Listen to Dr. Amanda Stafford explain the answer (video):
It should be pretty simple.
Alcoholism is a huge health and social problem in many countries in the world.
There are an estimated 270,000 alcohol dependent people in Australia. Every day in Australia, 15 people die and 430 are hospitalised for alcohol related illness.
Some alcoholics respond to simple interventions. Others try but fail the current treatments on offer. For most, alcoholism is a chronic relapsing condition at best and at worst, a fast track to poor health and social disintegration.
If you’ve reviewed the section How baclofen is different from other alcohol addiction treatments, you’ll know already that the current alcoholism treatments are pretty ineffective and that there have been no really new or innovative advances in the treatment of alcohol addiction for decades now.
So what if a new treatment came along? If there were studies showing it to be much more effective than currently used treatments and lots of reports from patients describing how it worked where all else had failed. As a bonus this was not a new and untested medication but an old cheap one which had been used for decades so we knew a lot about it over short and long term use. This old medication was being proposed for a new use, in alcoholism with its devastating health consequences and largely ineffective treatments. This would put the risk:benefit ratio greatly in favour of giving it a go. It wasn’t going to work in everyone but it looked like it could help 50% or more of people who had failed all other treatments. Worth a try at least.
So why isn’t everyone who looks after alcoholic patients prescribing it?
When I searched through the information about baclofen for alcohol addiction treatment, I wondered what the problem was. As I read further about the French experience with baclofen and discussed baclofen with medical colleagues who treated various aspects of alcoholism in Perth, I started to see why this was not going to be a smooth road.
Baclofen turns basic ideas about the treatment of alcoholism on their head.
There were some new and radical concepts emerging:
Maybe it’s not that alcoholism is really hard to treat, rather that we didn’t have effective enough treatment for it.
Maybe alcoholism isn’t inevitably a chronic, relapsing disease with a poor prognosis. Maybe if we treated alcohol dependence earlier with more effective treatments, we would see a radical change in the natural history.
That’s the root of the problem. It’s a new paradigm and in a fundamentally conservative profession like medicine, new ideas often take a long time from invention to adoption, around 10-15 years on average. This is not all bad. The first principal of medicine is “first do no harm”. But can also create long delays in important new treatments becoming widely available.
When I delved into the story of baclofen in France, it was obvious that there were two radically different opinions about baclofen for alcoholism treatment.
On one side were the Baclofen Supporters who felt that the slow acceptance of baclofen as a safe and valid treatment for alcoholism was criminal because of the health and social carnage caused by alcoholism in France. They cited the 130 deaths per day from alcoholism which continued while French health authorities argued that baclofen was not safe enough and that there was not enough scientific evidence to support it’s use.
The Baclofen Sceptics deplored the unconventional way in which baclofen treatment for alcoholism had become known. An alcoholic doctor experimenting on himself then publishing his anecdotal experience in a book designed for the general public.
What was interesting about the Baclofen Sceptics was that they didn’t contest the efficacy of baclofen – this had been shown in clinical trials, albeit few in number. Their argument was not that baclofen didn’t work but rather that it was too dangerous to be used for the treatment of alcoholism. This didn’t really make sense to me. Baclofen hadn’t been considered a dangerous medication while being used during four decades to relieve muscle spasms. Remember that baclofen wasn’t TREATING the cause of the muscle spasm, the spinal injury or multiple sclerosis, it was simply providing symptom relief and comfort.
Using baclofen for alcoholism was a very different proposition: it was being used to treat a condition which caused serious health problems and premature death and where current treatments failed most patients. So the argument of the Baclofen Sceptics that baclofen was too dangerous for use in alcoholism seemed nonsensical to me. Logically we should be accepting more, not less, risk for alcoholism treatment.
The Baclofen Sceptics also emphasised the side effects of baclofen, especially at the higher doses required to achieve suppression of cravings in some patients. That baclofen had side effects had never been disputed by baclofen supporters- the side effects can be very unpleasant but they generally disappear with time and are always reversible with reducing or stopping baclofen. It seemed to me though that alcoholism has such devastating effects on the health and lives of patients, that the focus should be on helping patients manage baclofen’s side effects so they could get the therapeutic effects. And in the end, it’s actually patients who decide to continue or cease baclofen treatment in the face of side effects
Other main argument of Baclofen Sceptics centred around their strongly held belief that the only possible aim of alcohol addiction treatment was permanent and total abstinence. They were appalled at the claim of baclofen prescribers that alcoholic patients on baclofen could aim for safe levels of drinking rather than abstinence if they wished. This was seen as totally irresponsible and impossible to achieve (link). This attitude didn’t make sense to me. If baclofen treatment could extinguish cravings for alcohol, then patients could potentially drink alcohol in a normal pattern ie in an occasional fashion or at safe levels. I couldn’t see how baclofen’s ability to allow safe levels of drinking made it dangerous to use.
As much as I searched and researched the arguments of the baclofen sceptics, I simply couldn’t find any which passed the credibility test for me.
It should be pretty simple.
Alcoholism is a huge health and social problem in many countries in the world.
There are an estimated 270,000 alcohol dependent people in Australia. Every day in Australia, 15 people die and 430 are hospitalised for alcohol related illness.
Some alcoholics respond to simple interventions. Others try but fail the current treatments on offer. For most, alcoholism is a chronic relapsing condition at best and at worst, a fast track to poor health and social disintegration.
If you’ve reviewed the section How baclofen is different from other alcohol addiction treatments, you’ll know already that the current alcoholism treatments are pretty ineffective and that there have been no really new or innovative advances in the treatment of alcohol addiction for decades now.
So what if a new treatment came along? If there were studies showing it to be much more effective than currently used treatments and lots of reports from patients describing how it worked where all else had failed. As a bonus this was not a new and untested medication but an old cheap one which had been used for decades so we knew a lot about it over short and long term use. This old medication was being proposed for a new use, in alcoholism with its devastating health consequences and largely ineffective treatments. This would put the risk:benefit ratio greatly in favour of giving it a go. It wasn’t going to work in everyone but it looked like it could help 50% or more of people who had failed all other treatments. Worth a try at least.
So why isn’t everyone who looks after alcoholic patients prescribing it?
When I searched through the information about baclofen for alcohol addiction treatment, I wondered what the problem was. As I read further about the French experience with baclofen and discussed baclofen with medical colleagues who treated various aspects of alcoholism in Perth, I started to see why this was not going to be a smooth road.
Baclofen turns basic ideas about the treatment of alcoholism on their head.
There were some new and radical concepts emerging:
Maybe it’s not that alcoholism is really hard to treat, rather that we didn’t have effective enough treatment for it.
Maybe alcoholism isn’t inevitably a chronic, relapsing disease with a poor prognosis. Maybe if we treated alcohol dependence earlier with more effective treatments, we would see a radical change in the natural history.
That’s the root of the problem. It’s a new paradigm and in a fundamentally conservative profession like medicine, new ideas often take a long time from invention to adoption, around 10-15 years on average. This is not all bad. The first principal of medicine is “first do no harm”. But can also create long delays in important new treatments becoming widely available.
When I delved into the story of baclofen in France, it was obvious that there were two radically different opinions about baclofen for alcoholism treatment.
On one side were the Baclofen Supporters who felt that the slow acceptance of baclofen as a safe and valid treatment for alcoholism was criminal because of the health and social carnage caused by alcoholism in France. They cited the 130 deaths per day from alcoholism which continued while French health authorities argued that baclofen was not safe enough and that there was not enough scientific evidence to support it’s use.
The Baclofen Sceptics deplored the unconventional way in which baclofen treatment for alcoholism had become known. An alcoholic doctor experimenting on himself then publishing his anecdotal experience in a book designed for the general public.
What was interesting about the Baclofen Sceptics was that they didn’t contest the efficacy of baclofen – this had been shown in clinical trials, albeit few in number. Their argument was not that baclofen didn’t work but rather that it was too dangerous to be used for the treatment of alcoholism. This didn’t really make sense to me. Baclofen hadn’t been considered a dangerous medication while being used during four decades to relieve muscle spasms. Remember that baclofen wasn’t TREATING the cause of the muscle spasm, the spinal injury or multiple sclerosis, it was simply providing symptom relief and comfort.
Using baclofen for alcoholism was a very different proposition: it was being used to treat a condition which caused serious health problems and premature death and where current treatments failed most patients. So the argument of the Baclofen Sceptics that baclofen was too dangerous for use in alcoholism seemed nonsensical to me. Logically we should be accepting more, not less, risk for alcoholism treatment.
The Baclofen Sceptics also emphasised the side effects of baclofen, especially at the higher doses required to achieve suppression of cravings in some patients. That baclofen had side effects had never been disputed by baclofen supporters- the side effects can be very unpleasant but they generally disappear with time and are always reversible with reducing or stopping baclofen. It seemed to me though that alcoholism has such devastating effects on the health and lives of patients, that the focus should be on helping patients manage baclofen’s side effects so they could get the therapeutic effects. And in the end, it’s actually patients who decide to continue or cease baclofen treatment in the face of side effects
Other main argument of Baclofen Sceptics centred around their strongly held belief that the only possible aim of alcohol addiction treatment was permanent and total abstinence. They were appalled at the claim of baclofen prescribers that alcoholic patients on baclofen could aim for safe levels of drinking rather than abstinence if they wished. This was seen as totally irresponsible and impossible to achieve (link). This attitude didn’t make sense to me. If baclofen treatment could extinguish cravings for alcohol, then patients could potentially drink alcohol in a normal pattern ie in an occasional fashion or at safe levels. I couldn’t see how baclofen’s ability to allow safe levels of drinking made it dangerous to use.
As much as I searched and researched the arguments of the baclofen sceptics, I simply couldn’t find any which passed the credibility test for me.
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