Baclofen: the controversial pill that could 'cure' alcoholism
September 19, 2016 8:26 AM Subscribe
France is ground zero for clinical research on Baclofen, a drug said to eliminate alcohol cravings. The medication will soon be more accessible than ever – but not everyone thinks that’s a good thing. (slTheGrauniad)
Very cool, thanks for sharing.
Can anyone share speculations on a mechanism of action?
posted by cotton dress sock at 8:36 AM on September 19, 2016
Can anyone share speculations on a mechanism of action?
posted by cotton dress sock at 8:36 AM on September 19, 2016
(GABA, apparently, but why is it having this effect at high doses? And what is causing psychosis?)
posted by cotton dress sock at 8:42 AM on September 19, 2016
posted by cotton dress sock at 8:42 AM on September 19, 2016
The drug may indeed be amazing, but god, the state of science journalism:
French doctors, she says, are quick to fight back with a utilitarian reasoning: if Baclofen can help half of the 120 people a day who die from alcohol-related diseases while only a tiny percentage experience severe side-effects, there’s no question it should be used.
AAARGH, that is not how medicine works, Grauniad.
posted by Mayor West at 8:55 AM on September 19, 2016 [5 favorites]
French doctors, she says, are quick to fight back with a utilitarian reasoning: if Baclofen can help half of the 120 people a day who die from alcohol-related diseases while only a tiny percentage experience severe side-effects, there’s no question it should be used.
AAARGH, that is not how medicine works, Grauniad.
posted by Mayor West at 8:55 AM on September 19, 2016 [5 favorites]
This new research is also interesting, albeit far from giving a clinical treatment.
posted by thelonius at 9:06 AM on September 19, 2016 [1 favorite]
posted by thelonius at 9:06 AM on September 19, 2016 [1 favorite]
jonmc: "Well, I figure the French wine industry won't be thrilled."
Interestingly enough, it's the rehab industry that isn't thrilled, according to TFA.
That may be a feature, not a bug.
posted by chavenet at 9:06 AM on September 19, 2016 [23 favorites]
Interestingly enough, it's the rehab industry that isn't thrilled, according to TFA.
That may be a feature, not a bug.
posted by chavenet at 9:06 AM on September 19, 2016 [23 favorites]
AAARGH, that is not how medicine works, Grauniad.
Actually, my highly regarded oncologist has much the same attitude. I had infusions of a targeted therapy drug called Herceptin for a year to treat early stage breast cancer. In some patients it can cause congestive heart failure but the occurrence is less than 1%, and my doctor told me, "We don't make treatment decisions for the 1%. I'm not going to withhold a life-saving drug based upon the small chance of side effects." So I don't know what the risk of psychosis for Baclofen is, but if the incidence is really that low and it can be reversed upon stopping the drug, I'd imagine most physicians would at least give it a go.
I appreciate the last part of the article, the "one size doesn't fit all addicts" section. I have a husband who whose life was saved by the 12 steps, and a father who tried everything for decades and died a drunk. For some people, nothing we have right now gives them a reliable fighting chance against this disease, and I appreciate every effort to explore these therapies.
posted by something something at 9:06 AM on September 19, 2016 [38 favorites]
Actually, my highly regarded oncologist has much the same attitude. I had infusions of a targeted therapy drug called Herceptin for a year to treat early stage breast cancer. In some patients it can cause congestive heart failure but the occurrence is less than 1%, and my doctor told me, "We don't make treatment decisions for the 1%. I'm not going to withhold a life-saving drug based upon the small chance of side effects." So I don't know what the risk of psychosis for Baclofen is, but if the incidence is really that low and it can be reversed upon stopping the drug, I'd imagine most physicians would at least give it a go.
I appreciate the last part of the article, the "one size doesn't fit all addicts" section. I have a husband who whose life was saved by the 12 steps, and a father who tried everything for decades and died a drunk. For some people, nothing we have right now gives them a reliable fighting chance against this disease, and I appreciate every effort to explore these therapies.
posted by something something at 9:06 AM on September 19, 2016 [38 favorites]
Well, I figure the French wine industry won't be thrilled.
The people who need this drug are not drinking French or high end wines, lol. When I see folks panhandling on the street I try to give them as much as I can to help them buy a can of high-alcohol beer. Detox is terrible, they have to go through it day after day after day, and the only thing that immediately helps is getting some alcohol into their system.
If this new drug can help them get off alcohol (without side-effects), that's a good thing.
posted by My Dad at 9:07 AM on September 19, 2016 [7 favorites]
The people who need this drug are not drinking French or high end wines, lol. When I see folks panhandling on the street I try to give them as much as I can to help them buy a can of high-alcohol beer. Detox is terrible, they have to go through it day after day after day, and the only thing that immediately helps is getting some alcohol into their system.
If this new drug can help them get off alcohol (without side-effects), that's a good thing.
posted by My Dad at 9:07 AM on September 19, 2016 [7 favorites]
The article states that lots of functioning alcoholics were using the drug. Not just panhandlers.
posted by Ferreous at 9:09 AM on September 19, 2016 [4 favorites]
posted by Ferreous at 9:09 AM on September 19, 2016 [4 favorites]
Not that it would really hurt the bottom line of french wine overall, but let's not pretend that the only people who can use help getting off booze are homeless people.
posted by Ferreous at 9:10 AM on September 19, 2016 [20 favorites]
posted by Ferreous at 9:10 AM on September 19, 2016 [20 favorites]
Since it's being prescribed off-label, and people are shopping around to other countries to get it, or coming up with their own dosages, there's a lot of chance of overdose or other side-effects. When the marketplace is your doctor it can be lethal, but then, desperate people don't care.
I guess I shouldn't be surprised that it ended up being prescribed for weightloss. I fully expect to see dodgy ads for it for that purpose before long, whether or not it does anything to help/is safe.
posted by emjaybee at 9:21 AM on September 19, 2016 [1 favorite]
I guess I shouldn't be surprised that it ended up being prescribed for weightloss. I fully expect to see dodgy ads for it for that purpose before long, whether or not it does anything to help/is safe.
posted by emjaybee at 9:21 AM on September 19, 2016 [1 favorite]
Baclofen is also used to treat migraine and chronic daily headache. FWIW.
I was recently hospitalized for 10 days for headache. One of the reasons they hospitalize you is that they can give higher doses and do quick med changes, with medical staff right there to monitor for side effects and efficacy. (Also so they can give medications in ways that can't be done at home, such as via IV). If Baclofen has promise as an anti-addiction medication, but causes side effects like psychosis in some people, perhaps a protocol like that will develop. Perhaps it will become a part of in-patient rehab, for example.
With headache, a great many medications from all kinds of drug families are effective for some people, and ineffective for others. While I was on the head pain unit, two of us got amazing results from lidocaine nasal spray; two other people tried it and said all it did was make their eyes burn. With meds that work, it's not always clear what the mechanism is. And there are a number of effective medications that were discovered accidentally. Botox, for example, started being used for headache after some people using it mentioned to their doctors that they'd had fewer headaches since starting Botox for cosmetic reasons. Benadryl in IV or intra-muscular injection is also very effective for headaches, but the pill form does nothing for headaches. This was also discovered via patient report after being given IV Benadryl for other purposes.
Of course, headache medicine is a wild frontier of trial-and-error, where many, many meds are used off-label in the attempt to help the suffering.
posted by not that girl at 9:21 AM on September 19, 2016 [12 favorites]
I was recently hospitalized for 10 days for headache. One of the reasons they hospitalize you is that they can give higher doses and do quick med changes, with medical staff right there to monitor for side effects and efficacy. (Also so they can give medications in ways that can't be done at home, such as via IV). If Baclofen has promise as an anti-addiction medication, but causes side effects like psychosis in some people, perhaps a protocol like that will develop. Perhaps it will become a part of in-patient rehab, for example.
With headache, a great many medications from all kinds of drug families are effective for some people, and ineffective for others. While I was on the head pain unit, two of us got amazing results from lidocaine nasal spray; two other people tried it and said all it did was make their eyes burn. With meds that work, it's not always clear what the mechanism is. And there are a number of effective medications that were discovered accidentally. Botox, for example, started being used for headache after some people using it mentioned to their doctors that they'd had fewer headaches since starting Botox for cosmetic reasons. Benadryl in IV or intra-muscular injection is also very effective for headaches, but the pill form does nothing for headaches. This was also discovered via patient report after being given IV Benadryl for other purposes.
Of course, headache medicine is a wild frontier of trial-and-error, where many, many meds are used off-label in the attempt to help the suffering.
posted by not that girl at 9:21 AM on September 19, 2016 [12 favorites]
Those are some monster doses. I have been prescribed Baclofen, not for alcoholism, but for the current on-label use as a muscle relaxant. The pills I had were 10mg and the doctor said to cut them in half.
FWIW, it didn't help my symptoms. But at least it didn't give me those side effects.
posted by elizilla at 9:27 AM on September 19, 2016 [1 favorite]
FWIW, it didn't help my symptoms. But at least it didn't give me those side effects.
posted by elizilla at 9:27 AM on September 19, 2016 [1 favorite]
OMG yes, the history of my migraine treatments is a seemingly endless series of shots in the dark. All bodies are not created equal. I know what it's like to be so desperate for a remedy that you don't care about the the danger of a new treatment if it offers any hope.
It can be incredibly frustrating when one treatment is the gold standard for most people but it just doesn't work on you, and so many insurance companies won't pay for one treatment unless you've tried all the others first.
Anyway, enough rambling. The more weapons in the arsenal the better.
posted by The Underpants Monster at 9:30 AM on September 19, 2016 [1 favorite]
It can be incredibly frustrating when one treatment is the gold standard for most people but it just doesn't work on you, and so many insurance companies won't pay for one treatment unless you've tried all the others first.
Anyway, enough rambling. The more weapons in the arsenal the better.
posted by The Underpants Monster at 9:30 AM on September 19, 2016 [1 favorite]
Interesting. My father used to take baclofen as a muscle relaxant for MS tremors and spasticity /muscle spasms.
It's been around for a long time.
posted by zarq at 9:39 AM on September 19, 2016 [2 favorites]
It's been around for a long time.
posted by zarq at 9:39 AM on September 19, 2016 [2 favorites]
Wasn't there an article a year or two ago about dopamine antagonists being used to treat alcoholism?
I'm glad to see people are approaching addiction from a medical standpoint rather than a moral standpoint. Even if none of the currently available drugs work, simply researching alcoholism from a medical standpoint seems like a great step forward.
posted by sotonohito at 9:41 AM on September 19, 2016 [16 favorites]
I'm glad to see people are approaching addiction from a medical standpoint rather than a moral standpoint. Even if none of the currently available drugs work, simply researching alcoholism from a medical standpoint seems like a great step forward.
posted by sotonohito at 9:41 AM on September 19, 2016 [16 favorites]
Interesting article. Thanks to Kitteh for posting it! A couple thoughts:
One thing I would be interested in is a comparison of Baclofen not just to placebo, but to other pharmacological treatments, especially naltrexone. Naltrexone is also prescribed to diminish cravings for alcohol and to reduce the pleasurable effects of alcohol. As far as I know, it has a lower side effect profile, and it is generally prescribed at a standard dose of 50 mg. There are some important side effects; one concern is the effect it can have on the liver and also there's the fact that it eliminates any response to opiates, so if you break your leg, you won't get relief from oxycodone/hydrocodone/etc.
Personally, I didn't find naltrexone that helpful when it came to quitting alcohol, but it made a huge difference for me in quitting smoking. Smoking cessation is an off label use, and I only discovered this use by chance. I was on Wellbutrin+naltrexone for awhile. (Wellbutrin is prescribed as an antidepressant but also as a smoking cessation aid.) At the time, my cigarette cravings were more manageable, and I also found I couldn't chain smoke the way I used to when I wasn't on the drugs. Then I relapsed with alcohol, went off both meds, and then later, got sober and just went back on the Wellbutrin. (I started taking antabuse instead of naltrexone.)
Suddenly, the Wellbutrin wasn't helping as much with the smoking cravings. I was back to constantly wanting to smoke, and chain smoking frequently. (Terrible, I know.) I couldn't figure out what the difference was, but then I read or heard something about naltrexone possibly being used for cigarette cravings. The research is mixed, but I decided to give it a shot, and I started taking the naltrexone as well, and it made such a big difference in the smoking cravings. Night and day. (I've now been alcohol and cigarette free for several years.)
Anyway, that was a somewhat tangential ramble, but I do think it highlights the fact that there's a lot we don't know about treating addiction, and also, different people really do have different responses to things. Still, considering the fact that naltrexone seems to have a lower side effect profile, I definitely think it makes more sense as a first line treatment. Of course, there's also antabuse*, but that doesn't help at all with cravings. It's pure deterrent.
*I actually begged to be put on antabuse, and I still take it, because I know impulse control is not my strong suit, and I sleep a lot better at night knowing I couldn't get drunk even if I wanted to. I mean, I could try, but it would end in vomiting and other horribleness. You can always stop taking it, of course, although it stays in your system for awhile. Still, it's really only useful for someone who is fully committed to long term sobriety.
posted by litera scripta manet at 9:57 AM on September 19, 2016 [15 favorites]
One thing I would be interested in is a comparison of Baclofen not just to placebo, but to other pharmacological treatments, especially naltrexone. Naltrexone is also prescribed to diminish cravings for alcohol and to reduce the pleasurable effects of alcohol. As far as I know, it has a lower side effect profile, and it is generally prescribed at a standard dose of 50 mg. There are some important side effects; one concern is the effect it can have on the liver and also there's the fact that it eliminates any response to opiates, so if you break your leg, you won't get relief from oxycodone/hydrocodone/etc.
Personally, I didn't find naltrexone that helpful when it came to quitting alcohol, but it made a huge difference for me in quitting smoking. Smoking cessation is an off label use, and I only discovered this use by chance. I was on Wellbutrin+naltrexone for awhile. (Wellbutrin is prescribed as an antidepressant but also as a smoking cessation aid.) At the time, my cigarette cravings were more manageable, and I also found I couldn't chain smoke the way I used to when I wasn't on the drugs. Then I relapsed with alcohol, went off both meds, and then later, got sober and just went back on the Wellbutrin. (I started taking antabuse instead of naltrexone.)
Suddenly, the Wellbutrin wasn't helping as much with the smoking cravings. I was back to constantly wanting to smoke, and chain smoking frequently. (Terrible, I know.) I couldn't figure out what the difference was, but then I read or heard something about naltrexone possibly being used for cigarette cravings. The research is mixed, but I decided to give it a shot, and I started taking the naltrexone as well, and it made such a big difference in the smoking cravings. Night and day. (I've now been alcohol and cigarette free for several years.)
Anyway, that was a somewhat tangential ramble, but I do think it highlights the fact that there's a lot we don't know about treating addiction, and also, different people really do have different responses to things. Still, considering the fact that naltrexone seems to have a lower side effect profile, I definitely think it makes more sense as a first line treatment. Of course, there's also antabuse*, but that doesn't help at all with cravings. It's pure deterrent.
*I actually begged to be put on antabuse, and I still take it, because I know impulse control is not my strong suit, and I sleep a lot better at night knowing I couldn't get drunk even if I wanted to. I mean, I could try, but it would end in vomiting and other horribleness. You can always stop taking it, of course, although it stays in your system for awhile. Still, it's really only useful for someone who is fully committed to long term sobriety.
posted by litera scripta manet at 9:57 AM on September 19, 2016 [15 favorites]
Anything that looks promising I'll grab onto with both hands. People who haven't had to deal with what terminal alcoholism looks like up front have no idea. As a culture that seems to be in a permanent collective moral panic about any number of drugs, we've just seemed to come to accept that a certain percentage of people will be chewed up and destroyed by a substance that one is expected to be surrounded by in order to engage with society. Like prison rape, "the shakes" has become a cliched joke that masks the outrageous cruelty of acquiescing to people dying of convulsions in a filthy alley because they can't get their hands on a drink and we have decided that "tough love" beats treating their problem like a medical one.
posted by [expletive deleted] at 10:00 AM on September 19, 2016 [39 favorites]
posted by [expletive deleted] at 10:00 AM on September 19, 2016 [39 favorites]
This is a crazy thing I learned: In Russia they sometimes give people Antabuse-releasing implants, although there are crooked clinics that give placebo ones.
posted by thelonius at 10:00 AM on September 19, 2016
posted by thelonius at 10:00 AM on September 19, 2016
Not that it would really hurt the bottom line of french wine overall, but let's not pretend that the only people who can use help getting off booze are homeless people.
Absolutely, but panhandlers (who are not the only people who are going to benefit from this drug) typically don't have the money to pay for booze, and when they ask to get money for booze (because they biologically need it) are judged pretty harshly.
My actual point was "the French wine industry" likely is not opposed to this drug, since they don't depend on alcoholics as their main revenue source. I say this as someone who lives in a jurisdiction that imposes a "sin tax" on booze because of traditional Puritan attitudes towards alcohol, making it more expensive for me to enjoy fine French wine in the first place!
posted by My Dad at 10:10 AM on September 19, 2016
Absolutely, but panhandlers (who are not the only people who are going to benefit from this drug) typically don't have the money to pay for booze, and when they ask to get money for booze (because they biologically need it) are judged pretty harshly.
My actual point was "the French wine industry" likely is not opposed to this drug, since they don't depend on alcoholics as their main revenue source. I say this as someone who lives in a jurisdiction that imposes a "sin tax" on booze because of traditional Puritan attitudes towards alcohol, making it more expensive for me to enjoy fine French wine in the first place!
posted by My Dad at 10:10 AM on September 19, 2016
I'm glad to see people are approaching addiction from a medical standpoint rather than a moral standpoint. Even if none of the currently available drugs work, simply researching alcoholism from a medical standpoint seems like a great step forward.
Agreed. The moral issue is a HUGE reason why the US is so stuck on AA as the end-all, be-all for treating alcoholics. I think AA as a treatment appeals to the moral concept that you need to suffer and be penitent for your "sins". That those sins should be treated with 80 year old superstitions that revolve around getting yourself right with God rather than medical science.
The idea that the court system and most rehab facilities rely on a mental health "treatment" that was developed at the same time as the frontal lobotomy craze tells me that we're doing it wrong. Somewhere around 6% of alcoholics successfully quit because of AA, which is about the same number as just quit cold turkey. Don't get me wrong, if AA works for you, that's awesome. But when 94% of people with alcohol issues are just out of luck as far as US health care is concerned, we have a serious issue.
I personally have had great success with self-medication of 50mg of Emoxypine twice a day. Within a few days, my desire to drink just went away. I just don't think about it anymore and I don't really enjoy the feeling when I've had a beer with friends.
I guess what I'm saying is that there are a lot of avenues of treatment for alcoholism that we're just not exploring. I suspect that there is a lot of pressure from the highly lucrative rehab industry to not change anything. And probably pressure from AA zealots and other "moral" people who think that the suffering that comes from AA, rehab and so on are an important part of the treatment.
posted by ensign_ricky at 10:18 AM on September 19, 2016 [27 favorites]
Agreed. The moral issue is a HUGE reason why the US is so stuck on AA as the end-all, be-all for treating alcoholics. I think AA as a treatment appeals to the moral concept that you need to suffer and be penitent for your "sins". That those sins should be treated with 80 year old superstitions that revolve around getting yourself right with God rather than medical science.
The idea that the court system and most rehab facilities rely on a mental health "treatment" that was developed at the same time as the frontal lobotomy craze tells me that we're doing it wrong. Somewhere around 6% of alcoholics successfully quit because of AA, which is about the same number as just quit cold turkey. Don't get me wrong, if AA works for you, that's awesome. But when 94% of people with alcohol issues are just out of luck as far as US health care is concerned, we have a serious issue.
I personally have had great success with self-medication of 50mg of Emoxypine twice a day. Within a few days, my desire to drink just went away. I just don't think about it anymore and I don't really enjoy the feeling when I've had a beer with friends.
I guess what I'm saying is that there are a lot of avenues of treatment for alcoholism that we're just not exploring. I suspect that there is a lot of pressure from the highly lucrative rehab industry to not change anything. And probably pressure from AA zealots and other "moral" people who think that the suffering that comes from AA, rehab and so on are an important part of the treatment.
posted by ensign_ricky at 10:18 AM on September 19, 2016 [27 favorites]
I have taken baclofen for MS symptoms. I can't believe people are taking 340 mgs in a matter of weeks and still able to walk. They tried to bump me up to 150 mg by mouth and I couldn't take the side effects, and my walking got worse at that high a dose.
I really understand the desperation behind wanting the compulsion to drink removed, but this sounds like it's own little trip to hell before, maybe, you might get better. Yikes!
posted by cairnoflore at 10:33 AM on September 19, 2016 [3 favorites]
I really understand the desperation behind wanting the compulsion to drink removed, but this sounds like it's own little trip to hell before, maybe, you might get better. Yikes!
posted by cairnoflore at 10:33 AM on September 19, 2016 [3 favorites]
There's a Radiolab about this: The Fix
posted by fiTs at 10:34 AM on September 19, 2016 [3 favorites]
posted by fiTs at 10:34 AM on September 19, 2016 [3 favorites]
cairnoflore: "I really understand the desperation behind wanting the compulsion to drink removed, but this sounds like it's own little trip to hell before, maybe, you might get better."
Well a few weeks or even months of hell compared to years of alcoholism culminating in death seems like a pretty good trade.
posted by Mitheral at 10:42 AM on September 19, 2016 [3 favorites]
Well a few weeks or even months of hell compared to years of alcoholism culminating in death seems like a pretty good trade.
posted by Mitheral at 10:42 AM on September 19, 2016 [3 favorites]
Yeah, alcohol is kind of an unusual drug. Nothing else uses the same GABA pathway. And I really think that a lot of people use it to self-medicate for anxiety and other issues. So if this is a less deadly way to get the same effect, I'm all for it.
Relatedly, if you're interested in a scientific and non-moralizing look at drugs and drug policy, I cannot recommend Drugs without the Hot AIr highly enough.
posted by Zarkonnen at 10:44 AM on September 19, 2016 [3 favorites]
Relatedly, if you're interested in a scientific and non-moralizing look at drugs and drug policy, I cannot recommend Drugs without the Hot AIr highly enough.
posted by Zarkonnen at 10:44 AM on September 19, 2016 [3 favorites]
I have enough mental health issues in my family that past generations treated with (sometimes terminal) alcoholism to be very convinced that a lot of alcoholics use alcohol to self-medicate some pre-existing chemical imbalance that the intoxicant/depressive/addictive aspects of alcohol make worse over time. This drug sounds like a godsend for a hell of a lot of people.
posted by moonlight on vermont at 10:47 AM on September 19, 2016 [5 favorites]
posted by moonlight on vermont at 10:47 AM on September 19, 2016 [5 favorites]
Baclofen helped me with alcohol cravings. I doubt my physician would prescribe it, though, so I went to on overseas pharmacy. There were no particular side effects that you wouldn't expect from a muscle relaxant, but, then, I didn't take those crazy three-digit doses that were cited in the article.
posted by kozad at 10:54 AM on September 19, 2016
posted by kozad at 10:54 AM on September 19, 2016
Very cool, thanks for sharing.
Can anyone share speculations on a mechanism of action?
This is nothing more than wild speculation, but baclofen is an agonist (chemical activator) of the GABAB receptor, which mediates inhibitory neurotransmission. GABABRs are thought to be a main target of alcohol in mediating its addictive effects. So perhaps baclofen has its effect on treating alcoholism by providing long-term, stable stimulation of GABABRs, which precludes any further action of alcohol, and possibly encouraging neurons to downregulate the number of GABABRs, leading to a gradual weakening of the neural pathways involved in alcohol craving. Because GABABR is a metabotropic receptor, there's also more options for engaging gene transcription and protein synthesis mechanisms for modifying synapses.
But I am not a neuropharmacologist, so that is only a half-educated guess. ("Half-educated" as usual meaning "probably all wrong, but thinking one is right.") I can say with somewhat more confidence that it very probably is having its anti-addiction effects at inhibitory synapses within the brain's reward systems (likely the nucleus accumbens). Generally speaking, increasing the overall level of inhibitory tone within this system is thought to increase the signal-to-noise ratio of information transfer, meaning only very strong, temporally coordinated neural activity gets through. But how exactly this phenomenon relates to addiction and reward is still not well understood.
posted by biogeo at 10:56 AM on September 19, 2016 [5 favorites]
Can anyone share speculations on a mechanism of action?
This is nothing more than wild speculation, but baclofen is an agonist (chemical activator) of the GABAB receptor, which mediates inhibitory neurotransmission. GABABRs are thought to be a main target of alcohol in mediating its addictive effects. So perhaps baclofen has its effect on treating alcoholism by providing long-term, stable stimulation of GABABRs, which precludes any further action of alcohol, and possibly encouraging neurons to downregulate the number of GABABRs, leading to a gradual weakening of the neural pathways involved in alcohol craving. Because GABABR is a metabotropic receptor, there's also more options for engaging gene transcription and protein synthesis mechanisms for modifying synapses.
But I am not a neuropharmacologist, so that is only a half-educated guess. ("Half-educated" as usual meaning "probably all wrong, but thinking one is right.") I can say with somewhat more confidence that it very probably is having its anti-addiction effects at inhibitory synapses within the brain's reward systems (likely the nucleus accumbens). Generally speaking, increasing the overall level of inhibitory tone within this system is thought to increase the signal-to-noise ratio of information transfer, meaning only very strong, temporally coordinated neural activity gets through. But how exactly this phenomenon relates to addiction and reward is still not well understood.
posted by biogeo at 10:56 AM on September 19, 2016 [5 favorites]
My actual point was "the French wine industry" likely is not opposed to this drug, since they don't depend on alcoholics as their main revenue source. I say this as someone who lives in a jurisdiction that imposes a "sin tax" on booze because of traditional Puritan attitudes towards alcohol, making it more expensive for me to enjoy fine French wine in the first place!
Well, the booze industry in general does get a large percentage of sales from heavy drinkers. Not sure about the "French wine industry" specifically (and not sure about percentage of revenue because of price discrimination).
posted by atoxyl at 11:19 AM on September 19, 2016 [2 favorites]
Well, the booze industry in general does get a large percentage of sales from heavy drinkers. Not sure about the "French wine industry" specifically (and not sure about percentage of revenue because of price discrimination).
posted by atoxyl at 11:19 AM on September 19, 2016 [2 favorites]
I have taken baclofen for MS symptoms. I can't believe people are taking 340 mgs in a matter of weeks and still able to walk. They tried to bump me up to 150 mg by mouth and I couldn't take the side effects, and my walking got worse at that high a dose.
Alcoholics almost by definition are likely to have come to treatment with a high tolerance to GABAergic drugs already. It's like how some people start off with 16+ mg of buprenorphine, or 80-100+ mg (that's a guess, I'm less familiar with this one) of methadone for opioid maintenance - would not be a good idea for the average opiate-naive person.
posted by atoxyl at 11:30 AM on September 19, 2016 [3 favorites]
Alcoholics almost by definition are likely to have come to treatment with a high tolerance to GABAergic drugs already. It's like how some people start off with 16+ mg of buprenorphine, or 80-100+ mg (that's a guess, I'm less familiar with this one) of methadone for opioid maintenance - would not be a good idea for the average opiate-naive person.
posted by atoxyl at 11:30 AM on September 19, 2016 [3 favorites]
Baclofen has also become an increasingly popular choice for certain types of neuropathic and fibromyalgia pain that don't respond to conventional treatments. I can't help wondering if its potential applications to alcoholism stem from the fact it helps restore the brain's filtering mechanisms, and suppresses certain types of pain and anguish that exist in a grey area between the mental and the physical realms.
posted by prosopagnosia at 11:35 AM on September 19, 2016 [2 favorites]
posted by prosopagnosia at 11:35 AM on September 19, 2016 [2 favorites]
Alcoholics almost by definition are likely to have come to treatment with a high tolerance to GABAergic drugs already.
Robin Williams had a joke: "So, a guy told me they came out with a pill that will cure alcoholism. And alcoholics immediately think, hey, what if I take two of them?"
posted by thelonius at 11:38 AM on September 19, 2016 [17 favorites]
Robin Williams had a joke: "So, a guy told me they came out with a pill that will cure alcoholism. And alcoholics immediately think, hey, what if I take two of them?"
posted by thelonius at 11:38 AM on September 19, 2016 [17 favorites]
I really understand the desperation behind wanting the compulsion to drink removed, but this sounds like it's own little trip to hell before, maybe, you might get better. Yikes!
I mean, if you can think of any way of coming off a highly addictive drug that isn't hell, I'm sure we're all ears.
posted by Dysk at 12:17 PM on September 19, 2016 [2 favorites]
I mean, if you can think of any way of coming off a highly addictive drug that isn't hell, I'm sure we're all ears.
posted by Dysk at 12:17 PM on September 19, 2016 [2 favorites]
Thank you for offering such a comprehensive reply, biogeo! (For entertaining it at all!) Flagged as fantastic (and super generous, in my head).
I have more questions that I can't really formulate right now, will sit on them until (& unless) I can coax them into sense...
posted by cotton dress sock at 1:08 PM on September 19, 2016
I have more questions that I can't really formulate right now, will sit on them until (& unless) I can coax them into sense...
posted by cotton dress sock at 1:08 PM on September 19, 2016
My Dad: "My actual point was "the French wine industry" likely is not opposed to this drug, since they don't depend on alcoholics as their main revenue source."
I wouldn't necessarily jump to that conclusion. In both the United States and the UK the alcohol industry makes a significant portion of its money from people who have drinking problems.
The Washington Post: "One consequence is that the heaviest drinkers are of greatly disproportionate importance to the sales and profitability of the alcoholic-beverage industry," he writes. "If the top decile somehow could be induced to curb their consumption level to that of the next lower group (the ninth decile), then total ethanol sales would fall by 60 percent."
The Guardian: "While the industry points to the fact that most people in the country are moderate drinkers, 60% of alcohol sales are either to those who are risking their health, or those – labelled harmful drinkers – who are doing themselves potentially lethal damage"
posted by Secret Sparrow at 1:28 PM on September 19, 2016 [5 favorites]
I wouldn't necessarily jump to that conclusion. In both the United States and the UK the alcohol industry makes a significant portion of its money from people who have drinking problems.
The Washington Post: "One consequence is that the heaviest drinkers are of greatly disproportionate importance to the sales and profitability of the alcoholic-beverage industry," he writes. "If the top decile somehow could be induced to curb their consumption level to that of the next lower group (the ninth decile), then total ethanol sales would fall by 60 percent."
The Guardian: "While the industry points to the fact that most people in the country are moderate drinkers, 60% of alcohol sales are either to those who are risking their health, or those – labelled harmful drinkers – who are doing themselves potentially lethal damage"
posted by Secret Sparrow at 1:28 PM on September 19, 2016 [5 favorites]
I am an alcohol and opiate addict in recovery. I agree we tend to high higher tolerances for certain meds but Baclofen is not a drug, because of its side effects, that any addict would want to take. But I guess if you are in withdrawal anything could make a person feel better. Having taken baclofen for spasticity and feeling horrible ill from it, I would never consider 340 mg a doable does for anything.
But what do I know? Obviously not everything.
posted by cairnoflore at 1:37 PM on September 19, 2016 [1 favorite]
But what do I know? Obviously not everything.
posted by cairnoflore at 1:37 PM on September 19, 2016 [1 favorite]
According to Drugs.com:
I wonder whether alcoholics taking baclofen are substituting one addiction for another.
posted by jamjam at 1:54 PM on September 19, 2016
Abrupt Withdrawal of Intrathecal TherapyIt's unusual for withdrawal symptoms from a drug to be fatal, but that is a major concern with alcohol.
Abrupt discontinuance of intrathecal [direct injection into the CSF] baclofen has resulted in high fever, altered mental status, exaggerated rebound spasticity, and muscle rigidity; in rare cases, progression to rhabdomyolysis, multisystem organ failure, and death have occurred.113
I wonder whether alcoholics taking baclofen are substituting one addiction for another.
posted by jamjam at 1:54 PM on September 19, 2016
I wonder whether alcoholics taking baclofen are substituting one addiction for another.
Maybe in some form, but the thing to compare it to is addiction to alcohol, not the lack of addiction. Also, the link you point it so for intrathecal baclofen, which does not appear to be used for alcoholism.
I liked Blaise's description of AA culture:
They function like a church. Their fourth step commands members to submit to a higher being, but suddenly, scientists arrive with a medication and rationally explain that a biological issue can be fixed. Suddenly, you don’t need abstinence, you don’t need a higher being. The very basis of the church comes crashing with it.
I realize AA helps a lot of people, but it also has a culty reality-distortion field that seems to prevent people from, uh, soberly evaluating it.
posted by andrewpcone at 2:07 PM on September 19, 2016 [1 favorite]
Maybe in some form, but the thing to compare it to is addiction to alcohol, not the lack of addiction. Also, the link you point it so for intrathecal baclofen, which does not appear to be used for alcoholism.
I liked Blaise's description of AA culture:
They function like a church. Their fourth step commands members to submit to a higher being, but suddenly, scientists arrive with a medication and rationally explain that a biological issue can be fixed. Suddenly, you don’t need abstinence, you don’t need a higher being. The very basis of the church comes crashing with it.
I realize AA helps a lot of people, but it also has a culty reality-distortion field that seems to prevent people from, uh, soberly evaluating it.
posted by andrewpcone at 2:07 PM on September 19, 2016 [1 favorite]
I wonder whether alcoholics taking baclofen are substituting one addiction for another.
Probably but again, see opioid maintenance - to substitute a substance which will hit the same receptors and prevent withdrawal and cravings while doing less harm is kind of the whole point!
posted by atoxyl at 2:26 PM on September 19, 2016 [2 favorites]
Probably but again, see opioid maintenance - to substitute a substance which will hit the same receptors and prevent withdrawal and cravings while doing less harm is kind of the whole point!
posted by atoxyl at 2:26 PM on September 19, 2016 [2 favorites]
Since abrupt cessation of therapy involving baclofen injection directly into the CSF can cause death from severe rhabodomyolysis, and alcohol withdrawal can also cause death, I thought it might be interesting to look for a connection between alcohol and rhabdomyolysis:
posted by jamjam at 5:28 PM on September 19, 2016 [1 favorite]
[Severe rhabdomyolysis syndrome in the course of alcohol withdrawal syndrome and hyponatremia].I think this strengthens the case that baclofen functions therapeutically against alcohol addiction as a direct substitute for alcohol at GABA receptors in the brain, and is presumably addictive in and of itself, yet given its severe side effects, it's not clear to me that baclofen would be less toxic or less harmful than alcohol in the long term.
Rhabdomyolysis and associated kidney failure is a medical problem, often faced by doctors working in the centers of toxicology. Its most common cause is mechanical damage to the muscles, but predisposing factors include a big group of other pathologies and clinical conditions, including: electrolyte imbalance, immobility, infections, drug or psychoactive substances poisoning. The article presents an example of a patient with severe rhabdomyolysis syndrome caused by an alcohol withdrawal syndrome. Based on our experience and scientific studies of other clinical centres the paper presents various causes of muscle damage, including the iatrogenic effects of ethanol intoxication treatment. The article explains the importance of a proper and quick treatment which prevents damage of internal organs, including kidney failure. [my emphasis]
posted by jamjam at 5:28 PM on September 19, 2016 [1 favorite]
French doctors, she says, are quick to fight back with a utilitarian reasoning: if Baclofen can help half of the 120 people a day who die from alcohol-related diseases while only a tiny percentage experience severe side-effects, there’s no question it should be used.AAARGH, that is not how medicine works, Grauniad.
I honestly don't understand the point here--seems to be a lot like how medicine works. Surgery, to take a picturesque example, has rare severe side effects but is used if it helps far more than it hurts.
Most drugs are the same, if not as extreme, and will still be used if the benefits are big, especially if the side effects are (1) detectable and (2) reversible.
posted by mark k at 8:37 PM on September 19, 2016
Even though the article strongly suggests it's controversial because the AA / rehabilitation crowd, AFAICT the only people in the article opposing it are cautious because of limited safety and efficacy data (plus I suspect a fear of encouraging people to self medicate with a potentially dangerous drug.) And the data's somewhat limited it seems.
The anti-AA quotes comes from those advocating for the drug. If they're making the pitch that this is why it's controversial, surely they could have got someone actually on record?
[Interesting article though btw.]
posted by mark k at 8:52 PM on September 19, 2016 [1 favorite]
The anti-AA quotes comes from those advocating for the drug. If they're making the pitch that this is why it's controversial, surely they could have got someone actually on record?
[Interesting article though btw.]
posted by mark k at 8:52 PM on September 19, 2016 [1 favorite]
I think this strengthens the case that baclofen functions therapeutically against alcohol addiction as a direct substitute for alcohol at GABA receptors in the brain, and is presumably addictive in and of itself, yet given its severe side effects, it's not clear to me that baclofen would be less toxic or less harmful than alcohol in the long term.
The psychiatric side effects are worrisome but you seem to be more specifically making the case that alcohol shares some of the bodily hazards of baclofen rather than the other way around. (You can find quite a few citations for alcohol-associated rhabdomyolysis including sometimes as a result of somebody passing out in an odd position and damaging limbs.)
posted by atoxyl at 9:08 PM on September 19, 2016
The psychiatric side effects are worrisome but you seem to be more specifically making the case that alcohol shares some of the bodily hazards of baclofen rather than the other way around. (You can find quite a few citations for alcohol-associated rhabdomyolysis including sometimes as a result of somebody passing out in an odd position and damaging limbs.)
posted by atoxyl at 9:08 PM on September 19, 2016
Wow, lots of misinformation about AA both in the article and in the comments.
“I’ve had patients who were in AA but still secretly took substitution drugs such as methadone or Subutex. They kept it a secret, out of shame and because they don’t want to be excluded from the group.”
Third tradition of AA: "The only requirement for AA membership is a desire to stop drinking." Full stop. The person doesn't even need to be sober or abstinent. There is nothing keeping someone from being on any sort of medication.
“They function like a church. Their fourth step commands members to submit to a higher being, but suddenly, scientists arrive with a medication and rationally explain that a biological issue can be fixed. Suddenly, you don’t need abstinence, you don’t need a higher being. The very basis of the church comes crashing with it.”
AA is nothing like a church; the program is based on spirituality, not religion. (And, FFS, people, it's not a "cult.") He's referring to the third step, not the fourth, and it reads, "Made a decision to turn our will and our lives over to the care of God as we understood Him." And, finally, if there were a miracle cure for alcoholism, lots of people, myself included, would be first in line for it.
posted by Halloween Jack at 12:21 PM on September 20, 2016 [3 favorites]
“I’ve had patients who were in AA but still secretly took substitution drugs such as methadone or Subutex. They kept it a secret, out of shame and because they don’t want to be excluded from the group.”
Third tradition of AA: "The only requirement for AA membership is a desire to stop drinking." Full stop. The person doesn't even need to be sober or abstinent. There is nothing keeping someone from being on any sort of medication.
“They function like a church. Their fourth step commands members to submit to a higher being, but suddenly, scientists arrive with a medication and rationally explain that a biological issue can be fixed. Suddenly, you don’t need abstinence, you don’t need a higher being. The very basis of the church comes crashing with it.”
AA is nothing like a church; the program is based on spirituality, not religion. (And, FFS, people, it's not a "cult.") He's referring to the third step, not the fourth, and it reads, "Made a decision to turn our will and our lives over to the care of God as we understood Him." And, finally, if there were a miracle cure for alcoholism, lots of people, myself included, would be first in line for it.
posted by Halloween Jack at 12:21 PM on September 20, 2016 [3 favorites]
…you seem to be more specifically making the case that alcohol shares some of the bodily hazards of baclofen rather than the other way around. (You can find quite a few citations for alcohol-associated rhabdomyolysis including sometimes as a result of somebody passing out in an odd position and damaging limbs.)
Yes; if you accept the premise that there are strong parallels between the effects of baclofen and alcohol, the fact that abruptly stopping the administration of baclofen which was only injected directly into the CSF and presumably had very little direct contact with muscle tissue, nevertheless can cause rhabdomyolysis so severe that it overwhelms the kidneys and leads to death, suggests that the severe rhabdomyolysis that can result from abruptly quitting drinking might also have nothing to do with anything alcohol was doing to the muscles directly, but instead is caused by stopping something alcohol was doing in the brain.
Which would be very strange.
posted by jamjam at 12:23 PM on September 20, 2016
Yes; if you accept the premise that there are strong parallels between the effects of baclofen and alcohol, the fact that abruptly stopping the administration of baclofen which was only injected directly into the CSF and presumably had very little direct contact with muscle tissue, nevertheless can cause rhabdomyolysis so severe that it overwhelms the kidneys and leads to death, suggests that the severe rhabdomyolysis that can result from abruptly quitting drinking might also have nothing to do with anything alcohol was doing to the muscles directly, but instead is caused by stopping something alcohol was doing in the brain.
Which would be very strange.
posted by jamjam at 12:23 PM on September 20, 2016
Not that strange - alcohol withdrawal obviously has neuromuscular effects - I mean what are "shakes?" Or looking at it another way, rhabdomyolysis has also been associated with use of stimulants. Withdrawal from a depressant drug tends to manifest as...?
I don't know enough to give an authoritative explanation of exactly what happens - I am also fundamentally just some guy with the ability to look up papers - but I'm guessing we're talking hyperthermia, peripheral stimulation causing involuntary muscle movement, etc.
posted by atoxyl at 12:50 PM on September 20, 2016
I don't know enough to give an authoritative explanation of exactly what happens - I am also fundamentally just some guy with the ability to look up papers - but I'm guessing we're talking hyperthermia, peripheral stimulation causing involuntary muscle movement, etc.
posted by atoxyl at 12:50 PM on September 20, 2016
I mean what is "doing directly" when we're talking about the nervous system? There may of course be myotoxic chemical effects of either or both of these drugs or their metabolites - I don't think muscle damage related to alcohol is confined to cases of withdrawal (or injury caused by intoxication)? I just mean if you're asking about this
but instead is caused by stopping something alcohol was doing in the brain
I don't find it incredibly surprising that this can happen.
posted by atoxyl at 12:55 PM on September 20, 2016
but instead is caused by stopping something alcohol was doing in the brain
I don't find it incredibly surprising that this can happen.
posted by atoxyl at 12:55 PM on September 20, 2016
I mean what is "doing directly" when we're talking about the nervous system? There may of course be myotoxic chemical effects of either or both of these drugs or their metabolites - I don't think muscle damage related to alcohol is confined to cases of withdrawal (or injury caused by intoxication)? I just mean if you're asking about this
It's a strange poison that kills you when you stop taking it.
posted by jamjam at 1:21 PM on September 20, 2016
It's a strange poison that kills you when you stop taking it.
posted by jamjam at 1:21 PM on September 20, 2016
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posted by jonmc at 8:30 AM on September 19, 2016 [3 favorites]