against the perception of normal.

This is a cultural disease that kills us disproportionately, because our brain chemistry isn't like everyone else's. And because God forbid the culture step back and look at itself, and its own problems--which, let's be very clear, is extremely profitable for select people--well, instead of thinking the culture is sick, the problems get pawned off on us and our weak spiritual malady. [EDIT to continue this thought: it's like DUIs. Full disclosure, I have 2 and the last one is total BS, but anyway I clearly have an investment in this example. So, driving drunk really is inexcusable, and extremely dangerous, selfish, irresponsible, etc. But what do we, as a society, do about it? We shame and punish those who are caught. But my real question is this: why do bars have parking lots? Defending my second DUI, the prosecutor made a huge deal about the fact that I was leaving a strip club at 4 AM, like I'm a terrible degenerate. Why is the club allowed to serve AL and have a parking lot, where people keep their cars? Why is the club allowed to be open until 4 AM? Why is it allowed to exist in the 1st place, if it's so morally reprehensible? Because no one in the local government is complaining about spending the tax revenue. No one's complaining about having lower property taxes, as they have the club to contribute to the local gov't budget. And when there is an issue... well, they can point to me and what's wrong with me for being there.]

Can we blame ourselves any more? And worry not! Whether we get white-knuckle sober and suffer, or find meditation or bac or whatever and get sober in healthy/happy/fulfilled ways, the end result that everyone will see is the same: we, the one's with the problem, are no longer drinking. The culture's safe, because we're the ones with the problem. Everybody else is all good.

Hopefully all this reads in a way that my sarcasm, and the direction of my... anger, comes across appropriately. OK, off to my thread, but I look forward to continuing this discussion if anybody still wants to talk to this hysteric. :H

[RedThread12]

Baclofen treatment - the next step

I'm completely down with you, Stuckin'la!

I'll stand there on top of that soap box with you. My whole life and my profession are, in a way, my own efforts find a way to be "in it, but not of it." That includes several arrests in my younger years, when actively organizing and protesting around certain issues in our society/culture that I wanted to change. It worked once. Kind of. Other than that, I AM left with the need to find tools that enrich my life ENOUGH that it is actually that . . . a rich life. And the only way I see to do that, at least for myself, is indeed through developing new and different dimensions within myself. I call that spiritual growth. It could be called personal growth. It could not be called anything, but if one is sober and miserable, it may still be necessary.

I don't know who said it, but even in my family as I was growing up, the phrase was, and continues to be: "To be sane in an insane world is to be insane." Lately, whenever anyone asks me how I am, I reply, "I'm as crazy as a loon. Aren't you?" Feels much more honest and satisfying than the all of the cultural pretense. Can stop a conversation dead, though. :H:H

[Otter]

Baclofen treatment - the next step

I found this on HBO. Sort of sums up my view on why it is important to take this issue beyond this forum:HBO: Addiction: Stigma & Discrimination: Coping With the Stigma of Addiction

Stigma & Discrimination :
Coping With the Stigma of Addiction

by David L. Rosenbloom, Ph.D.


Stigma is one of the meanest and most difficult aspects of addiction because it makes it harder for individuals and families to deal with their problems and get the help they need. Society imposes stigma - and its damage - on addicts and their families because many of us still believe that addiction is a character flaw or weakness that probably can't be cured. The stigma against people with addictions is so deeply rooted that it continues even in the face of the scientific evidence that addiction is a treatable disease and even when we know people in our families and communities living wonderful lives in long-term recovery.
Stigma is the reason there is so much social and legal discrimination against people with addictions. It explains why addicts and their families hide the disease. Discrimination always hurts stigmatized groups because they are excluded from the rules that apply to "normal" people. So insurance companies get away with refusing to pay for alcohol or drug treatment, or with charging higher deductibles and co-pays than for treating any other disease. People who need the help are often afraid to speak up. State and federal agencies feel safe in denying food stamps and baby formula to mothers who have past drug convictions because mothers who used drugs have few supporters in the political system and face lots of people who think they must be "bad mothers." Though studies have found that helping employees to recover is more cost-effective than termination, some employers believe that firing an employee with a drinking problem is a lot easier than providing rehabilitation. A firestorm of protest would erupt if employers treated workers with cancer or heart disease the same way.
People who are victims of stigma internalize the hate it carries, transforming it to shame and hiding from its effects. Too often, people with alcohol and drug problems and their families begin to accept the ideas that addiction is their own fault and that maybe they are too weak to do anything about it. In many ways, hiding an addiction problem is the rational thing to do because seeking help can mean losing a job and medical insurance, or even losing your child when a social service agency declares you an unfit parent because you have an alcohol or drug problem.
The stress of hiding often causes other medical and social problems for the individuals and their families. This is especially true when an adolescent has an alcohol or drug problem. Fear often prompts kids to conceal the problem from parents. Then, when parents find out, stigma makes them feel guilty and somehow negligent. Illness and family dysfunction explode. When that happens, parents find it even harder to fight for the care and resources their child urgently needs from a social and medical system that blames the family and the child.

FIVE THINGS YOU CAN DO TO FIGHT STIGMA
We may not be able to change overnight the way society feels about people with alcohol and drug problems, but we can end the legal discrimination caused by stigma
1. Demand equal medical insurance coverage for alcohol and drug treatment.
2. Tell your elected representatives to stop punishing babies for the past problems of their mothers.
3. Tell your state lawmakers to remove the legal barriers that prevent people recovering from addictions from getting jobs.
4. Give more than lip service to the reality that addiction is a disease, not a character weakness.
5. Be an advocate for an individual or family with an addiction problem.