About a week ago, a prof in my MRU loaned me a book he’d just read, saying it would be right up my alley. He was very right. I couldn’t put it down. It’s already changed a great deal about the way that I think about addiction, as well as the way I think about finding a cure.
The book was “The end of my addiction” by Olivier Ameisen. Half case report, half memoir, Olivier Ameisen was a well-known cardiologist doing some crazy good work in New York. Unfortunately, he was also an alcoholic. After more than a decade of broken friendships, joblessness, and near-death experiences, he managed to end his dependence on alcohol using a drug known as baclofen.
Addiction people will never say that someone is cured. Anyone is, at best, “recovering”. People are alcoholics or crack heads even if it’s been years or decades since they had their last dose. This is because they are merely abstinent. A single dose of that drug, or even a visit to places where they previously let the good times roll can spark off a huge craving that can trigger the entire cycle again, something a recovering addict must always be on the watch for.
But what if you could cure it? What if you could just take a pill and make it all go away?
Olivier Ameisen was a good person to write this book. Coming from a well-respected doctor, the spiral downward into addiction is even more striking. He does not hesitate to open up about his worst experiences; being committed to a psychiatric ward against his will, verbally abusing friends and family who tried to help, and walking right out of rehab and into a liquor store. He went to up to 3 AA meetings a day and was in rehab three times. He conveys a life of desperation in a simple, direct manner that is incredibly captivating.
One thing he wrote about really stuck with me. He talked about the wonderful feeling of hope and assurance he felt in rehab, how he just knew that this time he would be fine when we got out. But he never lasted. He compared it to the stars who go on shows fresh out of rehab, bright-eyed and talking about what they have discovered and how they will stay clean. And they HAVE discovered something, he says. It just doesn’t last. That scenario said more to me about addiction than any number of rehab and relapse reports that I have read.
So what happened? After many years of drinking, the closing of his practice, the death of his parents, and many other things, Ameisen ran across a study done by Dr. Childress, a well-known addiction researcher. She had a patient that had been given baclofen, a muscle relaxant, for his muscle spasms. The guy was also a crack addict, and after starting baclofen, he had a problem: he couldn’t get high. Not only that, he didn’t even really WANT to get high. Since her finding with this case study, Dr. Childress had performed a clinical study on drug addicts using baclofen, but the doses used didn’t have much of an effect on craving or drug use. Other studies had been done with rats and cocaine addiction, and some findings were promising, but levels of the drug seemed too high to put into humans. It seemed like a dead end.
But Ameisen didn’t know about the clinical studies. He had only seen the case study and the animal studies, and decided to try baclofen for himself. He called a friend of his who was a neurologist and asked how high he could go.
(An Aside: Baclofen. Beclofen is what is known as a GABA-B agonist. GABA, or gamma-hydroxy-amino-butyric acid, is the major inhibitory neurotransmitters in the brain, and GABA-B is one of its receptors. Alcohol is known to be a GABA agonist, increasing GABA in the brain, which may be cause of its anxiolytic effects. Some research has been done on GABA-A agonists as a possible treatment for alcoholism, but less has been done on GABA-B.)
It wasn’t known by researchers at the time, but baclofen was given in much higher doses than those used in the clinical trial. They had been using 40 mg. But it turns out that, for patients with muscle spasms, the dose can go up into the hundreds of mg with very few side effects. It’s about as safe as a drug can get, apparently. So Ameisen got a prescription and starting bringing his dose up.
And up. And up. He ended up hovering around 270 for a while, and then bringing it back down to 180 or so. Pretty high doses, and he had to be very careful for sleepiness. But at the highest doses, he felt no urge to drink, no craving. He also got relief from the anxiety which has plagued him for years, and which he believed to be the root cause of his drinking. After several months of this, he published his own results as a case study. This is really an incredibly brave thing to do, and is probably the first time that a physician has made their own drug addiction a published fact in a journal.
There were a couple of things that bothered me about the book. Ameisen is clearly a highly intelligent person, and his family is well-placed in French and American society. But it got to be a little much at times. I know you are a well-known cardiologist and I respect you for it. I am reading your memoir about your addiction. I don’t really need to hear your anecdotes about how you know Bette Midler and Elie Weisel.
Additionally, Ameisen clearly had several monetary advantages in his fight that most addicts do not have access to. He has not practiced medicine for many years, and yet was able to afford to go to rehab not once, but three times. Though he does worry about money, and though the most expensive programs are out of his reach, he is still able to go on living for significant periods of time without ever having to reach for unemployment or welfare, advatages which most addicts never get. Still, the book was incredibly well-written and very affecting, not least for its message of hope.
Since Ameisen published his cure, several other case studies have been done, and a couple of preliminary clinical trials. Most have seen at least some success. The book ends in bafflement that more studies are not taking advantage of what could be the cure addiction researchers have been looking for for years.
And I also wonder, why not? The book was published very recently, and I still haven’t heard of a large scale clinical trial for baclofen (though I could have missed it, of course). The drug appears relatively safe in high doses (as is known through its use in treating muscle spasms), and appears to provide relief from both the craving and the anxiety that drug users experience. What is going wrong?
Ameisen proposes one theory. He believes that, since baclofen is an old drug and no longer under patnet, drug companies will never fund a large scale clinical trial. There’s no money in it. He may very well be right. But I’ve got another theory. Most researchers who work in addiction know that addiction is a disease. It’s something that you simply cannot cure through an exercise of will. It’s not a problem with will power or lack of faith. And though we all know this, I wonder how many addiction researchers really believe it. A lot of the resistance that Ameisen encountered was from people who could give no real reason as to why they weren’t interested in a clinical trial. Could it have been the concept of a cure? The idea that you just take a pill and make it go away? It is possible that, even though we all know that alcoholism and other kinds of drug abuse are diseases that cost the public billions of dollars per year, that society has still made up believe in will power. That we think, at some level, that addicts should suffer for what they have done. Ameisen had no suffering. He just stopped. Is our society ready to accept that kind of a cure?
Of course, there is a third theory. Perhaps, due to the dead ends in the literature, researchers just didn’t believe there was much future in it. There may not be. But we won’t know unless we try.
I don’t know whether society is ready, but I think that drug addicts and alcoholics have suffered enough. And society is suffering along with them. And on a completely pragmatic level, what harm could a clinical trial do? If it works, we have a cure. If it doesn’t, money wasted, but baclofen is a safe drug, and bad side effects are unlikely. I’m not willing to hang my addiction theory hat on a case study, or a series of case studies. A series of anecdotes, however convincing, are not data. But give me a large scale clinical trial, or a series of animal studies (there are already some out there), and then I’ll let you know. It may not be a cure, but considering what we have available right now, I think it’s certainly worth a try.
Filed under: Addiction |
Are you Scicurious? 
Society is not ready. We have invested a enormous amount of time, energy, and money in The War On Drugs. We’ve given up many freedoms for the sake of said War. We’ve made the belief that Drug Users are irreparably vile creatures into our national discourse. A cheap pill that cures addiction with few side effects will make that invested time, energy, and money appear wasted. It would make it seem we had given up our freedoms for nothing. It would make condemnation of Drug Users look no different from condemnation of diabetics.
I agree with llewelly… society is not ready. I am, however. I’m sick of the War on Drugs on so many levels. For one, it has impacted pain relief. If one asks for pain medication other than an NSAID, it’s automatically assumed they are “drug-seeking” to feed a habit and whether they are in pain in not examined.
Outright laughter was my response to an obnoxious lab tech who told me that no narcotic would help with arthritis pain. What a joke! I think she meant to say that narcotics did not treat inflammation, but to say they don’t make the pain go away? Haha.
Anyway, I find all this about baclofen very interesting. I hope someone does do a clinical trial and soon.
While this information is very exciting, it apparently does not represent a “cure” for addiction, any more than antipsychotic drugs “cure” schizophrenia. You stop taking the drugs — because you can’t afford them, or you don’t like the side effects, or they make you feel so normal that you start thinking you don’t need them anymore — and you’re right back in the disease.
It would be wonderful to have an effective treatment for addiction. It would be misleading to think that taking a drug made the disease go away.
This is true
the drug does make the “disease’ go away but only as long as you are taking it
Wow – the world of neuroscience and addiction all solved by 1 person’s example. I certainly hope at some point in your education you will take 1) a statistics course, and 2) an experimental design course!
Maybe also a behavioral pharm course – baclofen is highly detrimental to learning and memory, among other things. Haloperidol at high doses also prevents relapse, mostly because the person simply isn’t capable of doing much or initiating ANY type of activity on their own. Does that make it a “cure” as well? What are the acceptable side effects? Haloperidol was hailed as a miracle cure for everything – and it was. If you consider creating zombies a ‘cure’.
While in this case the doctors self reported results were positive, it was a doctor treating himself and his own report of the results. So to begin with, a very flawed result. Now, if you can’t remember much, and have difficulty forming new memories because of the drug, you compound the built in inaccuracy of self report. Who knows if in his case a placebo wouldn’t have been just as effective?
And some experience publishing will help you as well – Hundreds of those experiments may have been ran already. If the results were negative, they wouldn’t have gotten published after published accounts of the drug not working.
and some experience with big pharma will help – baclofen is an old drug. A new analog with fewer issues, or just compounded with something else is patentable and highly marketable. Much like a migraine medicine that recently went generic. The original company is now selling a new improved (and protected…) version! They added ibuprofen to it.
and for Donna B – you have never been in long term pain – most narcotics DO NOT make the pain go away – they just make it so that you don’t CARE about it (or much else), even though you feel it. This is much the same with addiction treatments that currently exist – what exactly do they do to the persons overall over all experience of life?
Living in a grey world, numb, and not feeling is not “quality” life. We could easily cure most things if that was the case (see “peridol shuffle”).
As you illustrate with your review of all of his name dropping etc, this book is much more likely just that – BIG name dropping and there isn’t anything more fashionable right now than coming out as the poor drug addiction victim that made a miraculous recovery. I am sure he will make the whole talk circuit, and be very popular now. Funny – that should should also cut down on his anxiety, which is as he states, the probable root cause. Funny 2: Placebo are incredibly effective for treating anxiety… Hopefully you will see the logic flow there.
Terry: You make some very good points, but I’m afraid that the insulting, sarcastic, and condescending tone of your comment isn’t helping. Please look around the site before you bash my credentials. Anyway, here are some more opinions on the matter.
I am not so naive as to believe that this drug could solve all addiction problems, and as I stated in the post, an anecdote, or even a group of anecdotes, are not data. I simply believe that, based on this, several other case studies and a small clinical study done in Switzerland (see Garbutt, 2009 for review), as well as several animal studies (such as Roberts, 2005), that a clinical trial is warranted.
I am aware that baclofen can cause deficits in learning and memory, but I am also aware that this occurs at much higher doses than the ones used in this case report and in the animal literature (for example, 7.5 mg/kg in a study by Escher, 2004, which is much higher than the 1 mg/kg used in the case study and in other animal studies). Additionally, doses similar to those used in the book have been shown to in fact improve cognitive deficits associated with things like methamphetamine (Arai, 2008).
It is true that baclofen is a sedative, and the author had to ramp his dose up slowly to avoid sedative effects. However, even at the highest doses used, the doses he used were no higher than those prescribed by neurologists for muscle spasms in patients. Given that these doses have been shown to be safe when used correctly, and that animal studies show a promising correlation between baclofen administration and decreases in a drug taking (which is not correlated with decreases in locomotor activity, animals continued responding for food at the doses used), it seems possible that baclofen used at doses commonly used for muscle spasms could have effect on the taking of addictive substances.
You are correct, there are problems with the book. While the authors is a renowned cardiologist, he did not display a very thorough knowledge of addiction literature or neuroscience. I believe, however, that this book adds to studies in the literature which imply that baclofen could be a drug treatment worth exploring in the clinic.
Also, I would disagree with your “experience about publishing”. Negative results are still results, and still get published, especially in the animal literature. Additionally, studies have been done in humans (see Brebner, 2002) at lower doses of baclofen which proved ineffective, and these studies were published. Good science is published, not because it worked, but because it is well designed and executed, and answered a question effectively, regardless of what the answer actually was.
You are right, clinical studies would probably be done if a pharma company added ibuprofen to it. This upsets me a lot, actually.
Finally, although there is a placebo effect in treatment for anxiety, there are far more significant effects of anti-anxiety medication. I’m sure that alcohol itself would not be half so reinforcing if it didn’t also relieve anxiety.
Thank you very much for your comments, they were insightful, and caused me to address several aspects that I did not address in my initial book review. But I’m afraid that my opinion remains the same, and that I would still like to see a clinical trial of higher doses of baclofen.
The cynical side of me also thinks that (a) there’s a hella lot of money involved in rehab treatment, and (b) there’s a hella lot of emotional investment by the psychologists and counselors who do the rehab treatment. And (c) rehab treaters think that relying on *any* drug is a bad idea; replacing one addiction with another, or masking the underlying reasons why the addiction is there to begin with.
Scicurious – Thank you for redressing your report. I felt my sarcasm was in tune with the light-hearted, non-critical, fawning review I read in your original blog post. While some may say it is ‘just’ a blog, you should want to display your critical eye and sharp wit at all times. Your reply was quite good! Speaking of critical eye – be sure to make sure in the animal studies that the food control group gets the same schedule as the drug group – Quite often the drugs are administered on a second order schedule, and the food on a first order schedule. It is well documented that different structures play a variable role based upon order, but it is highly overlooked in many addiction related studies. So it is difficult to tell how much a drug would affect the food behavior on a second order schedule, the true control.
As to publishing – humm – good luck with that idealism! Like how reviewers are always helpful and never use reviews to delay or squash opposing view points. So “the current study replicates previous studies, showing that XXX still doesn’t work” does not get published, particularly when there are far more submissions to every journal than they can publish. Don’t get me wrong, the failure of journals to publish negative results (and of some PIs to admit that they have failed experiments/negative results) is actually one of the primary problems in this field right now, and it leads to a great deal of needless duplication. It is, however, the best justification ever for attending conferences without presenting so as to be able to speak to researchers in that topic area and not duplicate work!
As stated, the follow on studies may have already been accomplished, and just not published. As is usually the case in these situations, your best bet is to contact the authors of the earlier works. They may have already found the negative results, or they may know if it has been done, or they may be currently conducting the experiments. Regretfully this is the only way to find out if the work has already been attempted.
Scicurious – one aspect I may not have been clear on – yes FIRST REPORTS of failed results often get published, but extensions of the work after that first report most often do not. Also one reason to do good experimental design, and to do a full study. Science would have been far better served if the earlier authors would have done a more complete dose regimen for their initial publication. However, that said, there are always many influences that prevent that. And regretfully we also see many dead lines of research because a PI ran out of funding, or the postdoc/graduate student that was doing it moved on, and they just published the initial negative results.
Terry: The self-administration study in question had both the drug and the food on an FR1 schedule, I know that particular study rather well. But you’re right, often food and drug are on different schedules, and it’s definitely something that bears looking out for.
I’ll keep my idealism, thanks. 🙂 Or rather, I’ll temper it. The paper with data saying something doesn’t work WOULD get published, just in a journal that no one will look at.
Thank you for giving me the opportunity to clarify myself, a lot of that was stuff I wanted to cover in the initial review, but I thought it might get too technical for many of the people who read this blog. So I’m glad I got to pull out teh scienz.
I still think the book is a good read, as it is one of the better memoirs of addiction that I have seen. It is especially sad to see someone who is clearly so incredibly talented and has so much going for him lose it all so completely. I think that the book does a good job of highlighting the compulsion of addiction and the spiraling loss of control.
Terry — why so obnoxious? You have no idea what kind of pain I might have, whether it’s long-term or not, or whether I’ve ever used narcotics to deal with pain.
It is still silly to say that narcotics have no effect on arthritis pain. They do not treat the cause of the pain and they are not useful long-term, but they DO have an effect.
What I am saying is that I have had short-term pain from injuries where a narcotic would have been useful for a day or two, but I would never ask for it in an ER.
Hi, all,
I’ve never commented here before, just kind of looked and lurked. Anyway, I am only a lowly clinical neurologist, but will offer my 2 cents.
One thing that makes me doubtful about the usefulness of baclofen (with which I am very familiar)for multiple different addictions is the neurotransmitter system involved. Baclofen & alcohol both work on GABA, so I can see how baclofen might help damp down cravings there. However, crack & cocaine work in a different system, involving catecholamines; I guess baclofen could work in some way by dialing up GABA, which might then inhibit catecholamine activity. Or, it’s possible that baclofen works at some “deeper” site in the nervous system, mediating whatever underlies the fundamental neural phenomenon that leads to craving. And perhaps it’s this deep phenomenon that underlies addiction itself, rather than individual addictions to separate substances.
Also, though baclofen is pretty safe, it is not without side effects, the most prominent being sedation. Two hundred seventy mg is an enormous dose. If this man is truly tolerating 270 mg of baclofen a day, he has indeed been exercising his liver, hard, for many years. I hope he’s not doing cardiac catheterizations on that dose!
Not being obnoxious – just stating that the only people I know that believe narcotics eliminate pain are those that have never needed them. And I stand by what I said – narcotics do not get rid of pain and do not affect/treat pain directly, they alter how much you care that you are feeling pain, two very different things. (and not that it isn’t useful to do so, if that is your issue with my statement.) And so if the source of pain is still there when the narcotic wears off, the person is still in pain, as narcotics do not affect the pain itself. If the pain signals are still reaching and being processed by the brain, the pain still exists, narcotics change the nature of that EXPERIENCE, not the basic nature of the pain signal.
Back toward this post, as others have now said as well, if Baclofen mimics in some ways the alcohol, and diminishes the craving when the person quits baclofen – hello alcohol craving. Baclofen is not getting rid of the addiction, it is temporarily inactivating the craving. In this way – both things are ‘band aids’ that may HELP the person while teh real problem is healing/getting fixed.
To me it is silly of you to say that narcotics get rid of pain, and more than obnoxious to belittle and laugh at a lab tech here for their (correct) statement when they can’t even reply to you.
Terry, I think you have an epistemology problem.
The experience of pain IS pain. Pain does not exist without a brain to interpret it as a negative experience.
The spinal reflexes that help protect us from immediate injuries involve noxious stimuli, and as I’m sure you would point out, there is a separate pathway for the nociceptive data and the spinal reflex itself. But “pain”, rather than nociceptive input, is a subjective experience of the brain. A nociceptive stimulus is interpreted as a negative experience. If a patient gets a narcotic for, say, a kidney stone, to say that they are in pain when they report that they are not is insane. Yes, the noxious stimulus is present, but the experience of pain is not.
That, and I think you were being a pedantic asshat.
I did not say narcotics eliminate pain – I said they had an effect, which you now acknowledge. I did not say the effect was to rid oneself of pain. That’s silly and I think you are deliberately misinterpreting what I wrote. Why, I don’t know, except that you obviously have an agenda somewhere.
And, as far as the lab tech is concerned, she misstated what she meant – she said narcotics have no effect, when she meant they did not treat the disease. Her statement was NOT correct, and I laughed because she misspoke in an amusing way.
She was drawing my blood to check my liver function because of the non-narcotic pain medications I was taking. Also, this lab tech did not understand that acetaminophen did not treat inflammation.
Terry, you are apparently a young man, about the age of one of my daughters, if you went to college right out of high school. For you, as occasionally for my daughter, I prescribe a dose of humility — meaning you might want to consider that you, your ideas, your pet treatments may not be the center of the universe.
uh, opioid signaling has significant effects in pain transmission, in both ascending and descending pathways. i didn’t think there was much question about that. sure, perception is altered too, but transmission itself isn’t exactly unaffected.
i’m also skeptical of the baclofen hypothesis myself. but a quick pubmed search brings up some interesting results in alcohol preferring rats- namely that it seems to prevent acquisition of drinking behaviors. but there’s still that cross-species question.
dura mater: you have a GREAT handle. Never change. And I’m so glad you de-lurked! You have great points. The author did mention some significant sedation associated with the highest doses, and he did have to ramp himself up very slowly so he got used to each dose. And yeah, he’d been working his liver half to death.
I was also skeptical about using baclofen for things like stimulant addiction, but in fact some of the first animal studies on baclofen have been done in animals self-administering things like cocaine. My personal preference, however, would be to try it first for alcoholism, and only try it for other addictions after that.
And it is true, Terry, that baclofen would not “cure” alcoholism, and the craving would be there if they stopped treatment. I’m thinking of it more as a replacement therapy, like methadone, which has been successful in treating opioid addiction, as I’m sure you know. It’s not perfect, but it is a definite positive in terms of harm reduction, and having to be on baclofen, even with some side effects, for the rest of your life, might be an acceptable price to pay in comparison to dying of liver cirrhosis.
and leigh, you’re right, of course we can’t deny the cross-species question. But I still think it’s worth trying.
There is one trial listed on clinicaltrials.gov entitled “Effect of Baclofen on Marijuana Withdrawal and Relapse” that uses higher doses than normal (60-90 mg, which – although not as high as the author’s dose in the book – is certainly higher than the traditional 30 mg maximum dosage seen in most clinical trials). Interestingly, a Phase I Clinical Trial was initiated by Alkermes in November 2008 for “Baclofen ER” (extended-release). It involved 16 participants and the study was completed this month. The condition that the drug is being tested for? Alcohol dependence. Even though Baclofen is not currently approved for this purpose in its immediate-release formulation. And the dosage is listed as 30 mg.
Giovanni Addolorato (who has also studied GHB substitution for acute alcohol withdrawal and maintenance of alcohol dependence) was first author on a paper in Lancet entitled “Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study” in 2007 where 148 patients were assigned to baclofen or placebo for 12 weeks. As far as I can see, no larger-scale studies have been done on maintenance treatment of alcohol dependence. And unfortunately, most research on this drug has focused on withdrawal.
Equally as unfortunate is the fact that most substance abuse research focuses on withdrawal or on “blocking” either drug effect by antagonist or substitution treatment. Naltrexone is a perfect model of this in opiate addiction and yet naltrexone is widely regarded as a massive failure in addiction medicine. Why? Because opiate-addicted patients won’t take the medication. So instead researchers resort to 30-day injections and implantable devices – and don’t get me started on the cocaine vaccine – because clinical trial participants and real-world substance abusers aren’t rats. They have lifetimes of biological, psychological, and social factors that led to the development of their substance use disorders. But we never attempt to address these causes with pharmacotherapy or even to provide a baseline platform with pharmacotherapy so that the more rigorous work of psychotherapy can be undertaken.
Some may say that addiction cannot be “cured” with a medicine. But if addiction is indeed a disease, then why is there such strong opposition to the possibility of a cure or a maintenance treatment? Imagine if cancer researchers had been so strongly opposed to the idea of “curing” an illness that they had dismissed as invalid all research and even all discussion on the potential use of chemotherapy or radiation. Imagine if case reports had never been published on the successful supratherapeutic use of SSRIs in Obsessive-Compulsive Disorder. These case reports prompted larger-scale trials of high-dose SSRI pharmacotherapy in OCD patients and the results were dramatic enough to change APA dosing guidelines. Imagine if Jonas Salk never asked (in response to a question about the patent on his polio vaccine): “How could I patent the sun?”
There is considerable evidence from case reports and experts in the field that MAOIs (particularly tranylcypromine) can lead to seemingly-miraculous cures in patients with conditions ranging from depression to borderline personality disorder to body dysmorphic disorder. And whether written in 1978 or in 2008, they remain case reports with “calls for further research” … calls that will never be answered. A trial comparing Lamictal and tranylcypromine, for example, found tranylcypromine to be remarkably more effective than Lamictal for Bipolar II Disorder in preliminary results, but the trial was shut down, citing recruitment difficulties. A “call for further research” was made there, too – and a quick search for tranylcypromine on clinicaltrials.gov will tell you exactly how futile all of these calls have been.
How many calls does it take until science begins to listen? How many case reports? How many open-label studies? How many books? How many patients without the ability or the opportunity or the prerequisite initials required for journal publication remain silenced, never able to tell their own stories and make their own calls for research?
When will science realize that what is easy is not always what is right? When will science stop staring down into rat cages just to avoid seeing the truth in patients’ eyes?
ah – so now who presumes Donna B?? I would say it is you that needs the humility – I am not the one laughing at lab techs attempts to contribute, or assuming because someone doesn’t buy your line of “insight” that they must be young! There was another interesting blog recently about how labs have to just get along – quite informative – you might want to pull it up!
I don’t think I read anything extra into your post – I think you assumed you communicated more than you did. While it was clear in your head, the written words failed to convey all of your thoughts to someone not familiar with you and your opinions.
Pedantic – not really 1) this is the issue in brain research – particularly in addiction – there are two camps – one that only a pill can cure something, and the other that a pill can’t cure anything. Of course the truth is in the middle, but as long as perception is meaningless in one, and pharmaceutical meaningless in the other, we will not find answers to anything. Perception of the pain is the pain. I can tell you from vast personal experience that narcotics alter your perception of the signal to where you don’t care it is there. You clearly still feel the sensory input, and you KNOW it shoudl be hurting, you just don’t care.
And so in phantom pain – it is a myth? or are those people feeling pain? Is there pain less than others pain, even though you can show activity in pain centers?
2) science is an adversarial system where we are supposed to discuss and debate issues, not just buy the party line. So funny now that getting along is more important than discovering truths through discussion and disagreement. PCism run amok. Hopefully some day we can get back to where we challenge each other, instead of congratulate each other for being so smart that everyone just agrees. It is funny that so many take any disagreement as pedantic activity or being an asshat. But then we all want our little cliques of mutual self-appreciation. Far better to be in the group than original, thoughtful, or, god forbid, ever disagree.
and even funnier that so many do it the Blog arena – the medium STARTED so that people with dissenting views could make them known.
Sorry – I will just take the “everything is beautiful” pill and accept what anyone says as truth, as that is obviously what it takes to be a scientist in this climate.
Scicurious – I agree that these are stop gaps and bandaids – but the problem I see is that we are focusing ON those measures, and spending the majority of research funds to create better stopgaps instead of looking for real answers. They are important, yes, and Big Pharma loves lifetime drugs, and they heavily lobby for that direction in research. The more we focus on better stopgaps, however, the less we look for real answers. You can only find answers you are willing to look for, and that you admit you don’t currently know. Far too many say they know the answer is down road X if we just pump enough $$ down that road – and stifle other roads, as they somehow know a priori that those are dead ends.
The case you are pleading here is one of those little side roads off of their major freeways that now gets neglected. But how many other roads that didn’t parallel that major funding highway dried up and grew over before we knew what was in that direction at all?
Terry: Of course things like methadone maintenance, and possibly baclofen, are not cures. But we are certainly not remotely close to a REAL cure. We still haven’t figured out the underlying causes of addiction, and it may be some time before we do.
In the meantime, why should we not pursue a “stopgap” measure? Additionally, we may have methadone, but there is still a TON of opioid research going on, it hasn’t come to screeching halt just because of a stopgap measure. It’s true that it benefits the pharma companies a lot, but it benefits the people more. And I am all for stopping what suffering we can while we continue working to find a true cure, if such a thing exists. Would you deny people a stopgap measure until we have the perfect cure?
Terry — I am not a scientist. I do not work in a lab. I am lay person with an interest in science. Also, I am not stupid. You have chosen one limb of the tree and berate others who are looking at the other limbs, as if your limb is the only possible route to the trunk.
Defend the lab tech all you want. I was a patient in the doctor’s office where she worked. Her understanding of my disease was very superficial, as your understanding of addiction also seems to be. So far, at least.
I married a man who became an alcoholic. My brother has been an alcoholic since he was in college. My son suffered a closed head injury when he was 6. I’ve read and read and read and learned about brains and addiction as much as any lay person could in their spare time since 1983. I spent hours in med school libraries before the internet and its databases of articles became available.
I’ve read a good bit of your site tonight and think that you are on a valuable avenue of inquiry. Where I question your youth and lack of humility is that you appear (whether you intend to or not) to think that avenue is the only one that will lead to “truth”. (you know, that limb/trunk analogy I mentioned above?)
When you come to the roundabout where 5 or more avenues intersect, great things may happen. In the interim, it does not serve you well to diss the other avenues of thought and research.
(I love mixing analogies and metaphors.)
What’s with all the self-contradiction? “perception…is the pain” than “narcotics alter [that] perception…to where you don’t care it is there…”
Look, your own personal narcotic experiences are fascinating, but if you are not perceiving the input as pain, then you are no longer in pain. I also have lovely personal anecdotes about opiates and pain, and my experiences contradict yours…and my experiences are also not data…
Yo, Terry, my man! Instead of spewing your pompous bullshit, why don’t you do your motherfucking homework? It is well-established that peripheral nociceptors possess opioid receptors and that activation of those opioid receptors reduces nociceptor activity. Try reading the literature before mouthing off, m’kay asswipe?
I saw Dr. Ameisen on TV yesterday and it was a relief to find someone who was prepared to put their name and reputation behind a cure for this so-called “disease”. The idea that “alcoholism” should be treated any diffently than, say, diabetes has kept treatment in the relative stone-age. Any doctor you approach hides behind the medical guidelines that say that there are no medicines for the illness and that the patient must stop drinking, then seek help for the underlying psychological problem which caused it. Of course alcohol is addictive so you never get to the point where the patient can get any treatment and so you go round in an endless circle of despair.
My wife has struggled with alcoholism for nearly 20 years and it wasn’t until I discovered via the internet that there are all sorts of treatments for alcholism that we started to get anywhere. The interesting thing about Ameisen’s discovery is that GABA is used as a treatment, and has been for many years, by the Health Recovery Centre in Minnesota. The problem with alcohol is that it has side effects and that even after stopping drinking, most alcoholics have behavioral problems and are “irritable”. This can cause problems in inter-personal relations, driving people away and pushing the patient back into alcohol abuse. They often go back to drink because their nerves are shot away and they would prefer to be innebriated than feel like crap all the time. So, what do doctors do? They prescibe librium or valium thus cross addicting the patient.
The real problem with alcohol treatment is precisely that modern medicine has become so dependent on “clinical trials” conducted by pharmacy companies and ignores real results using non-patented treatments. As you point out it is rare that a doctor or any other professional would put his name on a report about his own alcoholism and Ameisen has to be commended for that. Most alcoholics don’t have the ability to do the research that Ameisen did and most professionals defer to doctors who follow the accepted creed that this is a disease which can only be dealt with through abstinence followed by talking therapies, hence the poor recovery rate.
Alcoholism is brought on by the use of alcohol to ease physiological problems. It has real physical effects on the body which need to be treated and repaired. And, as Ameisen points out so well, one has to get to the bottom of the physiological cause of the illness and effectively deal with it in order to prevent relapse.
That is the “cure” if there is one. For my part, I have seen my wife stop drinking after using various vitamins, minerals and a couple of prescription medications, as well as GABA, all of which are available via the postal service.
It is such a shame that we approach alcoholism as we do drug use as though it is a modern variant of “withcraft” with the unfortuates who become addicted thrown into the local dunking pond to see if they float or just sink out of sight.
There is at least one medication that is used for many peoples entire lives that is also not a cure, but without it those peoples lives would be much, much shorter then they are currently. It’s called insulin.
I have to add to the rather skeptical crowd. While I am not averse to the use of drugs like this as a harm reduction tool, the notion of longterm use is rather disconcerting. And while methadone treatment can be very useful, without adjunct therapy to deal with the underlying addiction and a plan for working a patient off, it is just bad news. And that I can attest to, having personal experience with a few people who discontinued methadone, only to end up in worse shape than when they were using heroin.
And I would be very reticent to try this therapy on a true “rock-bottomer.” The type that is drinking non-stop from the moment they awake to the moment they pass out again. The dosages necessary to have an effect concern me, especially if the dosage level becomes relative to the amount of drinking it is trying to counteract. At the very least, I would prefer to see a thorough detoxing before treatment with baclfen was started.
David, (since your closest to the bottom)
I am truly sorry that you and your wife have gone through the hell of dealing with her alcohol addiction and I am glad to hear that things have gotten better for you both. But it is important to understand that one, there is no “one size fits all cure” for any addiction and two, your wife’s addiction is not the same as every other alcoholics addiction.
At the heart of it, nearly all addiction does have a physiological component. But that does not mean that they are all the same or that the disease model of addiction is simply non-existent. The twelve step gospel is absolutely a load of shit, but that doesn’t mean the underlying principles aren’t effective for some people.
And while I understand your frustration about the use of drugs like valium or xanax, but for some people that is necessary for safe detox. Take the extreme drunk I’m talking about earlier. The Hooper Clinic in Portland, OR, will use chlonidine and xanax to get that drunk through the initial detox. The xanax helps with the nerves and the chlonidine treats the acute withdrawal symptoms. They also use this to help detox heroin addicts with a fair degree of success. I have a heroin junkie friend who managed to detox that way, started smoking pot and has (at least had for four months before I moved) managed to stay off smack.
It’s quite often just a harm reducing trade off. Ideally folks would also receive cognitive therapy and have people to work with them to find the solution that will work for that particular addict, but we’re just not there yet. We’re stuck on a war on drugs, abstinence is the only success and every addicts basically the same mentality. I’m going to school to get the education that will put me in a position to do my small part to change that, but we have a massive amount of momentum to fight to get there.
But please understand the very tactics you are disparaging, are tactics that have saved lives. None of them work for everybody, but that doesn’t mean they don’t work for somebody. The problem isn’t the strategies themselves, it’s the fucking morons who believe that their way is the only way.
OmegaMom –
I think you’re really giving addiction treaters a bit of a bad rap here. Trust me, most of the people I’ve talked to in street level rehab centers would love to have better fucking tools. Ditto on most of the people involved in various forms of cognitive therapies. The only ones who really have a problem with this sort of approach are the twelve step Believers. While on the one hand, it really does seem to work for some of them, on the other, any acceptance that there is any other way, that abstinence isn’t always critical for everyone, becomes a risk of them failing, because their recovery is entirely founded on Faith.
Don’t get me started on their notion of absolute abstinence from all psychoactives except tobacco and caffeine.
But believe me, with very few exceptions outside the Faithful, the vast majority of people involved in addiction treatment would absolutely love to have more tools – desperately.
Thanks DuWayne for a thoughtful commentary, though I disagree in some minor details.
#1: I think (without any proof at all to back me up on this) that many drug addicts are self-medicating, or at least started off that way. I include nicotine.
#2: The reason I believe #1 is that most of the illegal and legal drugs where addiction is a problem do have a therapeutic effect of some sort in some way.
#3: Nobody (yet, not even our lovely scicurious) understands ALL the ways in which addiction works and/or harms us and our brains.
The War On Drugs bothers me most because it is a political/law enforcement solution to something that is not a political/law enforcement problem, and is therefore not likely to change regardless their efforts. That their efforts have likely worsened the situation saddens me further.
DuWayne,
I don’t think you have any understanding of alcoholism, which is what I though this blog was about. It is the “rock-bottomers” as you call them that need this therapy. You say that they would need large dosages. So what! The therapies that do work use treatments that are safe in any dose just as Ameisen points out is the case with Benlofec. It is safer in large dosages than aspirin!
This is not a situation where really anyone who is actually on the front line in the battle against alcoholism gives two hoots about whether AA works for a small percentage of the population of alcoholics. What is important is that governments and professionals start taking this illness seriously and stop denigrating people like Dr. Aneisen who have actually given huge thought to the problem and its solution.
What is not important, and is really actually, very pointless is the kind of debate like the one you have taken up which just does not add anything at all to finding an answer to this horrendous affliction.
Helped to make the life of an alcoholic better recently, have you? I didn’t think so.
Easy there, David, I think DuWayne has a very good point. And DuWayne, I agree with you that baclofen would not be something I would want used without therapy. The way I think the baclofen would be used (if it gets used at all) is very similar to that of methadone use. Taken under supervision, in conjuction with therapy, and with an effort to wean people off the baclofen later. I certainly think, though, that in the meantime it could be a very valuable tool.
Daivd, I wouldn’t go whole-hog for baclofen just yet. I want to see the results of the clinical studies first. My main point that I’ve been wanting to make is that these clinical studies need to be DONE. I am hoping that some are in progress at high enough doses to be effective. But baclofen does have side effects, most particularly somnolence, and I would not want someone, say, driving while on the stuff.
Donna –
I actually wonder why you think you’re disagreeing with me, there is nothing you’ve said that I disagree with.
David –
It is safer in large dosages than aspirin!
Umm, I really don’t see any evidence of that being the case. Indeed what I have seen would be very contrary to that assertion.
It is the “rock-bottomers” as you call them that need this therapy.
I think you and I may have a very different impression of what rock bottom means. Someone who is on the verge of liver failure from the alcohol is in extreme danger and the drugs used to detox them must be closely monitored because of that.
Helped to make the life of an alcoholic better recently, have you? I didn’t think so.
Yes, as a matter of fact I have. I put a roof over the head of a friend who’s wife through him out, so he could detox. I helped him through the very worse of the DT’s, which were only marginally deflected by the medication that was provided, because the clinic that gave him a script was concerned about liver issues.
I put up with the foul smell, the moaning and had to dispose of the couch when he was well enough to go back home to his family. He is a large part of the reason that I have chosen to go into addiction research and have focused my education in that direction.
What is not important, and is really actually, very pointless is the kind of debate like the one you have taken up which just does not add anything at all to finding an answer to this horrendous affliction.
Fuck you David. Seriously, fuck you. The kind of discussion that I am trying to foster is exactly the sort of discussion that will help find solutions for this horrendous affliction. Being a fucking dickhead to people who are spending a great deal of time and devoting their lives to helping develop better models of addiction treatment doesn’t add a fucking thing to this debate. Assuming that because you happen to disagree with something they happen to say, they have no idea what they’re talking about doesn’t contribute anything to the fucking debate David.
I’ve been living and breathing addiction studies David. I’ve helped alcoholics dry up. I’ve helped heroin junkies detox.
What the fuck have you done David?
This is a very interesting book review, and I for one would absolutely love to see a large clinical trial with a placebo arm and an active placebo arm (something that mimics the sedation of baclofen).
In Canada, we’ve recently received (approx 1 yr now) approval to use Naltrexone, a partial opioid antagonist, for chronic maintenance therapy in alcohol dependence. We can prescribe it orally, or as a weekly/bi-weekly injection, which patients often prefer, since they don’t want to outsmart themselves and covertly stop the oral form (one of the big problems with antabuse). It’s not the cure all, but there are some very happy folks out there who have kicked the bottle because of it.
I worked for about 2 years in a chronic pain program which took all comers including individuals with current or inactive substance dependence. There are boatloads of people who do drink themselves quite silly to relieve chronic pain, and for some it does work, albeit only for a few hours, with enormous “collateral damage.” I’d often try cross tapering over to baclofen, benzodiazepines, or a combination. I’d never go above 80 mg a day, but I’d certainly now give it serious thought if I was working with someone sufficiently motivated and reliable.
As far as long-term methadone use goes, I’d *much* rather see someone on methadone for 20 years than injecting for 20 years. I’ve met people who go on to graduate school, new careers, marriage, and children while taking daily methadone. Sure it would be great if they could stop, but I’m not going to pull the plug based on my own vague preferences. Even if someone doesn’t become the poster-child for rehab, it’s well worth it to see someone simply get on stable anti-retroviral therapy for HIV (hugely prevalent in the IVDU population where I work), gain weight, and get off the revolving door cycle into the hospital.
Here’s three cheers to anything at all which helps out someone in chronic pain, addiction, or both.
Hello DuWayne
Well, we are a bit touchy then.
Disposed of a couch! Oh my, we know all about the subjec then don’t we.
What you descibed is a daily experience for those of us who live with an alcoholic. I don’t need to trade crentials with a foul mouth like you. I am a professional involved with drug addicts and alcoholics for the past 25 years. I used to have the same attitude that others had that alcoholism had no cure and was best dealt with by AA. I learned through hard personal experience that it is not nearly as successful as most people think. As you say, everyone is different, so why then do you think AA is the answer for everyone and put down people like Aneisen who have been successful in finding a way out of alcoholism for himself and several hundred other people who have already been involved in the trials he is running here in Europe.
There is a very good self help book you should read by Dr. Joan Lawson called “Seven Weeks to Sobriety”. I suggest you read it before you spout off about AA and cognitive therapy. You might then find out as she did when her son committed suicide from alcoholism what even the founder of AA realized that it was not the answer to alcoholism and there needed to be a huge amount more invested in therapies for the illness.
When you have another six years of dealing daily with alcholics come back to this blog and I might take what you say seriously.
Canada!!
I was interested to hear in the last entry that Naltrexone is being tested. It is used here to treat heroine addicts and many of my clients have benefited from it over the past several years. It is used by the UK police who are now meeting drug addicts at the prison gates and taking them to have implants. The reports I have heard from drug addicts I have worked with suggest that it is very good. As a result I tried to get it for my wife a few years ago having seen reports that it was being used for alcoholism. I managed to get some for my wife but found that the doctors and health visitors here were completely against it. We tried it for a while and it made my wife feel more drunk but did not stop relapses. I think the Beclofen sounds much more promising. I am also concerned about the use of sedatives like valium. I know people who have died using it because they become cross-addicted. It does not stop relapse and the two drugs together can be lethal as the heart is slowed and stops.
I am not sure about your last point about pain. Dr. Ameisen is not saying that he used Beclofen because he suffered from pain and drank because of that. He says that he suffered from anxiety and that made him drink. He says that his doctors told him the anxiety would go away if he stopped drinking but he insisted it was the anxiety that caused the drinking and not the other way around. This is exactly what my wife has told me and we have had the same dialogue with here medical advisors for years.
The point of taking Becolofen, like Naltrexone, is that it is an agonist and stops the anxiety which leads to drinking. What is encouraging is that it is much less expensive, I think about 76 cents a pill as opposed to a couple of hundred dollars for a small box of Naltrexone.
Anyway, it is nice to hear there are some advances in this field somewhere even if it will probably take several years for it to filter through to where I am.
David –
Yes, I am a bit touchy when fucking assholes make nasty comments. Especially when they haven’t actually read what I wrote. I never said anything that would even imply that AA is the answer for any but a very small percentage of people.
And I’m not putting anyone down, least of all Ameisen, I am just very skeptical of baclofen as any sort of wonder drug.
The only reason I mentioned the latest friend I helped through detox, is because you made the assumption that I have done nothing for any alcoholics lately. While I have yet to get the credentials you have, I have been dealing with my own addictions, including alcohol, for eighteen years now. Along the way, I’ve also done a lot for the people around me, who also suffer a variety of addictions. And this is, in part, what has driven me to devote my education and subsequent life to addiction research.
I certainly would hope that you pay more attention to what your clients say to you before you respond, than you did to what I initially wrote. Because if you had actually read what I wrote, instead of creating some straw-version of what I have to say, you would realize that I have virtually nothing good to say about AA. My only assertion, is that AA might be effective for a very limited number of people, but that said effectiveness comes at the cost of people using AA necessarily believing that AA is the only way.
Lawson is on my reading list. But it will be a while before I get to her. I am have a lot of Tatarsky’s Harm Reduction Psychotherapy, Stanton Peele’s 7 Tools to Beat Addiction and several articles to read before I get to it. I am also working on a couple of papers, one on social gender constructs and male depression, the other taking a more detailed look into defining addiction – delving into the idea of using a linguistics approach in the treatment of addiction.
Just to be perfectly fucking clear. I do not support AA. I just don’t buy into the idea that everything that the twelve steps assume is complete bullshit for absolutely everyone. I personally take a harm reduction approach to my own addictions, an approach that developed organically for me, when I came to understand the dopamine deficits that help define my severe ADHD. I am an alcoholic, yet I had a couple of drinks last night, the first time in a long time I’ve had a drink and the last time for quite a while. I have curbed my use of all psychoactive substances, but I have chosen specifically not to abstain, because fifteen years ago I decided that abstinence would be way too hard for me to accomplish. Over the years I’ve gotten to the point that I rarely use anything besides coffee and cigs, those less since I went on ritalin. But I still avoid the language of absolutes and allow myself the occasional taste of the substances that used to rule my life, because while I am very successful at managing my own addictions, I know that couching my management in terms of absolutes would be a recipe for failure.
Not exactly the AA/NA line.
And I have no qualms about helping a friend quit using opiates with the aid of marijuana. Given the depths of that particular individual’s relationship with opiates, it is likely that he will eventually go back. But I did what I could to help him, including helping him realize that detoxing and allowing himself to get high on something else less likely to interfere with him having a functional life was ok.
Not exactly the AA/NA line.
But by all means, make the assumptions you want, instead of actually paying the slightest attention to anything I wrote. And go ahead and pretend you have something up on my sensitivity to your comments, just because you don’t swear when you’re being incredibly rude and condescending to others. The only difference between your response to me and mine to you, is that I don’t pretend I’m being polite. I don’t try to make my rudeness look prettier than it is.
I’m fucking honest about what I’m about.
@David: yeah, I probably clouded the issues a bit by mentioning alcohol in a chronic pain context. That was just meant to be a “for instance” kind of situation which can make alcohol dependence not only exceptionally hard to treat but even (on some level) quasi-rational.
Baclofen is indeed anxiolytic, as is alcohol. Sorry to hear your wife didn’t have much luck with naltrexone and alcohol cravings. In your shoes, I’d certainly be pushing for an addiction specialist to try baclofen. However, addiction specialists often don’t work much with baclofen, so you may need a pain specialist or a neurologist who does interdisciplinary work in addiction.
I more or less ended up in pain and addiction simply because it was so obvious that there were huge overlaps that were being grotesquely under-addressed due to inability or unwillingness to consider the person in context, along with outrageously wimpy notions of addiction (by pain specialists) and outrageously stoic notions of pain (by addiction specialists). Here I am going off track again. . . Focus!
One pharmacologic puzzle from a theoretical standpoint would be, since SSRI’s are also front-line anxiety treatments, why don’t they seem to have a role in alcohol dependence, whereas more direct gaba agonists like baclofen might? Why does serotonergic agonism reduce anxiety but not craving? Craving must be a non-specific term for a variety of phenomena with varying interrelatedness to anxiety.
Hi Epictetus
I am in Scotland and the problem here with alcohol is horrendous. There seems to be a genetic factor in Celts which contributes to alcoholism or it might be that being so far north there is not so much sunshine. There is virtually no treatment for alcoholism here unless one pays huge money to go into a rehab clinic and I am not convince that is of much benefit. It did nothing for my wife.
She was prescribed a series of anti-depressants and they made matters worse. She was then diagnosed with bi-polar and put on Sodium Valproate which made her even worse. Evenually she got to the point with all the medications and the drink that I thought she was finished and then the doctors started saying she should not be on any of her curren medication for a variety of reasons but mainly that she was a stroke victim as well and had heart surgery. All in all a complete mess. She was then left with no medication at all and I started researching over the internet etc. I don’t say Naltrexone won’t be successful but I could not afford it and it did not seem to help much when she was trying to detox. I then stumbled on a book by Joan Larson and followed the detox formulas in that book and they have worked very well. I found that Hydergine is a treatment for stroke and also for aspects of alcoholism, Korsikoff syndrome so I tried that and got interested in Nootropics so tried Ampamet. I also found out about Lithium Orotate and the combination of those along with a load of megadoses of vitamins has worked very well. I have run out of these products a few time and she has relapsed on each occassion so it seems to me that there is good reason to think they are doing something. It seems to me that alcohol not only interferes with the operation of various organs and glands which produce hormones etc but also interferes with neurotransmission and the electrics of the body. I have developed an idea of the mind as being nothing more than our own sense of being in an electric circuit and when various components of that circuit are out o%f order we become “mentally ill”. I think that is why lithium works so well with bipolar in that it aids neurotransmission. Alcoholism seems to deplete various minerals in the body and I have read that about 80 percent of bipolar sufferers have alcohol problems so it is anybodies guess which is the cause. For my part I think bipolar is a lithium deficiency and in a lot of cases that deficiency is caused by alcohol. Anyway, it is impossible to get anyone here to take anything I say seriously. On the one hand they say my wife’s problem is one of the worst they have ever come across but won’t help with a prescription for Hydergine so I have to buy it myself. Now she has recovered and her liver has returned to normal the doctors still could not care less. The head of her doctors surgery told me to my face that neither he nor any of the doctors in his surgery had any interest in alcoholism!!! It makes me very angry. Forget about the Hypocratic oath.
My wife asked me to look into Baclofen for her and I pulled up this web site. I have done some other research and it seems to me that Baclofen is much the same in its actions as benzodiazapine. The problem I have with that is it is addictive and she does not want to get addicted to anything else. I got hooked on it myself when my father had a heart attack so I know how difficult it is to get off the stuff. I would not want my wife to start taking something which is additive as she is doing so well with what she is taking at the moment. Very few people appear to have heard of the Health Recovery Center in Minnesota which I think is a shame. Everything they use is natural and safe and it worked for us even without using their products. Most of what we use is from local health food shops.
I don’t know if you know anything about Baclofen but would be interested in learning more about its long term side effects.
By the way. I am a U of T grad and spent 12 years in Toronto.
Best wishes
DuWayne
I am sorry if I offended you. It is just that your initial comment in response to my support for Aniesen upset me. I have had a belly full of people telling me that there is no pill for this illness and telling my wife she just doesn’t want to get well. I suppose I just vented my anger and frustration at you.
I am no expert in this field at all and wish I had never got involved in it. It is the thankless and exhausting. I don’t say Baclofen or any other drug is a “cure”. I don’t think that word is appropriate or useful. What I am happy about is that at last someone with some clout has thrown some weight behind a search for another way out of this illness for the vast majority of alcoholics for whom AA just has not worked. I don’t know. Maybe being hooked on Baclofen for the rest of ones life is better than drinking a litre and a half of vodka every day until one dies. I don’t like pharmaceuticals but perhaps that is the way governments will move to curb this epidemic.
Please forgive me.
David –
Apology accepted and I definitely amend my assumption about your being an asshole.
While I am fairly skeptical of Baclofen, I am certainly supportive a better clinical trials. My main issue with it, is the assumption that some people have that it’s something that would be useful for all alcoholics, which seems to be a lot of what I’ve seen. The problem with that is the same problem I have with that assumption being made about any addiction treatment.
We all have our own relationships with the substances of our addictions. My own reasons for using the various substances I have are not the reasons a lot of people get into the same sorts of use/abuse patterns that I was involved in, though there are plenty whose reasons are exactly the same. Likewise, there are a lot of people who fall into alcohol specifically, merely because it’s available and legal.
One such person I came across discovered that he could smoke pot with a great deal of moderation and it fulfilled the same need that drove him to drink in the first place. The thing is, he is one of those people who really falls pretty squarely into the disease model of alcoholism that AA is based on. All the men in his line have either had serious problems with alcohol or abstained. He had started drinking because he also has a fairly high stress career and needs to unwind. Once he realized that he could functionally smoke a little weed on the weekends and occasionally during the week, he was able to accept abstaining from alcohol as a reasonable tradeoff. This isn’t to say that he doesn’t need support to stay “sober,” but it went a long ways towards making abstinence easier.
And I would never, never in a million years ever accuse someone with addiction issues of not having the desire to get well. I don’t give a shit if someone says that about themselves, I do not let that kind of bullshit slide.
I would say that given the tradeoff, it is likely that Baclofen for life would be preferable to alcohol for a much shorter life. But I also largely see it as quite probably too much like methadone for heroin, which is definitely a harm reducer for some people, but can actually make things worse for others. And part of my fear is that this is the way public policy will move to deal with far more alcoholics than it should ever be used for. Methadone has done tremendous things for a lot of addicts, but without accompanying cognitive-behavioral therapy of some sort it is not much good for very many people. Yet this is exactly how it ends up being used for most people who get into the “system.”
And David, there are a lot of folks with clout who are exploring a great many avenues for dealing with alcoholism and a great many other addictions. While I am a mere undergrad and new to that even, I am working on becoming just one of those people. And at risk of sounding even more remarkably arrogant than I actually am, I am on my way to becoming a rising star – my undergrad status not withstanding. Indeed, if all goes well, I will be using my undergrad status to help me along.
Hi again.
I think this is about it for me. I wonder if anyone has any idea if Baclofen is addictive like valium?
The problem where I am is that no one and I mean NO ONE is in any way intereted in finding any way forward with alcohol treatment. The UK is massively out of step with the modern world. As far as alcohol treatment is concerned I just have to echo what Scicurious said about Ameisen’s book, that it changed the way he thought about the subject. I found that with Joan Larson’s book. It is a painful book to read because it shows up the “establishment” way of looking at alcoholism for the past 50 years. Everyone seems to try to take apart treatment programs by coming up with double blind tests involving placebos and then pushing AA as the only solution. Has anyone ever done a double blind test on AA? It is the biggest placebo going. It reminds me of those narrow minded people who say, “Why don’t all the (you name it, gays, lesbians, whatever) get in a room together and talk to each other about their problems”. In other words. Don’t bother the rest of us, we’re all right.
All I know is that being an alcoholic is f—g awful both for the alcoholic and their family and anything that anyone can do about it should be welcomed and not dismissed out of hand as so many in the so-called “caring” professions do, at least where I am. I am not going to change the world or even anyone else’s views, in all likelyhood but I see alcohol treatment as no different from Aids research. If there is something out there that might help then it should be made as easy to get hold of as soon as possible and no one should be criticized for trying to help themselves or others just because they don’t want to die before some “trial” takes place and a bunch of academics misrepresent the results in learned journals for years.
And that is all I have to say on the subject.
(amen)
P.S. Best wishes in your studies, DuWayne
David –
I would like to recommend you read Dr. Lance Dodes The Heart of Addiction. I think that you would probably really enjoy it and it would probably speak well to your wife.
Now if we could get the rest of these assholes to read books like these. While there are certainly pockets of the U.S. that are embracing alternatives to the dominant, twelve step paradigm, they are all too few and far between. Especially when it comes to alcohol addiction. It may be better here than the UK, but I doubt if it is, it’s by very much.
There have been clinical trials for Baclofen. Nobody is hiding anything. As far as I can tell this guy is trying to make a quick buck. The role of GABAB receptors in addiction, alcohol and opiate, is a very active area of investigation.
Pinus: no, no one is hiding anything, but the clinical trial that have been done on baclofen have not used doses even close to what was used in the book. I’ve seen clinical trials at 30-40 mg (by Dr. Childress), and there is one in progress that is at 90 mg. The highest dose, and the one that had positive effects, was a trial done in Switzerland, which needs to be replicated in a larger cohort. But nothing else has been close to what the author used. So it’s not surprising that many findings have been negative or inconclusive.
I would never rule out the possibility of this guy trying to make a quick buck, but I still feel that, based on evidence from animal and human literature, higher dose clinical trials may be warranted, though of course they would have be carefully monitored for side effects. Basically, see my first response to Terry.
Scicurious
I see your points (I must admit I skipped the comments…too many to read!). I think the basic issue (and forgive me if you addressed this above) is that he is substituting one dependence for another. I would think that baclofen has less problems, so maybe it is a good idea.
Let me offer a bit of first-hand experience with baclofen. Completely anecdotal, yes, but it may contribute to the discussion.
I have not hit “rock bottom,” but I am very alcohol-dependent. I self-medicate for anxiety and depression, and need about 5-6 drinks EVERY evening – I cannot remember the last time I have gone without a drink on a given day. Occasionally I will have up to 8 drinks in an evening, but rarely more than that. I am not a typical “rock bottom” alcoholic, since I have never blacked out, and I very much dislike the feeling of being severely drunk (yes, 5-6 drinks gives me a pleasant buzz only, indicating the extent of my dependency).
I am understandably concerned about my long-term health, and I was very intrigued about Dr Amiesen’s experience with baclofen. I decided to try it myself (with the help of a physician, of course).
Baclofen is the only medication I am currently taking.
I began with 20mg a day, and I am now at 150mg. I think I have about reached my ideal dose, so I plan to stay at 150mg for several weeks before determining whether to continue increasing the dose or tapering off to a maintenance level.
Immediately I noticed a reduction in craving for alcohol, yet I have not been able to give up alcohol altogether, since it is so fully ingrained in my daily routine. Now at 150mg, I have gone from a minimum 5-6 drinks a day to splitting a single beer with my wife. For me this has been a revelation – I can drink half of a beer in the evening, and I have absolutely no urge to continue drinking.
My next step, which I will embark on next week, is to maintain the 150mg dose while ceasing alcohol altogether. This is a bit difficult for me. Even though 1/2 of a beer has zero intoxicating effect for me, it fulfills a habitual role in my daily routine that I find very difficult to give up.
What seals the deal for me is that baclofen induces absolutely NO CRAVING for baclofen itself (in this way it is much different from benzodiazepines, which can be highly crave-inducing). By this I mean that I must consciously remind myself to take the pills, and I never have the urge to take more. In fact, remembering to take the pills is a bit of a bother. This is in stark contrast to alcohol, where my whole drive home from work was filled with longing for that first glass once I got home. Anyone who has ever had problems with addiction will recognize what an enormous revelation this lack of craving has been.
Now for the side-effects: 1) sleepiness is an effect whenever the dosage increases. This subsides after a few days. 2) There is some very mild cognitive impairment, again mostly for the first couple of days after increasing dosage. However, I work in a very demanding academic field, and I have had no decrease in my work production or the quality of my work. Indeed, I am now able to work into the evening (when I would normally stop working in order to drink), and the mornings are free from mild hangover and mild dehydration that would occasionally occur with alcohol. 3) I am a bit more sluggish in the mornings (this is cured with a single cup of coffee, and poses no problem).
In all, these side-effects are very mild, and are much preferable to my previous alcohol dependency.
Beneficial side-effects include better sleep and reduced anxiety.
So in sum, my experience is just one more completely anecdotal piece of information, so take it for what it is. At the very least, however, it supports the call for more clinical studies.
If this discussion is still ongoing in a couple weeks, I will update with my progress.
billy –
Even if this conversations isn’t still moving in a couple of weeks, by all means give an update – indeed, I would greatly appreciate it if you were to email me (click on my name – my address is in the upper right corner). I am not going to write a post about this right now, because I am busy as all hell, but I will certainly write about it if/when I hear from you.
Though it sounds very much like you have a solid handle on where to take this, let me recommend that you take care with eliminating that half a beer altogether. Personally (but understanding that my relationship with alcohol is different than yours) I have found that not couching my relationship with the substances I have maintained addictive/abusive relationships with, has been to my advantage. Instead of saying that I simply don’t do this or that anymore, I break the absolutes down to a daily basis.
Put simply, I am not going to use hallucinogens today. I don’t even think about it everyday anymore, but pretty much every time I think about it, I like to remind myself that today is just not a good day to use acid or other hallucinogens….
@Billy: your current experiences with baclofen mirror those of most patients I treated with it in the chronic pain clinic, though I used it for muscle spasm, rather than alcohol craving. None ever reported a craving for it. None were ever anxious about coming off of it, or going on it. None reported withdrawal difficulties, though I would always tend to head that off at the pass by using fairly slow tapering regimens. They all found it helped with baseline levels of anxiety, improved sleep, and did take a few days of adjusting to each dose increase to overcome the transient sedation.
As far as half a beer a day goes, your level of drinking, if maintainable at its current level, actually puts you into the range of positive health benefits from alcohol. You were and are quite correctly concerned about life at the 5-6 drink per day level, and it’s great to hear you’ve got that tiger by the tail.
@David: Sorry i didn’t get back to you a bit sooner. I haven’t personally ever run into a baclofen addict. That’s not science, only clinical experience, but it is clinical experience arising from the main referring hospital (St. Paul’s Hospital) for Vancouver’s infamous Downtown East Side. In two years, having worked with several hundred substance dependent patients and several hundred chronic pain patients, none ever endorsed struggling with baclofen. Another marker of the habituating potential of a substance is how much it costs to illicitly acquire it on the streets of the DTES. Benzos, opioids, and stimulants are always trading briskly, but there’s no money to be made in baclofen it seems, so it’s seldom seen by street workers.
That said, given that your wife seems to be in a good place on her current regimen, there may be no need to consider an empiric trial with baclofen. Keep it in your back pocket though. As you say, I agree that a lifetime on baclofen is greatly prefereable to a lifetime on the bottle.
I hear too much bickering, babble, and squabbling, over petty issues like terminology. For those millions of us with problems this is a distraction from the reason I typed in a query under Baclofen. Please discuss what is known, what is not known, or what more can be learned. This reminds me of AA meetings that digress over the proper role of spirituality or a higher power in achieving contented abstinence. I am a believer in Deng Xiaoping’s maxim “I do not care if a cat is black or white so long as it catches mice”. In this case the question is, is the drug an effective solution for a significant fraction of alcoholics and/or addicts while using a safe dosage.
From reading Ameisen’s book the question of the moment seems to be what protocols should be established for further study and what needs to be done to get the research studies moving expeditiously. While these arguments drag on people are dying. Worse they’re dying while labeling themselves as terrible human beings and being labeled as such by those who purport to love them. They are as socially stigmatized as AIDS patients. End the nightmare. Do not wait 20 years before medicine gives up on AA and works hard on promising solutions.
With respect John, terminology is not as petty as you seem to believe, nor is there ever going to be a medical miracle that cures addiction. Language, terminology as you put it, is the fundamental foundation for sentience. In a great many ways it shapes our reality.
I’m an addict too, yet my relationship with the substances of my addiction is not the same as your relationship with yours. Even though the fundamental problem is the same, the solution or solutions aren’t going to be.
I am all too aware that people are dying, some of the people dying could probably be helped with baclofen or one of the many therapies outside the twelve step paradigm. This sort of conversation is critically important for exactly that reason.
You want the low down on baclofen? Here it is, for FDA approval as a treatment for alcoholism, a lot more study will be required. We do know that a few people have managed to quit alcohol using baclofen at high doses. You may well convince a doctor to prescribe it, but it will be a challenge to find a doctor willing to do so, because it is not FDA approved in those doses, for what you want to use it for.
The longterm side-effects at the doses that Dr. Ameisen is using it are unknown. The effects of discontinuing use at that dose are unknown, though some of the possible side effects of coming off it would lend me to think it might be problematic, possible recidivism to the original addiction aside.
I would very much like to find out about your experience with it, if you manage to use it – assuming this query is for you and not someone else. If you would like, I would also be happy to help you find alternatives to AA in your area. Indeed, there are many links already at my blog, linked in the sidebar (click my name). If you would like to find more than is easy to glean from the links that are there, please don’t hesitate to email me. There are a lot more options than the same old twelve step crap.
Hi All
Like many others, I am intrigued by Dr Ameisens book, the end of my addiction. I have, for many years, had an uneasy relationship with alcohol but never descended into the abyss for some reason. Like Dr A, I too am a musician and fulfilled an ambition to work in recording studios. This was brought to an abrupt end when it was discovered that I have a hearing loss that ENT specialists assumed would not cause me any problems. This was the 3rd job I lost in the space of 18 months. At school, I didn’t fair very well; always seeming to catch up. My role for the last 14 years has been as an audiologist, running my own business for the last 2 years.
I saw my binging as a sign of weakness. Clear for anything from 5 to 10 days then sinking 2-3 bottles of wine in a go.
Even after 1 bottle, I would feel very anxious the next day. I had for many years assumed the anxiety was caused by the booze. It was after 2 months off the booze, and still feeling anxious that I went to see a counsellor. It was another 4 months until I realised that booze does not cause anxiety. This was one hell of a revelation for me. I wondered at the time (last May)what chemicals in the body were at play here.Surely, there is an imbalance, it can be counter-balanced? One approach is to get to the root cause(es) of the anxiety but I’m not sure I will succeed. I have no idea if anxiety is hereditary either. My mum had mood swings between the PMT. Having looked back over the years, I realised that I have always experienced anxiety but never attacks. I am seen as a pillar of strength but deep down, am a bit of a wreck, even when sober. There are some days when I could take on the world which in itself gives me such a high I almost seem unable to cope with and end up having a drink in order to sustain it. Funny how I never realised the anxiety; I just thought it was caused by booze. I started my spiritual journey 5 years ago and have learnt meditation through the World Spirtual University. ch I find very difficult because of the underlying anxiety. Perhaps some people will benefit this as part of a drug programm of baclofen. I would love to take part in a trial. Anyone out there to give me some pointers?
I’ve read the book and am very interested in this drug. Extremely (ie life or death) interested. But my doctor is hesitant, and he has a good point. What happens if you stop taking it? How do you manage the weaning, or what if you run out of it at a time when you can’t get any more? Do you take it for the rest of your life?
Cheers,
with hope, and hope for everyone battling,
Mark
Andrew: I’ll keep an eye out for clinical trials. You might want to ask your doctor, they might know of something going on, esp if they an addiction specialist.
Mark: I’m afraid that I can’t give you any advice on this. I’m not a doctor, and I don’t study baclofen. It’s between you and your doctor what you try, and how much you take. But I agree that you should be careful, whatever you do. I think it may end up being something like methadone, where you DO have to take it for the rest of your life. Future studies are going to have to provide the evidence. I wish you all the best, and I hope you and your doctor can come up with something that works for you.
John: I’ve got several posts on addiction, but I don’t think any of them quite address your question. I will try and write something up soon on replacement therapy, which is basically what baclofen would probably be if it came into therapeutic practice for alcoholism. If you’re curious what replacement therapy is in the meantime, look up “methadone maintenence”. I recommend this: http://www.cdc.gov/IDU/facts/MethadoneFin.pdf, as well as anything from the National Institute on Drug Abuse: http://www.nida.nih.gov/.
Mark,
Your concerns are similar to mine when I started Baclofen. I have done an EXHAUSTIVE review of the medical literature on the drug in order to ease my anxieties. What I discovered is that there is indeed a risk associated with sudden withdrawal. There have been several very severe cases of withdrawal with life-threatening symptoms, including severe seizures and respiratory distress. These cases are rare, but they’re very worrisome nonetheless.
These cases have been largely associated with a different delivery method of the drug for MS patients (intrathecal, where it is injected via a pump directly into the spinal fluid).
Obviously, you should never stop taking Baclofen suddenly – it should always be slowly tapered off. For this reason it is a good idea to keep a couple weeks’ worth of the medicine locked away somewhere where you won’t lose it, in case you happen to lose you bottle and can’t get hold of a new prescription immediately. Also, as Dr. Ameisen mentioned in his book, it is a good idea to print out a little medical card to keep in your wallet explaining that you take the medicine. If an emergency room knows the cause, the negative effects of withdrawal are entirely reversible by administering a dose of Baclofen (this has been extensively documented in the medical literature).
To your other question: yes, if you start taking Baclofen you should probably plan on taking it for the rest of your life, although it is entirely possible to significantly reduce the dosage once you have achieved the beneficial effects.
The good thing is, this drug has been around for many years. Hundreds of thousands of MS patients take it regularly for their entire lives in order to ease painful muscle spasms (and the life expectancy for MS patients is similar to the general population, so they often take Baclofen for a number of decades). Therefore the long-term safety has been thoroughly tested in the real world, and the likelyhood of surprise long-term adverse effects is quite small.
Although I completely agree with Scicurious that it is crucial to have your doctor on board with you, I would also not be afraid to press him/her on it a bit – there’s nothing wrong with being pro-active where your own health is concerned.
If I sound like a bit of a cheerleader for this drug, it is with good reason. To update my last post, I have now successfully kicked my addiction. 150mg was indeed my therapeutic dose (this is on the low side it seems, but Ameisen describes therapeutic doses as low as 100mg in his book), and with it I was able to completely stop drinking with very little effort.
I previously mentioned a good bit of anxiety about stopping that last little bit of alcohol in the evenings that I had become habituated to. It turns out that after the first night of skipping that drink (which was a bit difficult for me, but also relatively painless since it was only one night), I had absolutely no desire to drink again.
Also, miraculously, I have since enjoyed a glass of wine twice at different dinner parties. Both times I felt no desire to have another glass, and I have not been tempted to drink again. I was having a glass to be sociable when it would have been awkward to refuse, and although I enjoyed the wine, I did not crave it. On one of those two occasions I actually forgot about my glass and ended up leaving about half of it un-drunk. I only realized it when my wife brought it to my attention on the drive home!
Although I try to be very cautious about this, I am very tempted to pronounce myself cured.
The adverse side effects have become much less noticeable since I have stopped increasing my dose. I still occasionally feel groggy in the morning, but the sleepiness and slight cognitive fuzziness is completely gone from my normal waking hours.
I have already decreased my dosage to 125mg, and I anticipate going down to 100mg in a week or two.
Billy,
Thanks for your thoughtful response. The idea of risking a glass of wine and not feeling the irrepressible urge to keep going is alien to me. I’ve given my doctor printouts on the Italian trials on cirrhosis patients (baclofen seems not to harm the liver), and the comparative trial with diazepam for alcohol withdrawl (just to get him started — withdrawal is not currently my issue as I’m able at present to look long term, but it could be, at almost any time). I’m hoping he’ll come around to starting me on a low dose and I can encourage him to take it from there.
I’d be grateful to hear how your dose reduction experience goes. Best of luck.
@Billy: very remarkable story!
There are so few (any?) silver bullets in addiction treatment that really anything with promise is worth public funding and research.
Have you thought about coming forward with your story to arouse public interest and political pressure to support a larger trial?
Hi Billy, very interesting, my Doctor has prescribed me Baclofen for my alcohol addiction & seemed genuinely interested & wants to keep tabs on me. At your highest dose, how long did you stay on it until you started coming down?
Mark, my understanding is that it doesn’t go through the liver – it is cleared in the kidneys, so it doesn’t exacerbate liver damage.
Epictetus, Although I would like to help as much as possible to increase public awareness, I do really need to remain anonymous.
Jeremy, I sort of felt it “click” at 150mg, and I only needed to stay there for about a week and a half. I am now at 100mg daily, but I will often skip the last 25mg in the evening.
Billy, thanks again for your update. One thing I found curious about the book however, was that Ameison apparently suffered severe kidney damage from drinking, but makes no reference to Baclofen’s effects on his kidneys. I understand it has barely detectable effects on the liver, however, which is of great interest to me. But still I don’t think my doctor wants to try it with me. He is concerned about being held responsible if anything goes wrong with an off-label prescription. Perhaps I might try another doctor, although I like and trust my present one.
M
Jeremy, I should also note that I do take 25mg extra “as needed” in case of extra craving. Although I never needed the extra bit when I was at 150mg, I have occasionally needed it when I was taking 100 or 125mg on a daily basis.
Dr. Ameisen describes a similar “as needed” dose in case of particular cravings.
Although everyone seems to react differently to the drug (Ameisen needed almost 300mg to get to his therapeutic level), here’s a brief rundown of my dosages so far. This is close, but I can’t guarantee perfect accuracy:
-Began early January, with 20mg a day (10×2)
-increased 10mg every three days or so until I got to 100mg (30,40,30). This was early February. Trouble with sleepiness and cognitive fuzziness, but alcohol cravings noticeably reduced. Still drinking several drinks every day, though, so although I see the promise of Baclofen, I’m not yet convinced.
-Switched to 25mg pills in early Feb, and increased 25mg every two weeks (side effects were more bothersome at 100mg and above, so I slowed down the increases).
-In early March, I felt it “click” one day, shortly after starting 150mg. I simply no longer felt the craving. After a few days, I stopped drinking altogether for about a week or so. Since then I have had the occasional glass of wine or beer (once or twice a week), never with any craving for more.
-In mid March, I started to reduce the dosage. It was actually probably closer to two weeks that I was at 150mg – I misspoke last time when I said 1.5 weeks. After starting to reduce the dose, I also started “25mg as needed” in case I felt cravings. Never more than 25mg extra in a given day.
-Once I started reducing the dose, side effects were greatly improved. They were never unbearable on the way up (and they were always preferable to hangover), but on the way down I barely notice them.
-I’m now at 100mg. I will probably stay here a while, since it feels comfortable. It may end up being my maintenance dose, or I may go down more. I sometimes take 125mg if I feel a bit of craving, and I sometimes take 75mg.
I started at 2x daily, but quickly changed to 3x daily. I found that 10:00, 3:00, and 8:00 worked best for me, with the heaviest dose at 3:00. The toughest time for me for cravings is late-afternoon/early evening, so that schedule worked well.
By the way, although there are very few testimonials in English, I found this forum in French, which has many testimonials. The vast majority are glowingly positive, but there are some notable exceptions, which are worth paying attention to (some people experience intolerable side effects that make them discontinue). Even if you don’t speak French (I don’t!), it is worth looking at through Google’s translator – you can usually get the gist. There are over 300 pages of posts in the thread:
http://www.e-sante.fr/fr/forums_sante/baclofene-46166-29-1-207.htm
Billy Great to hear your news. Whats the latest update on your progress
As long as this would help those that are in dire need of help in changing their alcoholic life. Most alcoholism are caused by depression and anxiety, which mental recovery is a must. Therapies, counseling and group discussion would truly help them bring their self esteem back and not see their life as worthless and wrecked.
Billy How is your reduction programe going. Was your doctor aware of your alcohol issue before you discussed using baclofen. If not how did you approach it with him to get him on board. I have only just moved and do not know my doctor and I am worried about how to approach it. My drinking is exactly the same as yours used to be and I am desperate to gain control. I have been on prozac for depression and have asked to start councilling. I would like to start Baclofen as well as your story has given me hope
Sounds promising ,I will keep abreast of this ,thank you.
Don’t know if this blog/thread has continued elsewhere but I am most interested in following up with the people that are on Baclofen, especially keeping tabs on “Billy’s” recovery process. Would someone please point me in to the right location? Also, I’m a Canadian (residing in Ontario) and would love to know of any doctors that are prescribing Baclofen. My son (and our family) has been suffering with his alcoholism and anxiety for over 6 years (only 24 years of age now) and after 3 years of CBT, 5 x 3 month stints at in-house rehab facilties, AA meetings (which he could never stomach but went), along with an assortment of anti-anxiety/depression meds, remains unsuccessful in managing alcohol. I can’t express how exciting it was to read this thread – find someone other than Dr. Ameisen, that has used the drug and has had positive results. I understand full well that it may not work for our son but Baclofen provides another opportunity to keep trying. He has yet to begin a life – he’s certainly not “living” anything close to one now.
Addiction is not just being unable to stop doing something. It is also the emotional illness that comes from doing something that numbs your feelings over and over again. Does Bacofen medicate emotions? If so then its just a substitute addiction.
The emotional side of addiction also progressively warps the personality as time goes on. Making a substitute addiction (like methadone) a pretty lousy ‘cure’.
A real cure will ‘reset’ the emotions and the unconscious.
You will not have to continue taking a real cure, nor will it numb your feelings thereby fueling progressive emotional illness.
Hello, All-
This is my first time posting to this group. Although I am not a medical professional, I am currently taking baclofen. Let me give you a bit of insight regarding my addiction. I have taken anything and everything that “takes the edge off” for years. My father and his father were both alcoholics and I think I have alcoholic potential as well, seeing as I always end up drinking 15 to 20 beers every time I drink alcohol. My main problem is and always has been stimulants (cocaine, and methamphetamine.) I used to take clonazepam for anxiety, but my addiction is such that I had a hard time sticking to my dosage.
Most professionals that I have seen appear hesitant (and rightly so) to prescribe benzodiazepines to me because of my addiction problems. I am on a “low” dose of 30 mg of baclofen per day, and I realized that I felt “indifferent to drugs” immediately after taking it, that is I have no desire to take drugs, whatsoever! This is truly an astonishing revelation to me seeing as how I would smoke crack, and shoot up cocaine and crystal meth anytime I had the chance! At the height of my addiction I was shooting up meth in 70 to 80 cc increments every 5 to 7 hours, while smoking it in between. I am the guy that gets so strung out that I stay up for a week to two weeks and by the time I either run out or come off because of my inability to continue functioning, I am malnourished to the point that I cannot even make a fist or lift some relatively small objects.
Again, I am not a medical professional, and my experience should NOT be taken as gospel by anyone. I advise everybody that this group is for informative purposes only, and nobody should take any advice from physicians, addiction specialists, or scientists in this group. Only your Doctor knows about you well enough to advise on the very serious nature of addiction. Thanks.
Cody
I also have a hard time believing that Baclofen can be very useful in long-term treatment of addictions. Although studies have shown changes in brain activity of crack cocaine addicts’ response to subliminal visual triggers for use and has had promising initial research done on alcohol, methamphetamine, and marijuana addictive behaviors, the medication has its limitations.
For example, individuals with spinal cord injuries (SCI)have a much higher incidence of drug/alcohol addiction than the general population. However, this same SCI population is given high doses of Baclofen to reduce spasticity in the limbs and torso. So is the amount used for spasticity overriding the craving reduction effects? Or are individuals with SCI more genetically predisposed to a physiological imbalance in their neurotransmitters that results in more addictive behaviors and the Baclofen can only address a set pattern of neurological disturbances in a hierarchical manner?
Adding to the Baclofen/Addiction treatment question for SCI patients is the fact that the majority of those injured were under the influence of some substance at the time of their injury. How would pre-injury addiction treatment with Baclofen compare to post-injury treatment. Although there is absolutely no way to randomly assign individuals with addictive behaviors to a SCI group, a comparative look at the SCI population vs. the general population might yield some interesting insights into the effectiveness of Baclofen.
Baclofen was recommended to me by a preeminent psychotherapist I’ve been working with for years on depression and alcohol issues. He has lots of plaques on his walls and outranks likely every poster here.
He offered me a chance at never wanting to play with my GABA receptors like I sometimes am want to do.
If it doesn’t work it doesn’t, if it works well, I’ll be glad to speak about it an a year or so.
Considering the side effects of Serotonin Re-Uptakes and all the other stuff people in the USA take every day, I don’t feel odd about entering an unofficial trial. It’s a shame it has to be unofficial at this point due to the AA/Drug war people who have a financially vested interest. When I had better general results from the Albert Ellis model AA people wanted me dead because I spoke about it publicly. I’ll hopefully speak about this soon as well just as I did about my results with Dr. Horvath. There’s no “one true way”. I’m going to try things to see if they work not try things to prove they don’t or anything in between.
Call me “Keith Richards”.
Cody, this really helps to give me some hope again! THANKS
I am on a “low” dose of 30 mg of baclofen per day, and I realized that I felt “indifferent to drugs” immediately after taking it, that is I have no desire to take drugs, whatsoever! This is truly an astonishing revelation to me seeing as how I would smoke crack, and shoot up cocaine and crystal meth anytime I had the chance!
Dimitri, Amsterdam
OmegaMom, as a psychiatric and addictions social worker of 16 years, I find your implication that we don’t care about our patients and would rather see them suffer than recover long term, using an effective and inexpensive old medication, insulting and inaccurate.
Social workers are virtually the only social group that gives a flying f*ck about people who suffer from the disease of addiction, and people who turn to street drugs for psychiatric or pain treatment because they are more affordable and accessible than medicine. Other people hate them, for the most part. If you doubt this, review a child’s “red ribbon week” school handouts on substance use.
FYI, most social workers are not in it for the money. We’re typically the lowest paid professionals with graduate education, with average salaries in the 20-30 thousands.
There is very little money in rehab, unless you count prison and jail funding, which I don’t. We’ll pay for 20 years of hard time for a nonviolent crack smoker, but only 30 days of rehab at much lower rates.
And for the past ten years at least rehab thinking nationwide has changed right under your nose. We are paying much more attention to harm reduction strategies and treating co-occurring illnesses and chronic pain. Rehab professionals in the majority no longer believe that any medication is bad. A large number of people who use have trauma histories, and both medication and therapy are encouraged actively. And as always, religious conversion is often a successful treatment. Although I am not religious myself, I have seen scores of people with addictions transfer their cravings from drugs to worship with permanent success.
In my experience, rehab workers of all stripes, many of whom are in recovery themselves, are happy to use any and every resource and treatment possible to help our clients.
In my highly educated and pride worthy opinion, addiction is a subjective state and therefore, the development of a treatment protocol is not of merit to the care or cure of said state. The notion does however make for a great conversation…albeit an ultimately moot one.
I propose we instead rally around an individualized approach to the treatment of addiction and dismiss the pursuit of a singular solution for what it really is…imaginary.
I’ve been psychostimulant/opiate/benzo/alcohol/catholicism free for 7 years and credit melatonin + l-tyrosine + B-6 + D-3 + Omega 3 + Omega 6 + whey protein supplementation + running six miles six days/week + great sleep hygiene + a totally organic, raw-food diet and lifestyle as my source of success…FYI.
Not sure yet about it, was unsure to participate in an off label trial for that matter.
As to if baclofen is a “band-aide” in the long run or not, provided it works, who cares? My friend who drank himself into pancreatitis 3 times and ended up diabetic (he’s abstinent from drinking for 6 years now, in case it matters) and having to take insulin now is “just applying a band-aide every day”, right? If he doesn’t take his insulin all his diabetic symptoms come back so he clearly shouldn’t take insulin (sarcasm intended). For a while non-insulin therapy worked for him but it eventually lost effectiveness so he’s stuck with daily band-aides and has a good quality of life.
So far non-Olivier stunt style doses at the rather extreme low end of the scale, 10mg a day split in two doses, have created a complete disinterest in drinking. I’m apparently an aberration, as others in the trial range from 80-180mg/day for the same effect. Not everybody is wired the same, though, as we all know.
Acid test is it has created complete disinterest, no biological/medical/rational reason one need go to extremes like Olivier if it isn’t needed.
Seems to work. Naltrexone didn’t.
BTH –
I really appreciate you stopping and telling us about this. I would love to get some more updates, if you don’t mind – my email address is duwayne.brayton at gmail dot com (though I would probably notice a comment here, it would be great to hear from you direct).
I am particularly interested in how it seems to have removed all interest, altogether. I hope that it continues to work for you and at the rather low dose. Most of all, I am very glad to hear that you aren’t drinking.
Thanks again for letting us know…
I am a practising psychiatrist in India.I have treated more than 100 alcloholics in my practice with beclofen and results are very satisfying in more than half of the cases.
Nothing has changed. Still as above. Still same result. Placebo or not? Not sure.
I feel the need to warn people because I used to tell people about this book I read called, “The End of my Addiction” by Oliver Ameisen:
I have almost died twice now recently and didn’t have a clue why, I now know the facts.
I didn’t know I was going to stay and babysit my grankids 3 hours from home so this new drug I’m on called Baclofen (I’ve been on it for 8 months now and is suppose to supress cravings and it does) so I took 3 Baclofen instead of my normal 2. . Greg (my husband, told me on the phone I’m slurring my words. I took one extra Baclofen this morning due the noise of the grandkids. My Dr. has told me to take extras anytime I feel the urge to calm down and that I cannot OD on it, which is not true.
I have been really been examining Baclofen ever since my husband told me I’m slurring my words this morning and have found it can can respiratory issues,(almost died twice and didn’t know why) sleep apnea (which I had) little or no REM sleep (which I have had, sometimes not sleeping for 3 days) and on and on, with or without alcohol mixed with it.
Hallucinations, which I also had among other things.
This man that wrote the book is going to end up in a lawsuit. Any alcoholic will certainly pay attention the part of the book where this Dr. in France states he can now drink like a normal person. This will be their favorite part of the book, like it was mine. Mmy husband kept telling me that when I was drinking over the last 8 months off and on while taking loads of Baclofen, which my Dr. told me to take as much as I want, that it’s not dangerous, that he could tell I was tipsy. Baclofen makes a person think they are not feeling any effect from alcohol as the man that wrote the book states he can now drink like a normal person. I must admit he’s on 4 times the amount I’m on though but I find this a dangerous combination, for me it was.
I didn’t crave alcohol but still the thought would come to my mind and I felt safe since reading that book.
Also, my Dr. told me when I’m having insomnia, to take a handful of Baclofen. It does the opposite of Xanax in ways or at least for me it does, I do not get REM sleep when taking more Baclofen from what I just read plus it hypes me up and I’m finding, the more investigating I’m doing this morning that it does hype many people up.
It all makes sense to me now what happened to me. They put on the hospital report that I was going through the DTs and my husband kept telling them it wasn’t the DTs. I’ve never had them in my life and the DTs are where a person is delerious and shaking, I was unconscious and they were unable to get me to breathe.
This Dr. that wrote the book wrote it partially so that organizations will do more investigating into Baclofen for cocaine addiction, alcoholism, meth addiction and heroin addiction but he put some information in there that obviously doesn’t work for everyone. He may think he’s not feeling the effects of alcohol when hd drinks because I also didn’t think I was but I was and I didn’t believe my husband but since I almost died twice this is a letal combination I”m finding out this morning.
DO NOT THINK YOU CAN DRINK LIKE A NORMAL PERSON AS THIS BOOK STATES, IT CAN KILL YOU.
Also, my Dr. would tell me when I can’t sleep at night to take a handful of Baclofen, Baclofen does not make a person sleep if you take too much, it hypes a person up.
I have contacted my Dr. and told him what I have learned so that he doesn’t end up in a lawsuit. He read the book he told me to read way after I read it and only scanned it, I read it and read it carefully. I told him to re-read that book and to all of the people he’s told to read it, they need to ignore the part that says you can drink like a normal drinker and take Baclofen.
I’m posting a lot about this so that when people type in “Baclofen” into google and “Can drink like a normal person” this post will come up.
I don’t want anyone to experience what has happened to me.
One other thing, I would like to add I had been sober for 22 years and relapsed 5 years ago and have drank probably 2 of those 5 years, I kept quitting and restarting again.
I do not think they will want to do clinical trials on this because there’s so many rehab centers making a pantload of money off of people’s addctions, it’s BIG $$$.
The FDA will be paid off to not do clinical trials on this. After all, the old commissioner of the FDA and others have made these damaging statements about the FDA. They are ONLY into money, not protecting the public.
Chelation (in that first quote) does work, the FDA wants it made illegal because it cures many problems people have. Chelation gets rid of toxins and a build-up of lead and other bad things for the body.
http://www.whale.to/vaccine/fda2.html
Hello everyone, After reading all the initial inquiries posted by everyone I feel an obligation to post an opinion. I am a 23 year old man who has battled drug abuse, Anxiety,PTSD, and serious brain trauma from the age of 15, and to point out; I feel that some of you have digressed from the intial topic and decided to make it a personal, possibly pride obligated issue. I want to make a point that allbeit, these statements are very articulate and pertinent, they mostly get off topic. I researched Baclofen and take 40 mg daily, as well as methadone and Clonipine, this being too maintain an active lifestyle. For Terry I agree entirely that narcotics don’t make pain dissapear, they simply make you not think about it. As for Scicurious, your ideas of giving more research to the drug is completely appropriate. To quote John Lennon; “Give Peace a Chance, Just Try, Flower Power didn’t work, So what, We try again.” I feel this is relevant because most people have not tried and if you don’t try we’ll never know the possibilities nor any results. But now I digress, 🙂 Everyone reacts differently and for myself, the daily regiment as posted above allows for a life worth living, and I truly feel a large contribution from the use of Baclofen. It may not cure this disease that at times has almost destroyed everything in my life, but if it is a possible step in the right direction to help with this terrible affliction, and gives a few lives back to the hopeless, than, “Give it a Chance.” I would like to say, although I may not be as research oriented as others or
I apologize, internet issues. But too conclude, I find it effective in that, with my methadone in hand and the opportunity to take that extra pill or two, to get “High”, I find it much easier too say no and stay on my prescribed dose than when I am not on Baclofen. I appreciate the value of all of your input, argument, and ideas, and I hope that what I have said may contribute in some small way, to fuel a more respectable debate. Thank You. Peace 🙂
One More thing, A book that had a profound impact in my life, that I would recommend for support if you have any addiction or mental health problems; Victor Frankl, “Mans Search For Meaning.” Short read 150 pgs. or so, but truly inspirational. Thanks again.
Doesn’t seem to be a placebo. I’m odd man out in this particular trial as I can skip days and am still at a lower dose than even Cole and I suppose I could drink if I wanted to but it’s still like somebody turned a switch off and I have ZERO interest in drinking.
I accidentally made a cake that through some surviving yeasts from the low temp baking process, fermented for a day after I made it. Yeast does that to unmetabolized sugars…breads and beers are related after all…ANYWAY, it was a “Hey, this cake tastes like alcohol!…on the level of a fruit cake. Interesting!…guess the center didn’t get quite hot enough to kill all the yeast in this moisture oriented cake recipe.” Ate the cake over the course of a week or so. Didn’t make me want to go buy alcohol or make alcohol in any form. Indifferent other than it added a flavor I remembered from the past.
I’m going to go with BACLOFEN MAKES ME PERSONALLY INDIFFERENT TO ETOH. Your mileage may very. Side benefit, as an anti-spastic/muscle relaxant, I never wake up with back or leg spasms/cramps anymore. had one issue of urinary incontinence in sleep when I had too much tea before bed. Otherwise no noticeable side effects other than the lack of muscle crapms/spasms.
~20mg/day. 10mg in the morning, 10 in the evening. Inexact to a degree, as I don’t weigh it out and 20s don’t always break evenly in half. Sometimes I forget a dose and yet I don’t buy alcohol anymore or want to. My Study/Trial Researcher finds me an aberration compared to everybody else, but an interesting one, as he has a number of people in the 140-220mg per day every day range who still sometimes have problems.
We are back to “everybody is wired slightly different,” are we not? Best of luck to all, whatever course you find best.
baclofen is not metabolized in the liver. it has been proven safe at 300mg per day in patients for years. it is much safer than continuing to drink alcohol. what are the negative side affects of continuing the drink?
baclofen is very safe and worth a try. let’s see, a case of beer a day, or try baclofen. do we drink till be die or take baclofen and no alcohol. alcoholism is a biological disease that cannot be helped with AA. rehab only increase the craving by alcohol deprivation. the more you keep something away, the more it is wanted and craved for. the day folks walk out of rehab, they go for the drug.
I can honestly say that after reading ALL day about this drug or that drug..this treatment vs that one to “treat” alcoholism….makes me want to just f*cking drink myself to death…ALL IN ONE FRIGGIN NIGHT!! My HEAD is spinning with all of these opinions and ideas. After being burned SO many times over the years with various “diagnosis” and the various DRUGS they have given to treat these “conditions”…I just don’t know who or what to believe! But what I DO know…if I don’t find something that works….I am going to be either dead like my younger brother or completely a wreck like my mother, (who is 62 years old, just got kicked out of her FOURTH marriage and is living with her 86 year old mother…with NO prospects AT ALL for any kind of life other than as a drunk..) Personally, I would rather do what I read on one of the alcoholic blogs I was reading today: I will just have that one last binge drinking day and then drive my drunk ass self off a friggin cliff…….
sigh
Dr Gupta. It would be helpful if you could tell us more about your experiences with bacloven. What dosages are you using, what other medications are they taking, are you providing psychotherapy, and if so, what modality? I am particularly interested in working with people who have quit cold turkey–in one case, following a stroke, and in another case, because of an auto accident resulting in constant pain. In the latter, the patient is being given opioids, but is unable to return to work because of …. I don’t know why.
This Medication (Baclofen)I am on for the use of the treatment of my alcoholism…I have really suffered for years with this having gone to treatment centres and going to twelve step AA meetings faithfully…Baclofen thank god I got to read this Book of doctor Olivier Ameisen…and a hugely supportive intelligent doctor I have here willing to read his book and to prescribe Baclofen has, is a literal life saver for me…I am so great full for this medication it has totally cut my addiction out of my life and many more changes all totally positive…yea saved my life…you bet i’m great full to this very intelligent respectable doctor to put out what he personally went through and how he found this drug and expermimented as he bravely did…most people unless they have had alcoholism can never understand what it is like…you never will…i’m disgusted with the addiction community believing Cognitive therapy’s and 30 day stays at a treatment centres and a AA 80 year old spiritual awakening will cure this disease…I live in British Columbia in Canada…im totally profoundly great full to Doctor Olivier Ameisen!!!
What about using Baclofen to help people who are addicted to nicotine? Has it helped people stop smoking?
I found the article you written very interesting.
I realize that alcoholics and addicts do suffer and all individuals around them in some way are effected directly or indirectly.
While I am not an alcoholic, Ameisen’s reference to anxiety driving him to drive drink caused me to look into it at as well (I suffer from depression and social anxiety). Takine ~80-100mg a day seems to do wonders for both my depression and social anxiety. I don’t feel so awful anymore, and I actually desire contact with people again.
I read your book with great fascination, wonderful story . I discussed it with a friend who works for an Anhauser Busch distributor and he suggested going to the major brewers and distillers to look for funding for a study.
I am a family doctor. I read the book and have thus far started 5 patients on Baclofen for alcohol dependence. They had each failed or relapsed after AA, rehab programs or other treatments (acamprosate was helping one lady but she continued with troubling cravings and occasional binges). They had each had terrible problems due to their addiction. The dose range for them is 60-100 mg per day in divided doses.
All 5 (out of 5) are doing very well. The longest is at 4 months. I look forward to seeing how they do after longer experiences.
Interestingly the one smoker in the group gave up nicotine within the first few weeks of starting the baclofen! I am cautiously optimistic.
I read the book and have checked out a number of related article.
Dr N
Thanks-you for the fascinating posts and good luck to everyone in their searches – a couple of small points..
I am an acupuncturist in a detox centre but also have a background in study of body-based psychotherapy.
I have heard of people changing their addictive tendencies, their cravings going and so on when they experience a breakdown of their severe long-term bodily tensions (called armouring in orgone psychiatric therapy). It struck me that perhaps baclofen may work by reducing overall body ‘armouring’ (by relaxing the tense deep musculature) to the point whereby the person no longer experiences cravings. If you change the armouring you change the person’s psychic experience.
These effects I should imagine only occur at certain dosages strong enough to impact the body armouring, or deep musclular tension.
A note on the methodone – it is the hardest drug for me to treat withdrawals using acupuncture, I have to very strong treatments when the ‘meth’ addict is ‘rattling’. Clean heroin may be better in my opinion.
Please email me on leonsouthgate@gmail.com as I may not read further comments
Hi
Anyone who wants to know more about Baclofen and alcoholism should go to the Mywayout forums on Baclofen and other treatments. There are now thousands of people worldwide who are taking Baclofen according to Dr. Ameisen’s instructions and finding their alcoholism ending. My wife is one of them.
It is a cure!
Thanks Dr. Ameisen.
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I’m sitting here in 2016 so hopelessly desperate that, despite my ability to read all sides with a degree of understanding for what each is saying or feeling, I don’t give a fuck about whether or not society is ready, or what logical argument has been made against baclofen…I’m ready to try anything to give me a chance at a life I get to watch others around me have.
Unfortunately I have no intellectual comment to offer the diacussion, nor do I have enough energy to join the conversations debate in a challenging, stimulating way. All I have to offer is this: back in 2009, February 26th at 6:37am our friend, llewelly, wrote the brutal truth (which doesn’t make it right – and that’s not a personal attack on llewelly at all) that society isn’t ready to help their suffering because it’ll make them look foolish for all the years lost when they could have. I haven’t done much of any research to make a claim that this problem is eslusivle to the United States in terms of a society being too proud to admit, “woops we fucked up, we had some more resources to offer but couldn’t because we’d look like assholes ultimately so good luck addicts” but it’s easy for my mind to go there real quick and think the grass is greener elsewhere. Desperate for a solution anywhere.
I’m trying to overemphasize that I’m self recognizing that I have almost NO ability to remain an unbiased, unaffected party so as to help you understand I’m 100% emotionally driven when I furiously yell through the internet GROW THE FUCK UP SOCIETY, I’M LIVING HELL EVERYDAY. I’M TEASED WITH THIS HOPE OF GETTING A CHANCE TO FEEL LIKE I CAN FUNCTION NORMALLY WHEN A I CLEAN UP. THIS BULLSHIT HOPE THAT I’M AN ACTUAL ADULT LIKE THE REST OF SOCIETY, THAT SIMPLE ADULT REAPONSIBILITIES, LIKE FUCKING CALLING THE BANK WHEN SOMETHING SMALL AND INCONSEQUENTIAL NEEDS TO SIMPLY BE DISCUSSED, DOESN’T OVERWHELM ME TO THE POINT OF A PANIC ATTACK THAT’S BEEN DEEMED AS OVER DRAMATIC IN TURN MAKING ME FEEL THAT WHAT I AM HONESTLY FEELING THROUGH MY ENTIRE BEING IS THIS PATHETIC, WEAK, CHILDISH BEHAVIOR THAT SHOULDN’T BE TAKEN SERIOUSLY. I’M BROKEN. I’M DESPERATE. I DON’T WANT TO BE ME AS MUCH AS THE REST OF SOCIETY DOESN’T WANT ME TO BE ME. THIS MENTAL CAGE IS INDESCRIBABLY DOOMING.
This is no life. No one, NO ONE, deserves this. I truly hope each person who has commented and each person who visits and reads doesn’t know and will never have to know what this is. I hope you’re loved ones are never affected by this, and I truly hope that you are able to live a life with the ability to stop and say “I’m not going to partake in x,y or z activity because I have a healthy fear for the consequences that would await”.
I know that all my loved ones around me are just as confused and are in just as much pain in their own way because of my addiction. That just makes me feel shittier because of it, and I’m not trying to turn it around and back into “I’m the poor suffering addict”…no because of this addiction we (me and my loved ones) are the poor suffering bystanders. No one wins.
We’ve come a LONG way from where we’ve been, but we’ve got a FUCKING LONG way left to go. I only hope that society decides their ready in my lifetime (however long that may or may not be).
I’m sorry for that rant. Thank you for reading. I know I’m equally biased on the other spectrum…but this is all I’ve got to go off of. This life.
Been an opiate addict for 20 years stumbled across baclofen by accident and the book is right didn’t want drugs (opiates). Actually all drugs. I do all drugs. I even tried opiates on it and didn’t fill high. I didn’t take a large amount, at least not to my standards. I am very interested in this baclofen study.
Thank you for sharing 😊😄😀😃😅😂
Jesse