some people on reddit saying naltrexone vs baclofen success rates r higher...

[neophyte]

there is a new subreddit on reddit Alcoholism: Scientific and Medical Treatment Options: The Sinclair Method, Baclofen, Campral, Anta

In the side bar it lists naltrexone as having a success rate as 78%, baclofen at 42-62%

I raised concern about this, since from my understanding baclofen is much more effective, so I made a post saying this is wrong, baclofen is closer to 70% based on the studies ive seen.

I'll admit i havent dug into the naltrexone studies but i remember reading that the naltrexone studies were not as successful as baclofen, this was mention in Dr A's book and well it has become the defacto go to here. I don't really know where to start with this to say otherwise i.e. proof.

My post is here Baclofen should be of higher consideration than naltrexone and other medications to treat alcoholism : Alcoholism_Medication

I was responded with this, not trying to start a war or anything but genuinely curious to anyone whos done any serious research into naltrexone as a solution and done digging into the studies and literature. The 78% figure seems overly high to me across 120 studies. I don't really know where to begin other than digging through pub med and im not reading 120 studies... 120 quality studies seems like a very high number given the limited quality studies we have seen with baclofen.

I was hoping someone learned in this area could educate me on this, what they think the success rates of natrexone are and the mechanism of action. I'll post my original post to reddit below. ill cross post this to the other forum as well. Hoping smart guys like TerryK can chime in.

Welcome, Neophyte! I knew it was only a matter of time before we'd hear from you. I don't particularly care to enter a discussion with respect to which method is superior as both have their strengths and weaknesses. Instead know that the sequencing in the margin is structured by success rates. TSM arrived at a 78% figure over 120 clinical trials and 30 years of research. I reviewed your materials on your sub as well as a number of other resources with regard to BAC's rates. You yourself say 'close to 70%' so I don't think my high of 62% to be inaccurate and unlike TSM it's notably lacking in clinical studies. Personally, I hope that will soon change. Also, augmenting the statistical data Baclofen is even less known in the U.S and U.K and arguably the world (I am aware that it is sanctioned in France.), has no medical support structure and overall is a harder to obtain medication as I understand it. I don't mention that to deride and instead to address additional obstacles and access issues. In any event the effort here is not to yardstick the finish line, but to provide thorough direction and understanding of people's options. I like to think I made a pretty fair case for Baclofen here. If you think something in particular, perhaps a resource or study, is worthy of attention kindly PM me and I can make adjustments to the margin guide.

Both you and 'Move' are more adept at articulating the finer biological points and modes of operations than I. That said I do take issue with a few of your general assertions or find them misleading:

"Many people on Naltrexone dont achieve abstinence but only reduce their consumption."
The goal of The Sinclair Method which utilizes Naltrexone as a tool is not to achieve sobriety per se. Instead through 'extinction' compulsions and cravings are removed. Thereafter, it's a personal choice for the individual as to whether they wish to continue drinking having reached a 'normal' state in that practice. Per the text and clinical trials 20% elect abstinence. Interestingly, in the U.K where Nalmefeme is exclusively prescribed we're seeing an anecdatal 40% electing abstinence. The correlation theoretically being that the latter medication has notable side effects and logistically one must wait (2) instead of (1) hour before consumption.
With 'extinction' / 'deaddiction' comes an exodus from the dualistic trappings of abstinent and not abstinent. Which suggests one is better than the other for an AUD sufferer. Namely right and wrong moralistically. Instead through TSM and retraining the brain alcohol takes on a healthy impermanence. Drinking, not drinking, drinking occasionally all blends together as a non-issue with no particular draw in any direction. No darkness resides over the activity in any variation. The path is the goal.
"...it also does not address cravings directly, only indirectly by alcohol having less of a euphoric effect."
The Sinclair Method utilizing Naltrexone as a tool and through a Pavlovian process retrains the brain thus removing compulsions and cravings. It should be noted that while it does remove the euphoric effect it still allows for inebriation and many still find some pleasure in that in a responsible manner.

We're glad to have someone knowledgeable about treating AUD with Baclofen join us. Again, welcome.
I listed your sub in our 'Additional Resources' section for BAC.

my original post:

I've been on baclofen since 2013 and have achieved sobriety with it. Before I started on baclofen I was looking to see if there were any medications that could assist after failed therapy, AA and abstinence only attempts.

I went through the pros and cons of each of the known drugs to help naltrexone/Nalmefene (u-opioid antagonists), baclofen (gaba-b agonist), topamax, campral and antabuse.

I narrowed it down to naltrexone and baclofen. looking over the studies baclofen has a higher success rate, more studies have since come out giving more evidence of this.

Many people on naltrexone dont achieve abstinence but only reduce their consumption, it also does not address cravings directly, only indirectly by alcohol having less of a euphoric effect. blocking u-opioid receptors is only one of the pieces of the puzzle in terms of what alcohol does in the brain to produce euphoria and cravings, by far gaba-a agonist activity and its effect on dopamine via modulation in the nucleus accumbens (reward center in the brain). The effect on the nucleus accumbens is the primary cause of cravings as over time alcohol down regulations dopamine receptors there. so alcoholics need to drink to feel normal / satisfy cravings.

Why baclofen works better as it directly addresses cravings by blocking dopamine release in the nucleus accumbens. gaba b receptors are located on the cell bodies of dopamine neurons. by activating gaba-b receptor via an agonist (baclofen) causes an inhibitory action on dopamine neurons, this is the primary mechanism through which baclofen suppresses alcohol stimulated dopamine release and in turn dopamine mediated alcohol reinforcement and motivated behaviors.

A review on alcohol: from the central action mechanism to chemical dependency

I'm not sure where the figure of 78% success rate of naltrexone in the side bar comes from, i dont recall figures exactly but they were much lower when i was looking at studies and baclofen is closer to 70%.
I hope that gives a good explanation as to why baclofen is a superior choice, there are studies that back this i.e. high success rates at abstinence and units of alcohol consumed.

I have a sub with loads of information about baclofen /r/baclofenforalcoholism not trying to steal traffic from this sub, its a good thing that there is a general discussion medication sub and I had toyed with starting one anyway. My motivation is that people simply need to be aware that there are other options than AA, which is completely unscientific or proven, and that there are better medications than naltrexone which people immediately jump to as a solution.

There is also a great forum where baclofen users discuss their experiences and theres more information there The End Of My Addiction - Forum discussing Baclofen, Naltrexone and Other Medications for the Treatment of Alcohol Dependence

other medications are discussed there too, that said if naltrexone works for you, then thats great. The only downside to using this is that in medical emergencies pain relief via opioids will not work.

[YouKayBee]

I don't think it really matters, what matters is what works for the individual.

I am sick and tired of folk trying to argue that their way is the best.

By the way the TSM 70% stat is considered inaccurate by most who use that method, and it also depends on the person using it.

[Otter]

I don't think it really matters, what matters is what works for the individual.



I am sick and tired of folk trying to argue that their way is the best.



By the way the TSM 70% stat is considered inaccurate by most who use that method, and it also depends on the person using it.

The problem is that Nal is part of a commercial product called TSM so one cannot be assured that the stats are based on the same kind of studies that baclofen researchers use. One has to look closely at what is being said in terms of what the 70 percent of people claiming to be happy with TSM are actually saying. Have they moderated, or quit? Is the test for TSM that people are controlling their drinking by reducing their consumption? Or are they saying that Nal suppresses alcoholic craving?



They can't say that Nal suppresses alcoholic craving because it doesn't. It's a CRA, craving reduction agent. Baclofen is a CSA, craving suppressing agent. So, these are two completely different approaches to dealing with the problem. Even if you say Nal is more successful on a percentage basis, it isn't doing the same thing. It's comparing apples and oranges and it is a case of different strokes for different folks. Most "drinkers" aren't alcoholic under DSM-V criteria, and aren't "ill". They might want to slow down their drinking so Nal may be great, so may tapering off or smoking dope, but it isn't a cure for those with an illness caused by a neurological dysphoria who are hell-bent on destroying their lives through chronic, unending, liver destroying, daily bingeing on a liter and more of Vodka a day and who would be dead without baclofen.