High-dose baclofen for alcohol treatment

Oliver Ameisen, an associate professor of medicine and cardiologist at Weill Medical College of Cornell University, reported in Alcohol and Alcoholism that he successfully used high-dose baclofen as an alcohol treatment and achieved complete and prolonged suppression of symptoms of his own alcohol dependence (2005).

Ameisen had been diagnosed with alcohol dependence and comorbid anxiety disorder. He reports that his anxiety disorder preceded his addiction to alcohol. He had tried other medications for alcohol dependence with no success. Ameisen decided to try baclofen, a gamma-amino butyric acid receptor agonist that is used to control spasticity. Previous research showed that baclofen had reduced alcohol craving in alcohol dependent patients and suppressed cocaine self-administration in rats; baclofen has also been used to treat anxiety disorders. Previous animal research showed that the motivation-suppressing effect of baclofen was dose-dependent. Ameisen postulated that at high doses, baclofen might suppress alcohol craving.

Ameisen self-prescribed baclofen starting at 30 mg/day and increased by 20 mg increments every third day (with an additional 20 to 40 mg/day to combat craving). He notes that neurologists safely use up to 300 mg/day for controlling spasticity. After 5 weeks, he reached a dose of 270 mg/day and experienced suppression of alcohol craving. Ameisen reports that his symptoms of alcohol dependence were suppressed (for a total of nine months at the time of the report), and his anxiety was well controlled.

“At the end of my ninth month of complete liberation from symptoms of alcohol dependence, I remain indifferent to alcohol, “Ameisen wrote. Abstinence has become natural to me. I no longer plan my life around alcohol. Alcohol thoughts no longer occur. I undertook personal and professional projects, which I was unable to do so before as I had to anticipate consequences of unpredictable drinking episodes (canceling appointments when possible and blackouts). As taught in [cognitive-behavioral therapy], I avoided places, situations, social settings, and vacations where alcohol might have been present. I no longer notice liquor sections in supermarkets. Some of these changes have been pointed out to me by relatives and friends. I no longer suffer anticipatory anxiety of relapse, of embarrassing or dangerous alcohol-related situations. I am no longer depressed about having an incurable stigmatizing disease. Liberation from symptoms of alcohol dependence substantially improved my self-esteem.”

“High-dose baclofen induced complete and prolonged suppression of symptoms and consequences of alcohol dependence, and relieved anxiety,” he continued. “This model, integrating cure and well-being, should be tested in randomized trials, under medical surveillance. It offers a new concept: medication-induced, dose-dependent, complete and prolonged suppression of substance-dependence symptoms with alleviation of comorbid anxiety.”

Although Ameisen reported success with high-dose baclofen and called for further trials, no trials have been reported at this time five years later. However, some trials have been conducted to test Ameisen’s model of baclofen therapy for cocaine addiction. Note that the discontinuation of baclofen itself may cause withdrawal symptoms similar to benzodiazepine or alcohol withdrawal symptoms, including hallucinations, confusion, agitation, insomnia, anxiety, depersonalization, and mood disturbances. Baclofen withdrawal symptoms are more likely with abrupt discontinuation.

Reference

Ameisen, O. Complete and prolonged suppression of symptoms and consequences of alcohol-dependence using high-dose baclofen: a self-case report of a physician. Alcohol and Alcoholism. 2005; 40(2): 147-150.