Dr. Amanda Stafford from the Royal Perth Hospital
How baclofen is different from other alcohol addiction treatments?
Baclofen is effective in more patients than current treatments.
Baclofen’s use has been driven by “people power”.
Baclofen treatment suppresses cravings effectively.
Baclofen helps anxiety as well as alcohol cravings.
Baclofen is well suited to outpatient treatment.
Baclofen can also be used to treat alcohol withdrawal.
Baclofen treatment is cheap and not time limited.
Baclofen is metabolised by the kidney, not the liver.
SECTION 1: Baclofen is effective in more patients than current treatments:
Baclofen has a much higher success rate in obtaining abstinence or low risk drinking than the currently offered treatments, Acamprosate and Naltrexone.
Table:
As the table shows, naltrexone and acamprosate show only a 10% improvement over placebo in the large number of studies done on these two medications. This gives a Number Needed to Treat (NNT) of 9. This means an average of 9 patients must be treated for one of them to find benefit over the placebo effect of the medication. These results have been found repeatedly and consistently – naltrexone and acamprosate are reliably ineffective for most patients (Up to Date Review: Pharmacotherapy Alcohol Use Disorder).
In contrast, the randomised controlled trials of baclofen in heavy daily drinkers show 42-49% improvement over placebo (link). This gives a NNT of 2.2 ie an average of 2.2 patients must be treated for one of them to find more benefit than placebo.
Slide
The most recent study, BACLAD showed abstinence rates at 24% for placebo vs 68% for baclofen at 3 months.
SECTION 2: Baclofen’s use has been driven by “people power” rather than pharmaceutical companies:
Another major difference between baclofen and other alcohol addiction treatments is in how it came into widespread use. It’s been made possible by the information revolution– internet forums and social media collect and then diffuse information from patients about treatments which are not being promoted by pharmaceutical companies. New, effective treatments are pushed into widespread use faster because it’s patients seeking treatment who drive the process. This phenomena was first seen in the 1980s with first HIV medications during the AIDs epidemic and is shown in the 2014 film, Dallas Buyers Club.
The usual way a medication becomes widely used is that a pharmaceutical company markets its product to doctors who, if persuaded of its benefits, prescribes it to patients. However this has frequently led to pharmaceutical companies overemphasising positives about their medications and hiding negative information in order to maximise sales and therefore profit.
In addition to this, the conservative medical profession is often slow to adopt radically new paradigms of treatment and it typically takes 10-15 years for new treatments to become widely used.
The story of baclofen for alcohol addiction has turned this process on its head. It’s patients who are driving the growth in baclofen use, without the help or even against the attempts to slow baclofen’s acceptance and widespread use by pharmaceutical companies and sceptical doctors.
Patients are finding information from sources like Olivier Ameisen’s book, press articles or internet searches. Those who want to try baclofen seek out willing prescribers or, if this is not available, obtain baclofen by other means such as the internet. They describe their experiences on internet and social media forums. It’s a bit like having “Trip Advisor” for addiction treatments. The good, the bad and the ugly are all laid bare. There’s no “polishing of turds” here: no filtering of information to conceal problems or make a treatment sound more effective than it is, all too common in pharmaceutical company promotions.
Clearly internet forums don’t replace clinical trials but they provide another source of information on how a medication performs in “the real world” as well as the patient experience of a medication. When I read patient experiences of baclofen treatment, I was struck by how dramatically it changed their relationship with alcohol. Baclofen freed them from constant thinking about and cravings for alcohol. They felt calmer and more in control. They could be around alcohol without it bothering them. I’d never heard anything quite like it.
SECTION 3: Baclofen treatment suppresses cravings effectively:
The aim of baclofen treatment is to completely suppress cravings for alcohol and replace the compulsion to drink with choice.
People who are not addicted to alcohol simply don’t comprehend how many cues to drink alcohol are around us in everyday life. They are literally everywhere: alcohol advertisements are on billboards, around sporting fields, in newspapers and magazines. There are people drinking in TV shows and bottle shops everywhere, pubs and bars spilling out on to pavements. Pretty much every after work, evening or weekend social function includes alcohol. Non-alcoholics barely notice this stuff. But the alcohol addicted brain scans the environment constantly, thinks about alcohol constantly and is always planning how to keep the addiction “fed”. Resisting the compulsion to drink requires massive mental energy and constant willpower to resist the incessant demands of the addiction.
My patients tell me that the most extraordinary about baclofen treatment is that it stops them thinking about alcohol. Their brain behaves more like a non-addicted brain. Alcohol triggers are still around but now largely ignored. Choice replaces compulsion. This is amazingly liberating.
SECTION 4: Baclofen helps anxiety as well as alcohol cravings:
Baclofen has a powerful anti-anxiety (anxiolytic) effect and this is immensely helpful for alcohol addicted patients. My experience is that the hardest alcoholics to treat are those with severe anxiety which they “medicate” with alcohol. This is well described by Olivier Ameisen in his book The End of my Addiction.
As an anti-anxiety agent, alcohol ticks all the boxes. It’s rapidly effective, cheap, easily available, socially acceptable and legal. Most of our population uses alcohol at some time to relax, de-stress or enhance social interactions – at the end of a hard day’s work or at an awkward party full of strangers.
However for patients with chronic anxiety, the immense relief they feel after drinking alcohol is a trap. Many rapidly become dependant on its relaxing effect. With time they need to increase the amount of alcohol to get the same relaxing effect and become addicted.
For anxious patients, stopping the alcohol provokes not only withdrawal, which feels like bad anxiety, but also unmasks their underlying anxiety problem. This double whammy makes it very hard for anxious alcohol addicted patients to sustain sobriety, especially when faced with stressful situations or life events.
By reducing cravings AND anxiety, baclofen reduces the risk of relapse. For many patients this stops an endless cycling between agonising sobriety and relapsing into heavy drinking. They can experience stable sobriety and the chance to reconstruct their life.
How baclofen is different from other alcohol addiction treatments?
Baclofen is effective in more patients than current treatments.
Baclofen’s use has been driven by “people power”.
Baclofen treatment suppresses cravings effectively.
Baclofen helps anxiety as well as alcohol cravings.
Baclofen is well suited to outpatient treatment.
Baclofen can also be used to treat alcohol withdrawal.
Baclofen treatment is cheap and not time limited.
Baclofen is metabolised by the kidney, not the liver.
SECTION 1: Baclofen is effective in more patients than current treatments:
Baclofen has a much higher success rate in obtaining abstinence or low risk drinking than the currently offered treatments, Acamprosate and Naltrexone.
Table:
As the table shows, naltrexone and acamprosate show only a 10% improvement over placebo in the large number of studies done on these two medications. This gives a Number Needed to Treat (NNT) of 9. This means an average of 9 patients must be treated for one of them to find benefit over the placebo effect of the medication. These results have been found repeatedly and consistently – naltrexone and acamprosate are reliably ineffective for most patients (Up to Date Review: Pharmacotherapy Alcohol Use Disorder).
In contrast, the randomised controlled trials of baclofen in heavy daily drinkers show 42-49% improvement over placebo (link). This gives a NNT of 2.2 ie an average of 2.2 patients must be treated for one of them to find more benefit than placebo.
Slide
The most recent study, BACLAD showed abstinence rates at 24% for placebo vs 68% for baclofen at 3 months.
SECTION 2: Baclofen’s use has been driven by “people power” rather than pharmaceutical companies:
Another major difference between baclofen and other alcohol addiction treatments is in how it came into widespread use. It’s been made possible by the information revolution– internet forums and social media collect and then diffuse information from patients about treatments which are not being promoted by pharmaceutical companies. New, effective treatments are pushed into widespread use faster because it’s patients seeking treatment who drive the process. This phenomena was first seen in the 1980s with first HIV medications during the AIDs epidemic and is shown in the 2014 film, Dallas Buyers Club.
The usual way a medication becomes widely used is that a pharmaceutical company markets its product to doctors who, if persuaded of its benefits, prescribes it to patients. However this has frequently led to pharmaceutical companies overemphasising positives about their medications and hiding negative information in order to maximise sales and therefore profit.
In addition to this, the conservative medical profession is often slow to adopt radically new paradigms of treatment and it typically takes 10-15 years for new treatments to become widely used.
The story of baclofen for alcohol addiction has turned this process on its head. It’s patients who are driving the growth in baclofen use, without the help or even against the attempts to slow baclofen’s acceptance and widespread use by pharmaceutical companies and sceptical doctors.
Patients are finding information from sources like Olivier Ameisen’s book, press articles or internet searches. Those who want to try baclofen seek out willing prescribers or, if this is not available, obtain baclofen by other means such as the internet. They describe their experiences on internet and social media forums. It’s a bit like having “Trip Advisor” for addiction treatments. The good, the bad and the ugly are all laid bare. There’s no “polishing of turds” here: no filtering of information to conceal problems or make a treatment sound more effective than it is, all too common in pharmaceutical company promotions.
Clearly internet forums don’t replace clinical trials but they provide another source of information on how a medication performs in “the real world” as well as the patient experience of a medication. When I read patient experiences of baclofen treatment, I was struck by how dramatically it changed their relationship with alcohol. Baclofen freed them from constant thinking about and cravings for alcohol. They felt calmer and more in control. They could be around alcohol without it bothering them. I’d never heard anything quite like it.
SECTION 3: Baclofen treatment suppresses cravings effectively:
The aim of baclofen treatment is to completely suppress cravings for alcohol and replace the compulsion to drink with choice.
People who are not addicted to alcohol simply don’t comprehend how many cues to drink alcohol are around us in everyday life. They are literally everywhere: alcohol advertisements are on billboards, around sporting fields, in newspapers and magazines. There are people drinking in TV shows and bottle shops everywhere, pubs and bars spilling out on to pavements. Pretty much every after work, evening or weekend social function includes alcohol. Non-alcoholics barely notice this stuff. But the alcohol addicted brain scans the environment constantly, thinks about alcohol constantly and is always planning how to keep the addiction “fed”. Resisting the compulsion to drink requires massive mental energy and constant willpower to resist the incessant demands of the addiction.
My patients tell me that the most extraordinary about baclofen treatment is that it stops them thinking about alcohol. Their brain behaves more like a non-addicted brain. Alcohol triggers are still around but now largely ignored. Choice replaces compulsion. This is amazingly liberating.
SECTION 4: Baclofen helps anxiety as well as alcohol cravings:
Baclofen has a powerful anti-anxiety (anxiolytic) effect and this is immensely helpful for alcohol addicted patients. My experience is that the hardest alcoholics to treat are those with severe anxiety which they “medicate” with alcohol. This is well described by Olivier Ameisen in his book The End of my Addiction.
As an anti-anxiety agent, alcohol ticks all the boxes. It’s rapidly effective, cheap, easily available, socially acceptable and legal. Most of our population uses alcohol at some time to relax, de-stress or enhance social interactions – at the end of a hard day’s work or at an awkward party full of strangers.
However for patients with chronic anxiety, the immense relief they feel after drinking alcohol is a trap. Many rapidly become dependant on its relaxing effect. With time they need to increase the amount of alcohol to get the same relaxing effect and become addicted.
For anxious patients, stopping the alcohol provokes not only withdrawal, which feels like bad anxiety, but also unmasks their underlying anxiety problem. This double whammy makes it very hard for anxious alcohol addicted patients to sustain sobriety, especially when faced with stressful situations or life events.
By reducing cravings AND anxiety, baclofen reduces the risk of relapse. For many patients this stops an endless cycling between agonising sobriety and relapsing into heavy drinking. They can experience stable sobriety and the chance to reconstruct their life.
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