Abstinence and 'Low-Risk' Consumption 1 Year After the Initiation of High-Dose Baclofen
A Retrospective Study Among ‘High-Risk’ Drinkers
Laurent Rigal; Constance Alexandre-Dubroeucq; Renaud de Beaurepaire; Claire Le Jeunne; Philippe Jaury
Alcohol Alcohol. 2012;47(4):439-42. © 2012 Oxford University Press
This is a retrospective study of 181 patients, each 12 months after beginning high dose baclofen for alcohol dependence. The average dose was 145 mg per day (min = 30, max = 400) much higher than the 10 mg TID seen in other studies. Patients were gradually titrated upward "progressively (steps of 15 mg/week, then 30 if possible, according to tolerance) until it abolished craving, to the extent possible".
Of the original 181 patients, 132 were still available for follow up at 12 months. 78 patients were abstinent, 28 were drinking at low levels, which leaves 26 still drinking heavily. If we assume the patients lost to follow up were also drinking heavily (worst case scenario) then of the original cohort 43% were abstinent, 15% had mild alcohol use and 41% continued to drink heavily.
The average alcohol use at the start of the study was 182 grams per day, 13 standard drinks per day in the USA. Low risk drinking was defined as less than 40 grams daily, less than 3 standard drinks.
86% had some adverse effect, usually transient, during dose increases, and sometimes while drinking alcohol. Baclofen increased somnolence and confusion induced by alcohol, as we would expect for a GABA drug. Only six patients stopped their treatment . Only 6 of the patients stated that they stopped the medication due to adverse effects.
It is noted that the authors did not confirm alcohol use or abstinence by family reports or by biological testing.
The authors are very supportive of reduced drinking, short of abstinence, as a therapeutic goal.
At least some more doctors in France are offering very high dose baclofen for alcoholism. The overall sobriety rate of 43% and 15% drinking less is hopeful but not incredibly impressive. Since this wasn't a controlled trial we can't speak to whether the benefit was due to the medication itself or placebo effect or provider support or even regression to the mean as the authors point out.
There are risks to baclofen, perhaps less in the using than in the stopping. This GABA-B agonist can have it's own withdrawal, similar to benzodiazepine or alcohol withdrawal although the incidence may be less often.
This study at least suggests, that if we do want to try baclofen to help a patient quit drinking, ongoing alcohol use or cravings might be treated with increasing dose to high levels rather than abandoning the effort.
The average alcohol use at the start of the study was 182 grams per day, 13 standard drinks per day in the USA. Low risk drinking was defined as less than 40 grams daily, less than 3 standard drinks.
86% had some adverse effect, usually transient, during dose increases, and sometimes while drinking alcohol. Baclofen increased somnolence and confusion induced by alcohol, as we would expect for a GABA drug. Only six patients stopped their treatment . Only 6 of the patients stated that they stopped the medication due to adverse effects.
It is noted that the authors did not confirm alcohol use or abstinence by family reports or by biological testing.
The authors are very supportive of reduced drinking, short of abstinence, as a therapeutic goal.
This study also renews the questions about abstinence. A reduction in craving allowed some patients to advance towards abstinence and to maintain this state without having to experience the personal hardships of detoxification (Ameisen, 2008). This change is likely to modify the individual's experience of treatment by limiting the usual feelings of guilt and failure. Abstinence is neither a preliminary requirement nor an objective that can be met only in pain. And, if some patients succeed in maintaining moderate consumption, should we not prefer consumption at low risk to abstinence as the principal endpoint of trials (European Medicines Agency, 2010)?What does this mean?
At least some more doctors in France are offering very high dose baclofen for alcoholism. The overall sobriety rate of 43% and 15% drinking less is hopeful but not incredibly impressive. Since this wasn't a controlled trial we can't speak to whether the benefit was due to the medication itself or placebo effect or provider support or even regression to the mean as the authors point out.
There are risks to baclofen, perhaps less in the using than in the stopping. This GABA-B agonist can have it's own withdrawal, similar to benzodiazepine or alcohol withdrawal although the incidence may be less often.
This study at least suggests, that if we do want to try baclofen to help a patient quit drinking, ongoing alcohol use or cravings might be treated with increasing dose to high levels rather than abandoning the effort.
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