Given the recent furore, which I was fortunate enough to miss most of, I thought it would be helpful to take a look at the evidence. On one hand we have people saying baclofen doesn?t work, or it works a little bit, and on the other we have people swearing by it. I started trawling the net, and collated the studies I could find, the results are as follows:
The highest dose I could find that was tested was 60mg?s. They compared the results to both placebo and 30mg?s. The results were: ? Compared with patients allocated to placebo, patients allocated to the B10 mg group had a 53% reduction in the number of drinks per day (P < 0.0001) and patients allocated to the B20 mg group had a 68% reduction in the number of drinks per day (P < 0.0001), with respect to the number of drinks per day during the 28 days before randomization. The effect of baclofen 20 mg t.i.d. was greater than that of baclofen 10 mg t.i.d. (P = 0.0214, Wald test) showing a dose-effect relationship.? The link is here for anyone interested: Dose-response effect of baclofen in reducing daily alcohol intake in alcohol dependence: secondary analysis of a randomized, double-blind, placebo-controlled trial.
Another one looked at the combined results of baclofen studies (I couldn?t see what studies they were referencing), and found ?Compared with placebo, subjects randomized to baclofen experienced higher rates of abstinence and lower anxiety scores; the effect of baclofen was statistically significant in two trials assessing patients with more severe alcohol dependence and non-significant in a trial of outpatients receiving concomitant manualized psychotherapy.? Presumably, the first study I referenced was one of the ones discussed in this report. They go on to say ?Though baclofen may hold promise, the different outcomes and sample populations of the three studies highlight the need for more research to better understand the appropriate target patient population to benefit from this medication. Questions still remain about optimal dosing and duration. There is not enough evidence to support the use of baclofen as a first-line treatment option, except for those alcohol-dependent patients with moderate-to-severe liver cirrhosis in whom other pharmacological treatments are not safe or practical.?
There are quite a few other studies discussed on this site: Baclofen - Published Studies
If anyone is interested in looking further. Summarising like this is more boring than I first thought it would be, so I?m stopping here. None of the studies report that baclofen is the be-all-and-end-all, but importantly, none of the studies go above 60mg?s. If we looked at the MWO baclofen experience as a whole, very few individuals would have benefitted in these studies, so it?s no surprise that the results are inconclusive. In fact, inconclusive is too strong a word; even at that paltry dose, results are impressive. That?s also the reason the studies tend to say that baclofen was ?fairly well tolerated.?
I couldn?t find out what happened to the study in Holland. I would have thought it would be done by now. If anyone knows, or is able to track it down, I?d be very interested to know.
Which brings me to case studies. Obviously these are inconclusive, and open to healthy scepticism. There is the one that started all of this, from Dr Amiesen, and then this one, SUPPRESSION OF SYMPTOMS OF ALCOHOL DEPENDENCE AND CRAVING USING HIGH-DOSE BACLOFEN
, which is an interesting read. By themselves, they wouldn't convince me, but I have mine to add to the mix, and that one has me sold 100% on the efficacy of HDB.
Hopefully someone can link to more studies, as I?m sure I have missed some interesting ones.
Anyway, I have children to feed. Hopefully this can encourage a debate that is free from attacks and accusations, from both sides. I have read through this post, and realise that although my initial intention was an unbiased report, I have personalised it, obviously in favour in baclofen given what it has done for me, but so be it.
I must just add, before I submit this, that my views have changed from when I first took baclofen. At the time, I was convinced that anyone who didn't immediately stop what they were doing and start baclofen was nuts. It is somewhat embarrassing to realise that I was like any new convert in my fervour; I now believe that it is one tool among many that are available, and each has its plusses and minuses. Saying that, I think some tools are better than others, and I believe baclofen to be one of the more effective tools available.
The highest dose I could find that was tested was 60mg?s. They compared the results to both placebo and 30mg?s. The results were: ? Compared with patients allocated to placebo, patients allocated to the B10 mg group had a 53% reduction in the number of drinks per day (P < 0.0001) and patients allocated to the B20 mg group had a 68% reduction in the number of drinks per day (P < 0.0001), with respect to the number of drinks per day during the 28 days before randomization. The effect of baclofen 20 mg t.i.d. was greater than that of baclofen 10 mg t.i.d. (P = 0.0214, Wald test) showing a dose-effect relationship.? The link is here for anyone interested: Dose-response effect of baclofen in reducing daily alcohol intake in alcohol dependence: secondary analysis of a randomized, double-blind, placebo-controlled trial.
Another one looked at the combined results of baclofen studies (I couldn?t see what studies they were referencing), and found ?Compared with placebo, subjects randomized to baclofen experienced higher rates of abstinence and lower anxiety scores; the effect of baclofen was statistically significant in two trials assessing patients with more severe alcohol dependence and non-significant in a trial of outpatients receiving concomitant manualized psychotherapy.? Presumably, the first study I referenced was one of the ones discussed in this report. They go on to say ?Though baclofen may hold promise, the different outcomes and sample populations of the three studies highlight the need for more research to better understand the appropriate target patient population to benefit from this medication. Questions still remain about optimal dosing and duration. There is not enough evidence to support the use of baclofen as a first-line treatment option, except for those alcohol-dependent patients with moderate-to-severe liver cirrhosis in whom other pharmacological treatments are not safe or practical.?
There are quite a few other studies discussed on this site: Baclofen - Published Studies
If anyone is interested in looking further. Summarising like this is more boring than I first thought it would be, so I?m stopping here. None of the studies report that baclofen is the be-all-and-end-all, but importantly, none of the studies go above 60mg?s. If we looked at the MWO baclofen experience as a whole, very few individuals would have benefitted in these studies, so it?s no surprise that the results are inconclusive. In fact, inconclusive is too strong a word; even at that paltry dose, results are impressive. That?s also the reason the studies tend to say that baclofen was ?fairly well tolerated.?
I couldn?t find out what happened to the study in Holland. I would have thought it would be done by now. If anyone knows, or is able to track it down, I?d be very interested to know.
Which brings me to case studies. Obviously these are inconclusive, and open to healthy scepticism. There is the one that started all of this, from Dr Amiesen, and then this one, SUPPRESSION OF SYMPTOMS OF ALCOHOL DEPENDENCE AND CRAVING USING HIGH-DOSE BACLOFEN
, which is an interesting read. By themselves, they wouldn't convince me, but I have mine to add to the mix, and that one has me sold 100% on the efficacy of HDB.
Hopefully someone can link to more studies, as I?m sure I have missed some interesting ones.
Anyway, I have children to feed. Hopefully this can encourage a debate that is free from attacks and accusations, from both sides. I have read through this post, and realise that although my initial intention was an unbiased report, I have personalised it, obviously in favour in baclofen given what it has done for me, but so be it.
I must just add, before I submit this, that my views have changed from when I first took baclofen. At the time, I was convinced that anyone who didn't immediately stop what they were doing and start baclofen was nuts. It is somewhat embarrassing to realise that I was like any new convert in my fervour; I now believe that it is one tool among many that are available, and each has its plusses and minuses. Saying that, I think some tools are better than others, and I believe baclofen to be one of the more effective tools available.
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