Baclofen was designed as a muscle relaxant. But a small group of physicians now prescribe it to patients suffering from alchoholism as a way to reduce patients’ craving for alchohol. Rehman Tungekar spoke with doctors and patients using the medication to help kick the habit.
Rebecca agreed to meet in a quiet park, where there would be few people to overhear her speaking. Her real name isn’t Rebecca - she asked for an alias to be used. Rebecca’s been drinking since she was a teenager, but it was only in the past two years that she really began drinking excessively. “Oftentimes I would black out,” she recounted, “and every time I did it I would tell myself ‘Well, I’m not going to do that tomorrow night.’ And yet I did.”
In the past, Rebecca had tried Alcoholics Anonymous and even saw an addiction specialist, but it never seemed to be enough. “I think my drinking improved for a bit, but then it just kind of went back to drinking excessively,” she said, “so I really decided to start researching pharmacological agents to help with alcoholism.”
She began reading promising accounts about a drug called baclofen, and eventually was able to locate a doctor that was willing to prescribe it to her. “I’ve never felt so much hope in my life,” she recalled, “and when I talked to him and he told me, ‘I have every confidence this will work for you, you’re not going to have to live like this anymore,’ I hung up the phone and I cried.”
Dr. Fred Levin is an Associate Professor of Clinicial Psychiatry and Behavioral Sciences at Northwestern University. He’s also Rebecca’s prescribing physician, and for the past several months, he’s coached her and others through the recovery process.
He only began prescribing baclofen recently. Like Rebecca, he read an account by a French cardiologist named Olivier Ameisen, who used the drug to treat his own alcohol addiction. In the past year and a half, Dr. Levin has treated as many as 300 patients who were addicted, many of whom have gotten better.
Baclofen has been used safely for decades as a muscle relaxant. It’s believed to stimulate a neural receptor called GABA-B, which consequently leads to a reduction in the release of dopamine, a neurotransmitter associated with the brain’s reward system. Doctors who prescribe baclofen for addiction argue that this reduction could lead to a suppression of craving. And it may not be limited to just alcohol. Dr. Levin believes the drug could treat a variety of addictions, ranging from heroin, to cocaine to alcohol.
But not everyone agrees. Dr. Dan Angres is the Medical Director of the Resurrection Addiction Services Program and a Clinical Associate Professor of Psychiatry at Rush Medical College. He believes there isn’t sufficient data for him to begin using it in his practice. “I think we always have to be careful for any kind of quick fix for something as complex as addiction,” Dr. Angres cautioned.
Baclofen isn’t FDA approved to treat addiction, and the recommended dose for muscle spasms is lower than what addicts are prescribed. While doctors are able to prescribe medications for symptoms they weren’t approved for – which is called off-label use – the few randomized controlled trials assessing baclofen’s efficacy have shown mixed results. And questions still remain over the long term effects of baclofen in high doses. A large clinical trial set to begin at the University of Amsterdam may shed light on baclofen’s ability to treat alcoholism, but until then, physicians like Dr. Levin remain convinced, “How could I see 300 people and only have two failures? Come on, that doesn’t make any sense at all.”
There are also the side effects. Some users of baclofen complain of insomnia, lethargy and even hallucinations. Early on, even Rebecca found that she had difficulty concentrating. But Dr. Levin maintains that any unwanted side effects could be caused by improperly following his dosing protocol.
Despite the risks, Rebecca says she wasn’t worried. She was determined to reach what she calls, “the switch.” “It’s where you reach a point where alcohol doesn’t matter anymore,” she said, “so I decided to stop working to find the switch.”
By her own reckoning, Rebecca’s on her way to becoming healthy. She hit her switch several weeks ago, but had to lower her dose because of complicating side effects. She’s working back up to it though, and doesn’t plan on giving up anytime soon.
Music Button: Do Make Say Think, “Soul and Onward”, from the CD And Yet And Yet, (Constellation)