Alcohol, Xyrem and Baclofen – all GABA, all day long

Alcohol, Xyrem and Baclofen – all GABA, all day long

Alcohol and Alcoholism Vol. 37, No. 5, pp. 504-508, 2002
© 2002 Medical Council on Alcohol


PROCEEDINGS OF A SYMPOSIUM ENTITLED: ‘GABAB RECEPTORS: A TARGET OF NEW TREATMENTS FOR ALCOHOLISM AND DRUG ABUSE’

BACLOFEN EFFICACY IN REDUCING ALCOHOL CRAVING AND INTAKE: A PRELIMINARY DOUBLE-BLIND RANDOMIZED CONTROLLED STUDY

Giovanni Addolorato*, Fabio Caputo2, Esmeralda Capristo, Marco Domenicali2, Mauro Bernardi2, Luigi Janiri1, Roberta Agabio3, Giancarlo Colombo4, Gian Luigi Gessa3,4,5 and Giovanni Gasbarrini Institute of Internal Medicine and
1 Institute of Psychiatry, Catholic University of Rome, Rome,
2 ‘G. Fontana’ Centre for the Study and Treatment of the Alcohol Addiction, University of Bologna, Bologna,
3 ‘Bernard B. Brodie’ Department of Neuroscience, University of Cagliari,
4 C.N.R. Institute of Neurogenetics and Neuropharmacology, Cagliari and
5 Neuroscienze S.c.a r.l., Cagliari, Italy

Received 15 March 2002; first review notified 19 April 2002; accepted 22 April 2002

ABSTRACT

Aims: The {gamma}-aminobutyric acid (GABAB) receptor agonist, baclofen, has recently been shown to reduce alcohol intake in alcohol-preferring rats and alcohol consumption and craving for alcohol in an open study in humans. The present study was aimed at providing a first evaluation of the efficacy of baclofen in inducing and maintaining abstinence and reducing craving for alcohol in alcohol-dependent patients in a double-blind placebo-controlled design. Methods: A total of 39 alcohol-dependent patients were consecutively enrolled in the study. After 12–24 h of abstinence from alcohol, patients were randomly divided into two groups. Twenty patients were treated with baclofen and 19 with placebo. Drug and placebo were orally administered for 30 consecutive days. Baclofen was administered at the dose of 15 mg/day for the first 3 days and 30 mg/day for the subsequent 27 days, divided into three daily doses. Patients were monitored as out-patients on a weekly basis. At each visit alcohol intake, abstinence from alcohol, alcohol craving and changes in affective disorders were evaluated. Results: A higher percentage of subjects totally abstinent from alcohol and a higher number of cumulative abstinence days throughout the study period were found in the baclofen, compared to the placebo, group. A decrease in the obsessive and compulsive components of craving was found in the baclofen compared to the placebo group; likewise, alcohol intake was reduced in the baclofen group. A decrease in state anxiety was found in the baclofen compared to the placebo group. No significant difference was found between the two groups in terms of current depressive symptoms. Baclofen proved to be easily manageable and no patient discontinued treatment due to the presence of side-effects. No patient was affected by craving for the drug and/or drug abuse. Conclusions: Baclofen proved to be effective in inducing abstinence from alcohol and reducing alcohol craving and consumption in alcoholics. With the limits posed by the small number of subjects involved, the results of this preliminary double-blind study suggest that baclofen may represent a potentially useful drug in the treatment of alcohol-dependent patients and thus merits further investigations.

 DR WEEKS’  COMMENT:

I treat people suffering with addiction using many instruments, so it is always hard to evaluate the efficacy of one specific agent.   I find that we humans are a “trickle down” entity whereby thought effects feeling which then effects chi which ultimately effects biochemistry  more effectively than the reverse:  a physical agent “trickling up” to effect thought and behavior.  (Certainly these are conceptual constructs, models of and not actually reality but it helps my patients and I get on the same page.)  Granted addiction is a physical biochemical fact, but it is also influenced to a very considerable and often underestimated degree by the thought (spirit and will) of the person.  Often a recovered addict will attribute his or her success to the following deed:  “I just made up my mind…”   Therefore,  so I rarely offer only a drug or assortment of orthomolecules –  I use the physical agents to support the CorrThot.

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