Nav: Home

Prescribing of baclofen for alcohol dependence 'should be reconsidered'

November 30, 2016

The drug baclofen has received high visibility as a possible breakthrough treatment for alcohol dependence*. Now a new randomised controlled trial from the University of Amsterdam found no evidence for the usefulness of high-dose baclofen in treating alcoholism when added to psychosocial treatments.

Recent trials have suggested high doses of the GABA-b agonist baclofen can be effective in the treatment of alcohol dependent patients. These studies, coupled with individual patient testimonies, have given baclofen a high public profile, prompting the French authorities in 2014 to give permission to physicians to prescribe high doses baclofen for alcohol-dependent patients, pending results from ongoing randomized clinical trials. Even before that permission, more than 200,000 persons had used baclofen "off label" in France alone. Baclofen is licenced for use as a skeletal muscle relaxant for spasms (spasticity).

Now researchers from the Netherlands have carried out the largest randomised controlled trial (RCT) on baclofen for alcohol dependence so far. Their report, published in the peer-reviewed journal European Neuropsychopharmacology (December 2016), indicates that the effects of the drug may add little to the effect provided by psychosocial treatment.

151 alcoholic patients took part in the 16 week trial. 58 were given high-dose baclofen (starting with low dose, with the dose rising to up to 150 mg/day), low dose baclofen (31 patients, 30 mg/day), or placebo (62 patients). At the end of the trial the researchers found no differences in relapse rates (measured as the time to the first heavy drinking day post-treatment) between the groups: about 25% relapsed in each group.

Lead researcher, Professor Reinout Wiers (University of Amsterdam), said:"This came as a surprise to us. In August 2015 a small German RCT** had indicated that high dose baclofen showed good results, but their control group did not receive any treatment, whereas all our patients, including the placebo group, received psychosocial treatment. Together these studies indicate that baclofen may be as effective as psychosocial care, but does not seem to increase effectiveness further. This means that we may have to further study the effectiveness of baclofen before we can recommend it for use. For example, perhaps it can help a subgroup of alcohol-dependent patients who do not respond to psychosocial treatment. We believe that prescribing baclofen widely, as currently happens in France, might be premature and should be reconsidered".

Professor Wiers continued:"We are planning a new RCT, where we will test high dose Baclofen, up to 330 mg per day, in alcohol-dependent patients who have not responded to regular psychological treatment. For comparison, the maximum recommended adult dose of baclofen for its normal (spasticity) use is 80 mg/day. We need to consider safety and side-effects. We are not closing the door on baclofen, but we are saying that we need more research".

Commenting, Professor Jonathan Chick, Medical Director, Castle Craig Hospital, Edinburgh, Scotland said:"Baclofen showed promise in the original trials in Italian liver clinics where patients did not receive intensive psychosocial treatment. The new Dutch study recruited patients from 4 and 6 week residential programmes, one of which was based on the 12-step model. Intensive treatment, especially with 12-step aftercare, is known to be powerful as shown here - all groups had better outcomes than usual in European studies. Given that such good results are obtained with psychosocial treatment, any additional effects of baclofen probably wouldn't reach statistical significance in a group of this size".

The use of Baclofen for alcohol dependence was stimulated by the book 'The end of my addiction', written by the French physician Olivier Ameisen, who claimed to have cured his own alcohol dependence by self-administering a high dose of Baclofen. Until then, Baclofen had been used in a much lower dose as a muscle relaxant for spasms (spasticity).
-end-
See paper, http://www.europeanneuropsychopharmacology.com/article/S0924-977X(16)31968-X/fulltext

*See for example, "Baclofen: the controversial pill that could 'cure' alcoholism", https://www.theguardian.com/society/2016/sep/16/baclofen-controversial-pill-cure-alcoholism

**The 2015 German study had followed 56 alcohol-dependent patients, who either received a high dose of baclofen (up to 270 mg/day) or placebo. It found that 68 % of the patients on baclofen remained abstinent compared to only 24% of the patients on placebo. Ref; High-dose baclofen for the treatment of alcohol dependence (BACLAD study): A randomized, placebo-controlled trial Mueller et al., European Neuropsychopharmacology, Volume 25, Issue 8, August 2015, Pages 1167-1177

Funding for this study was provided by a private donation through the University of Amsterdam Fund.

European College of Neuropsychopharmacology

Related Alcohol Articles:

This is your brain on alcohol (video)
It's almost time to ring in 2017. And since most New Year's celebrations include alcohol, Reactions' latest episode explains the chemistry behind its effects -- drunkenness, frequent bathroom breaks and occasionally poor decision-making.
Heavy alcohol use changes adolescents' brain
Heavy alcohol use during adolescence alters the development of brain, according to a recent study from the University of Eastern Finland and Kuopio University Hospital.
Maryland's 2011 alcohol sales tax reduced alcohol sales, study suggests
Maryland's 2011 increase in the alcohol sales tax appears to have led to fewer purchases of beer, wine and liquor in the state, suggesting reduced alcohol use, new Johns Hopkins Bloomberg School of Public Health research indicates.
Alcohol related deaths are likely to increase after cuts in alcohol taxation
Alcohol related deaths are most likely set to increase in England as incomes outstrip rises in taxation, argue experts in The BMJ today.
Alcohol aromatherapy eases nausea in the ER
Nauseated patients in the emergency department who sniffed pads saturated with isopropyl alcohol were twice as likely to obtain relief from their symptoms as nauseated patients who sniffed pads saturated with saline solution, according to a study published online today in Annals of Emergency Medicine ('Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial').
Alcohol ads linked to teen alcohol brand choices
Overall exposure to brand-specific alcohol advertising is a significant predictor of underage youth alcohol brand consumption, with youth ages 13 to 20 more than five times more likely to consume brands that advertise on national television and 36 percent more likely to consume brands that advertise in national magazines compared to brands that don't advertise in these media.
Should women consume alcohol during pregnancy?
In The BMJ this week, experts discuss the evidence and current guidelines on the controversial topic of alcohol consumption during pregnancy.
The Lancet: Harmful alcohol use linked with increased risk of alcohol-related cancers and injury
A new study of alcohol use in countries of all income levels shows that current use increases the risk of alcohol-related cancers and injury, with no reduction in risk of mortality or cardiovascular disease overall.
Web interventions for alcohol misuse
A systematic evidence review published in Annals of Internal Medicine finds that low-intensity electronic interventions may slightly reduce alcohol consumption among adults and college students, but may be ineffective for reducing binge-drinking frequency and the negative social consequences associated with alcohol misuse.
Marijuana users substitute alcohol at 21
A recent study looked at marijuana and alcohol use in people between the ages of 18 and 24.

Related Alcohol Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Climate Crisis
There's no greater threat to humanity than climate change. What can we do to stop the worst consequences? This hour, TED speakers explore how we can save our planet and whether we can do it in time. Guests include climate activist Greta Thunberg, chemical engineer Jennifer Wilcox, research scientist Sean Davis, food innovator Bruce Friedrich, and psychologist Per Espen Stoknes.
Now Playing: Science for the People

#527 Honey I CRISPR'd the Kids
This week we're coming to you from Awesome Con in Washington, D.C. There, host Bethany Brookshire led a panel of three amazing guests to talk about the promise and perils of CRISPR, and what happens now that CRISPR babies have (maybe?) been born. Featuring science writer Tina Saey, molecular biologist Anne Simon, and bioethicist Alan Regenberg. A Nobel Prize winner argues banning CRISPR babies won’t work Geneticists push for a 5-year global ban on gene-edited babies A CRISPR spin-off causes unintended typos in DNA News of the first gene-edited babies ignited a firestorm The researcher who created CRISPR twins defends...