Baclofen is a medication that can be used for the treatment of addiction to alcohol. It is a medication that has been around for a long time, initially used as a muscle relaxant that was prescribed to treat muscle spasms. Today, it can be a very useful drug for people who have difficulty controlling their alcohol use.
How Baclofen Works
Alcohol primary acts on the GABA-A receptor in the brain, causing psychological relaxation and temporary relief from stress and anxiety. In some patients, alcohol use can be directly tied to stress, and emotional issues. For these types of patients, taking a medication such as Baclofen, one that works on the GABA system, can be quite helpful.
Some people drink, in part, to calm symptoms of anxiety and stress. In this type of patient, when the alcohol is taken away, the original anxiety becomes symptomatic, along with new alcohol withdrawal anxiety. So now the patient has to deal with two types of anxiety. This type of psychological stress can be one of the reasons for continued heavy drinking. It also can be the reason for relapse in patients who have been successful in achieving abstinence for a period of weeks, months or even years.
Baclofen mainly works at the GABA-B receptor site in the brain. In addition to muscular relaxation, it also causes psychological relaxation, giving relief from stress and tension. It can be thought of as a “parallel agonist” to alcohol. It works on the GABA receptor system, but in a different way than alcohol. It alleviates the underlying stress and anxiety from alcohol withdrawal and cravings.
Baclofen has a secondary action: It limits or “attenuates” the neurotransmitter dopamine in the brain. Dopamine is responsible for the euphoric and rewarding effects of alcohol. Consequently, Baclofen also decreases the positive feedback loop associated with alcohol consumption. This helps the brain “unlearn” the rewarding effect of excessive alcohol consumption.
Baclofen treatment requires starting the medication at a low dosage, and “titrating” the medication up to higher doses. This is because the medication can have mild side-effects including fatigue, lightheadedness, and nausea. But they are transient, resolving after a few days. However, the unwanted symptoms can be largely avoided by starting the medicine at a low dose, and increasing gradually until alcohol cravings are reduced or eliminated. This titration from a low to a high dose, for purposes of avoiding significant side-effects, can take some time. It is usually up to several months before the dose has been titrated up to an adequate level to achieve a reduction or elimination in alcohol use.
Additionally, Baclofen is a “short acting” medication. It’s effect usually lasts just five to six hours. Consequently, it needs to be taken three times per day. For Baclofen to be effective in reducing alcohol use, it is essential that the patient be compliant in taking the medication a minimum of three times per day as prescribed.
Baclofen is the most effective GABA medication that is prescribe for alcohol addiction. The medication can be very effective for many people who identify themselves as alcoholics or heavy drinkers. Many patients who start Baclofen describe a significant loss of cravings, and a progressive indifference to alcohol. Some patients using Baclofen stop drinking completely within several months of starting the medication. Others significantly reduce their drinking to a healthier level. I have found Baclofen to be helpful for some patients who want to comfortably moderate their drinking. They achieve control of their alcohol use, rather than the alcohol controlling them.
In my addiction practice, I treat many high functioning people with stressful jobs who will not drink during the workday. However, drinking to relieve stress will start almost immediately when the workday is over. The alcohol provides relief from the anxiety, tensions, and stressors of the day. Baclofen works by treating these symptoms without the intoxication of alcohol. With this type of biological treatment for alcoholism, patients are able to reduce their drinking. Then if they choose, they can stop drinking altogether.
We utilize Baclofen in conjunction with naltrexone in our Sinclair Method (TSM) practice when appropriate.
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