Baclofen: a 2-year observational study of 100 patients just published

[DonQuixote]

Hi @all,

I have good news. A few days ago, an article in ?Frontiers in Psychiatry? has been published:?Suppression of alcohol dependence using baclofen: a 2-year observational study of 100 patients?

Results: While all patients were rated ?at high risk? at baseline, approximately half of them were rated ?at low risk? at 3, 6, 12, and 24 months. The sum of patients who were at ?low risk? and at ?moderate risk? (improved patients) was 84% at 3 months, 70% at 6 months, 63% at 1 year, and 62% at 2 years. The constancy of improvement over the 2-years was remarkable. The average maximal dose of baclofen taken was 147 mg/day. Ninety-two percentage of patients reported that they experienced the craving-suppressing effect of baclofen. Significant relationships were found between the amount in grams of alcohol taken before treatment and the maximal dose of baclofen required, and between the existence of a mental disorder and a lesser effect of baclofen.

DonQuixote

[Colin]

Baclofen: a 2-year observational study of 100 patients just published

Great find Don.

"In case of ineffectiveness, the treatment was increased by 30 mg/week during the following weeks. " That is considerably faster than the conventional wisdom on MWO. Hmmmm.

[Xadrian]

Baclofen: a 2-year observational study of 100 patients just published

Colin;1424401 wrote: Great find Don.

"In case of ineffectiveness, the treatment was increased by 30 mg/week during the following weeks. " That is considerably faster than the conventional wisdom on MWO. Hmmmm.

The instructions that come with the (my) baclofen (Ratiopharm) say 15 mg every 3rd day, which is roughly 30 mg/week.

[redhead77]

Baclofen: a 2-year observational study of 100 patients just published

Thanks for posting this, Don. I think for anyone out there who doesn't know how to titrate bac, or doesn't have a doc they're working with, that maybe they could look and use the titration schedule the researchers wrote about as a general guide. I still think bac titration is an individual thing, but having a guide helps a ton. They wrote exactly how they advised the patients to titrate. Just thinking for a few of you out there who are struggling with titration without a doctor. :l

[Ne/Neva Eva]

Baclofen: a 2-year observational study of 100 patients just published

Thanks, Don. It is really appreciated that you continue to share information here with us.
I haven't taken a good look at the article, but look forward to doing that soon.

For those that can't use the link, here's the introduction:

Suppression of alcohol dependence using baclofen: a 2-year observational study of 100 patients
Renaud de Beaurepaire
Groupe Hospitalier Paul-Guiraud, Villejuif, France

Aims: The purpose of this study was to examine the long-term effects of baclofen in a large cohort of alcohol-dependent patients compliant to baclofen treatment. Methods: A hundred patients with alcohol dependence, resistant to usual treatments, were treated with escalating doses of baclofen (no superior limit). Alcohol consumption (in grams) and craving for alcohol were assessed before treatment and at 3, 6, 12, and 24 months. Assessments were simply based on patients’ statements. The outcome measure was the consumption of alcohol, rated according to the World Health Organization criteria for risk of chronic harm. Results: While all patients were rated “at high risk” at baseline, approximately half of them were rated “at low risk” at 3, 6, 12, and 24 months. The sum of patients who were at “low risk” and at “moderate risk” (improved patients) was 84% at 3 months, 70% at 6 months, 63% at 1 year, and 62% at 2 years. The constancy of improvement over the 2-years was remarkable. The average maximal dose of baclofen taken was 147 mg/day. Ninety-two percentage of patients reported that they experienced the craving-suppressing effect of baclofen. Significant relationships were found between the amount in grams of alcohol taken before treatment and the maximal dose of baclofen required, and between the existence of a mental disorder and a lesser effect of baclofen. Conclusion

: Baclofen produces an effortless decrease or suppression of alcohol craving when it is prescribed with no superior limit of dose. Potential limitations in the effectiveness of baclofen include the coexistence of a mental disorder, the concomitant use of other psychotropic drugs, a lack of real motivation in patients to stop drinking, and the impossibility to reach the optimal dose of baclofen because of unbearable side-effects (sometimes possibly related to too sharp a protocol of dose escalation).

[soberwannabe]

Baclofen: a 2-year observational study of 100 patients just published

Thanks Don for sharing this information. Interestingly,
This one statement has stirred many questions in my mind..

Significant relationships were found between the amount in grams of alcohol taken before treatment and the maximal dose of baclofen required.

Does anyone have any thoughts/comments on this statement?

[TexasAg]

Baclofen: a 2-year observational study of 100 patients just published

Thanks Don, this is great news!

I personally know it works but studies like this will go a long way to helping others in need. If I'm not mistaken, other studies results should be coming out soon? It might be worth compiling in a single area (or thread). Y'all might be way ahead of me on this, but maybe we can "pin it" at the top of the Meds threads? Just a suggestion, but dammit, when something that saves a person's life comes around, you want to scream it from the rooftops!

The added bonus for me is the acceptance by naysayers and also people I care about that this medicine isn't a fluke.

Cheers!

[joanna_d]

Baclofen: a 2-year observational study of 100 patients just published

great info! thanks Don!

[Xadrian]

Baclofen: a 2-year observational study of 100 patients just published

Today I had an appointment with my psychiatrist. I gave him a copy of the study. He was very pleased.
I hope he can use it for the good sake.

Thanks again for posting, Don.

[DonQuixote]

Baclofen: a 2-year observational study of 100 patients just published

Hi @all

TexasAg wrote: If I'm not mistaken, other studies results should be coming out soon?I don?t think so. The results of two big French clinical studies should come in 2014. But I see serious problems in recruiting the necessary number of participants, so it will be probably in 2015. Then the results have to be published, acknowledged and accepted by the physicians. After that somebody has to run for an application for admission. I fear that all this will take years and years.

Xadrian wrote: Today I had an appointment with my psychiatrist. I gave him a copy of the study. He was very pleased.

Well done, Xadrian! And don?t forget to spread the ?Baclofen prescribing guide? you can find here...

DonQuixote

P.S. Sorry, my English isn?t so good.

[Xadrian]

Baclofen: a 2-year observational study of 100 patients just published

DonQuixote;1425009 wrote: Well done, Xadrian! And don?t forget to spread the ?Baclofen prescribing guide? you can find here...

I gave him that too He was pleased with the attached titration schedule.

[DonQuixote]

Baclofen: a 2-year observational study of 100 patients just published

Hi Xadrian & @all

Xadrian wrote: He was pleased with the attached titration schedule.

Once again well done, Xadrian! The titration schedule mentioned in the ?Baclofen prescribing guide? is a very cautious one. This titration schedule intends to avoid as much as possible undesirable side effects, beause they are one of the main reasons, high dosed Baclofen therapy against alcoholism remains unsuccessful. In ?normal cases?, you can simply double the speed. If undesirable side effects occurs, just slow down.

DonQuixote

[Otter]

Baclofen: a 2-year observational study of 100 patients just published

I had an email today from a doctor who uses baclofen in a London hospital. He mentioned that a doctor/professor at Imperial College at the University of London https://www.google.co.uk/search?q=anne+lingford-hughes&rlz=1C1TEUA_enGB482GB482&aq=0&oq=ann+lingfo r&sugexp=chrome,mod=7&sourceid=chrome&ie=UTF-8 applied for funding of a trail of baclofen in 2010.

This is interesting because the head of her faculty is Dr. David Nutt https://www.google.co.uk/search?q=david+nutt+imperial+college&rlz=1C1TEUA_e nGB482GB482&oq=david+nutt+imperial+college&sugexp= chrome,mod=7&sourceid=chrome&ie=UTF-8

He collaborated with Dr. Jonathan Chick on this paper in which baclofen is recommended for treatment of alcoholism: https://www.dropbox.com/sh/85ybb2gvgkp8oml/ygJH255dkY/Chick%20and%20Nutt%20report.pdf

Dr. Lingford-Hughes is an advisor to the National Instituted for Clinical Excellence NICE which advises on the best treatments for use by doctors. In spite of the epidemic status of alcohol abuse in the UK and the devastatgion this brings to families and, well, everyone, NICE refuse to take any active stance in reviewing the use of alcohol, saying they watch developments but, if the are not told to reconsider their position then they don't. I cannot understand the position they are taking as it seems there are changs in this field every few months.

[Otter]

Baclofen: a 2-year observational study of 100 patients just published

Here is what the report says about obstacles to using baclofen:

https://www.dropbox.com/sh/85ybb2gvgkp8oml/ygJH255dkY/Chick%20and%20Nutt%20report.pdf

What are the barriers to alcohol
substitution treatment?
Barriers to alcohol substitution treatment come in many
forms. Abstinence based treatments such as delivered by
AA have been the bedrock of alcoholism treatment in the
UK and especially the USA for decades. The philosophy of
AA cautions against the use of substitution treatments, which
are perceived as ‘chemical crutches’ that delay or obscure the
possibility of emotional and spiritual recovery. The general
public tends to view alcohol dependence as a failure of will
which is therefore best dealt with by psychological
approaches to strengthen determination or deal with underlying weaknesses, and few are aware that other options exist.
This is seen also in commentaries on opioid addiction where
there are those who oppose substitution treatment with methadone partly on moral and philosophical grounds even
though many studies have shown it to be a cost effective
way of reducing social harm.
Another major hurdle is resistance from the medical professions who tend to the populist view of alcoholism as a
moral rather than a medical problem. This is manifest by a
degree of hostility to substitution therapy which often
emerges as a disproportionate concern over the negative or
adverse effects of alternative agents. Thus the problems of
benzodiazepines are exaggerated and much lower thresholds
for harms or concerns are tolerated compared with the toxic
effects of alcohol itself. This issue is exaggerated by the threat
of medical negligence charges that hangs over benzodiazepine
prescribing especially in people with a history of drug and
alcohol dependence. The very cautious guidance offered by
professional bodies such as the Royal College of Psychiatrists
(1997) is not helpful in some situations.
Ongoing issues about the dependence liability of the benzodiazepines limit their use even though they are much safer
than alcohol. Notwithstanding a risk of paradoxical effects as
noted above, a prescription of these drugs might benefit some
alcoholic patients with chronic anxiety; yet this is denied
while further damage from alcohol ensues. Similar concerns
are now being raised about baclofen and GHB substitution
therapy even though these agents do not have the toxicity of
alcohol and its main metabolite acetaldehyde. Some of this
prejudice derives from older experience with more toxic
agents such as the barbiturates and meprobamate which
could be fatal in overdose.
The fact that people in treatment with these drugs may
experience a degree of dependence on them, and indeed
some liking or craving for them, should not be a barrier to
their use. Indeed in the opioid field such experiences are considered an essential element of the treatment regime for they
improve or even drive compliance and so reduces relapse to
the more dangerous drug of primary dependence, heroin.
Xyrem was introduced, at least in the USA, with a fairly
elaborate and apparently successful system to limit its misuse.
Nevertheless concern has been expressed as to the effectiveness of such controls if the patient population are alcohol
dependent (Sewell and Petrakis, 2011). Others advise against
premature closure on this question (Caputo, 2011). In Italy
and Austria, where Alcoverr />has been marketed since the
1990s, Alcover
is almost only prescribed to outpatients by
centres specializing in alcoholism or addiction. This pattern of
prescription has effectively prevented the occurrence of drug
diversion or abuse.
Such treatments will not be a substitute, however, for the
psychological and social changes that many patients will need
to make to consolidate their recovery. The role of medications
is to allow a period of sobriety so that the planning and practice of those changes can be commenced. One cannot learn to
navigate in a sinking ship.
To change the attitude of UK addiction psychiatrists
to substitution therapy for alcohol dependence will require
considerable education and evidence, but with the high UK
death rates from alcohol-related liver disease (Leon and
McCambridge 2006; NHS Statistics on Alcohol, 2010;
Information Services Division, 2009) now is the time to
engage in the debate.

[glenns]

Baclofen: a 2-year observational study of 100 patients just published

Otter;1438113 wrote: Here is what the report says about obstacles to using baclofen:

What are the barriers to alcohol
substitution treatment?
Barriers to alcohol substitution treatment come in many
forms. Abstinence based treatments such as delivered by
AA have been the bedrock of alcoholism treatment in the
UK and especially the USA for decades. The philosophy of
AA cautions against the use of substitution treatments, which
are perceived as ?chemical crutches? that delay or obscure the
possibility of emotional and spiritual recovery. The general
public tends to view alcohol dependence as a failure of will
which is therefore best dealt with by psychological
approaches to strengthen determination or deal with underlying weaknesses, and few are aware that other options exist.
This is seen also in commentaries on opioid addiction where
there are those who oppose substitution treatment with methadone partly on moral and philosophical grounds even
though many studies have shown it to be a cost effective
way of reducing social harm.
Another major hurdle is resistance from the medical professions who tend to the populist view of alcoholism as a
moral rather than a medical problem. This is manifest by a
degree of hostility to substitution therapy which often
emerges as a disproportionate concern over the negative or
adverse effects of alternative agents. Thus the problems of
benzodiazepines are exaggerated and much lower thresholds
for harms or concerns are tolerated compared with the toxic
effects of alcohol itself. This issue is exaggerated by the threat
of medical negligence charges that hangs over benzodiazepine
prescribing especially in people with a history of drug and
alcohol dependence. The very cautious guidance offered by
professional bodies such as the Royal College of Psychiatrists
(1997) is not helpful in some situations.
Ongoing issues about the dependence liability of the benzodiazepines limit their use even though they are much safer
than alcohol. Notwithstanding a risk of paradoxical effects as
noted above, a prescription of these drugs might benefit some
alcoholic patients with chronic anxiety; yet this is denied
while further damage from alcohol ensues. Similar concerns
are now being raised about baclofen and GHB substitution
therapy even though these agents do not have the toxicity of
alcohol and its main metabolite acetaldehyde. Some of this
prejudice derives from older experience with more toxic
agents such as the barbiturates and meprobamate which
could be fatal in overdose.
The fact that people in treatment with these drugs may
experience a degree of dependence on them, and indeed
some liking or craving for them, should not be a barrier to
their use. Indeed in the opioid field such experiences are considered an essential element of the treatment regime for they
improve or even drive compliance and so reduces relapse to
the more dangerous drug of primary dependence, heroin.
Xyrem was introduced, at least in the USA, with a fairly
elaborate and apparently successful system to limit its misuse.
Nevertheless concern has been expressed as to the effectiveness of such controls if the patient population are alcohol
dependent (Sewell and Petrakis, 2011). Others advise against
premature closure on this question (Caputo, 2011). In Italy
and Austria, where Alcover
has been marketed since the
1990s, Alcover
is almost only prescribed to outpatients by
centres specializing in alcoholism or addiction. This pattern of
prescription has effectively prevented the occurrence of drug
diversion or abuse.
Such treatments will not be a substitute, however, for the
psychological and social changes that many patients will need
to make to consolidate their recovery. The role of medications
is to allow a period of sobriety so that the planning and practice of those changes can be commenced. One cannot learn to
navigate in a sinking ship.
To change the attitude of UK addiction psychiatrists
to substitution therapy for alcohol dependence will require
considerable education and evidence, but with the high UK
death rates from alcohol-related liver disease (Leon and
McCambridge 2006; NHS Statistics on Alcohol, 2010;
Information Services Division, 2009) now is the time to
engage in the debate.
The problem with AA is that AA says our drinking is the result of a spiritual disease; that the bottle was "only a symptom." But what happens if you don't have a spiritual problem? What happens if you have few--or no--resentments to list in your Fourth Step inventory?
That any resentments you may have really are the Other Person's fault? What do you do then?

AA does not try to solve this problem; only craving reduction can.