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The Dutch Begin Studying Baclofen For Addiction

2011 April 28

So here we are again, back at the baclofen question. My Dutch friend sends me a link to a news story (in Dutch!) about the University of Amsterdam starting a study of baclofen as a treatment for alcoholism and drug addiction. Managed to cobble some sense out of the story, which begins:

Is this the wonder pill which will bring rescue to, among others, alcoholics, junkies and smoke-drug addicts?

“Smoke-drug addicts”—very much like that one. My mother, a die-hard smoker for 30 years before she died at 58 of lung cancer, was definitely a “smoke-drug addict.”

(Another interesting tidbit: the Dutch word for “addiction” is “verslaving”—which, my friend says, means “a slave to a substance.”)

Baclofen is a derivative of gamma-aminobutyric acid (GABA) and is a GABA-receptor agonist—just like, as it happens, alcohol. Surprise, surprise! they work in the same way. … Baclofen is prescribed as a muscle-relaxant for spasticity in conditions such as multiple sclerosis. It is also prescribed off-label to reduce addictive cravings. And it’s dependency-producing. You can’t just quit baclofen—it must be tapered up and down when getting on or off it; stopping use suddenly leads to the same kind of (prolonged, painful) detox that benzos induce.

So they’re gonna study us alcoholics, junkies and smokers, BUT: not gamblers, because apparently there’s no medical evidence that gambling addiction actually exists. The researchers are, according to the story, somehow really hoping it works for drug-addicts. Leading us to believe “junkies” are maybe worse than the other types?

The story quotes a guy from a drug-rehab who has administered baclofen to 100 patients addicted to alcohol, cocaine, cannabis, GHB and benzos, and, apparently, about half of them no longer use their (other) drugs.

The best part of the story: the researchers are speculating that baclofen works better on addicts who use out of “angst.” The story reads (according to my Dutch friend–thanks P):

“With people who use substances from a more positive emotion we do not believe baclofen to be very effective,” according to [Professor Reinout] Wiers [of Amsterdam University]. One assumption of the researchers is that the muscle relaxer also has a calming effect on addicts who try to mask and conquer their fear.

Which would make sense. I mean, what real alcoholic doesn’t drink out of conscious or unconscious “angst”?

Also: I was not fully aware of this, but angst is the Germanic word for fear. So, take a pill, and my fear is relieved. … This brought back the words of my first sponsor, a deeply spiritual woman and former “junkie” who once advised me, as I detoxed off fentanyl and started work on my Fourth Step only to discover that I had a few bits of “angst” going on:

DON’T call it “anxiety.” It’s plain old fuckin fear, OK? If you call it “anxiety,” you can go to the doctor and get a pill for it. It’s OK to medicate “anxiety.” But nobody goes to the doctor and says, “I’m having some FEAR, I need a pill.”

I took her point.

But maybe now, with baclofen, you’ll be able to do that.

Olivier Amiesen, M.D., who controls his alcoholic cravings with Baclofen

The whole baclofen business started with Olivier Amiesen, a French cardiologist who for 15 years practiced in New York and taught medicine at Cornell’s Weill Medical College. Unable to stay sober despite following up on all his practitioners’ recommendations, going to rehab, and sitting in two AA meetings per day for seven years, Amiesen experimented on himself: he started taking high doses of baclofen, which, he wrote in his 2008 book The End of My Addiction, eradicated his cravings and allowed him to become a social drinker. Amiesen called for randomized studies of baclofen’s effectiveness—of which, presumably, the Amsterdam study is one.

One wonders if it would even be OK to become a social drinker while taking high-dose baclofen. Though not classified as a benzo, baclofen basically has a benzo profile and the same kinds of OD risks. In addition, though it seems not to have any tolerance effect (unlike alcohol), dosages have to be closely monitored, because over 80mg/day baclofen can interfere with functioning and cause drowsiness. Amiesen uses baclofen at doses of 200mg+.

I once brought my questions about baclofen up at a meeting early in my sobriety. I got a number of very interesting responses. One was from a young man, maybe 28 or 29, who had been clean for about a year or so. Smart guy and very physically fit. His face lit up like a torch when I mentioned baclofen. After the meeting he said:

It’s funny when people talk about using baclofen to get rid of cravings. My experience was, when I used baclofen WITH alcohol, the combination was juuuuust right. If you know what I mean.

I knew what he meant.

For me, using a chemical to fight chemical addiction is like using water to avert a flood.

Amiesen’s statistic sounds so disappointing: 5,000 meetings over seven years failed to keep him sober. Another friend, a former heroin addict who got sober the way I did, bristled when I mentioned this statistic:

For an addict like me, sitting in two AA meetings per day for seven years ISN’T the solution.

What this person meant was, for an addict like her, the solution = working the steps. Meetings alone don’t keep her sober.

I can buy, along with Gabor Maté (one of my true addiction-treatment heroes), that some people just can’t get sober with the steps and may need to take “maintenance” drugs to escape the “junkie” lifestyle. That’s cool. In Stephen King’s words, there’s more than one way to de-fur a feline. But if they want to research the addiction-treatment possibilities of baclofen, on which the patent has expired and from which ain’t nobody gonna make no big bucks, why don’t they also research the effectiveness of other cheap and non-patentable “solutions” that have worked for millions of people for much longer?

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  • N. E. Riley

    There are several inaccuracies in this post related to baclofen. One of the most profound is this one:

    “And it’s dependency-producing. You can’t just quit baclofen—it must be tapered up and down when getting on or off it; stopping use suddenly leads to the same kind of (prolonged, painful) detox that benzos induce.”

    On the contrary, one does not develop a dependency on baclofen. It must be tapered down just as most antidepressants need to be.

    It is not at all related to benzodiazapenes, in the way that it works, or in the result.

    There are several other relative inaccuracies, mostly having to do with “using a chemical to fight a chemical addiction.” This is a point of view that is so entrenched it is almost impossible to discuss with people for whom it is the basis of their solution.

    The study in Amsterdam is specifically looking at the anxiety connection because it seems that there is a correlation between anxiety and addiction.

    Dr. Ameisen did in fact do the 12 steps of AA, had a sponsor and followed the protocol as outlined by the Big Book. All of this is information can be found in The End of My Addiction.

    I also followed the AA way. It didn’t work.

    I thoroughly enjoyed and relate to your sponsors description of anxiety. I look forward to sharing it at my next AA home group, which I still attend.

    Baclofen saved my life. I’m sober because of it, and it alone. It is irresponsible to dismiss it so blatantly, especially without all of the facts.

  • guinevere

    @N.E. … thanks for your response… I disagree that I’m “dismissing” baclofen—I’m critiquing the study, and the medical model in general.

    To respond to some of your criticisms… my post never said that baclofen is a benzodiazepine, or that it is related to benzos. It said that baclofen withdrawal resembles that of benzos, which is well understood and accepted. (I also might have stated that both baclofen and benzos, in addition to alcohol, work on the GABA receptors, which they do. However, they apparently work in different ways.)

    In addition, “dependency-producing” means that the body becomes tolerant to the drug such that it must be tapered during discontinuation. I never said baclofen was “addictive.” You may be equating the two ideas. … My point here is that baclofen acts on the central nervous system, and as such can’t simply be stopped all at once. Many people, when they hear there’s a pill that “cures” a problem, expect to be able to stop the drug without any problems. Also, they hear that the drug will “cure” alcoholism, and they assume it will cure it the way penicillin will cure an infection—you eventually stop taking the drug. You can’t do this with baclofen.

    I also find it interesting that you think my critique of treating drug addiction with drugs is an “entrenched” point of view. From my perspective—as someone who uses the 12 steps to recover from addiction, and who rarely (if ever!) sees well funded studies of 12-step effectiveness, much less NIDA-funded brain scans of people who have recovered (instead of the endless pictures we get of “your brain on drugs”)—non-drug approaches are not the dominant medical view of recovery. The dominant view of recovery from any illness in American society, the one that is researched and funded because it can produce profits, is about finding a drug to make the problem go away.

    With all that said, I’m glad to hear you’ve been able to stop your alcoholism with baclofen. :) I’ve said before, and I’d be glad to say again, that there are many ways to recover from addiction, and that I agree with some experts who say that there is a certain proportion of addicts/alcoholics who need some kind of pharmaceutical to take away their cravings so they can live a sane life. I’m glad you’ve found that.

    But let me say this: I read Amiesen’s book, and nowhere in it does he describe taking the 12 steps. He talks about going to meetings. In my experience, if someone wants to try the 12 steps, they have to take the 12 steps. Meetings don’t make anyone sober for long.

    Thanks again for being here.

  • Matt

    This is a terrible article. There is NO open mindedness at all. It is soaked in a misinterpretation of AA ideology that spiritual development is the ONLY path to overcoming addiction. It reminds me of the “spiritual” programs meant to turn gay people straight. They are supposed to pray the gay away, lol.

    Your sponsor that is anti medication is ignoring AAs own advice on taking medication.

    On page 133 of the Big Book of A.A-
    “But this does not mean that we disregard human health measures. God has abundantly supplied this world with fine doctors, psychologists, and practitioners of various kinds. Do not hesitated to take your health problems to such persons. Most of them give freely of themselves, that their fellows may enjoy sound minds and bodies. Try to remember that though God has wrought miracles among us, we should never belittle a good doctor or psychiatrist. Their services are often indispensable in treating a newcomer and in following his case afterward.”

    It also doesn’t mention ANYWHERE that Dr. Amiesen does not beleive Baclofen alone is a sufficient treatment. He advocates taking it in combination with therapy or an AA style support group. Reducing anxiety helps recovering addicts think clearly and be open to CHANGE.

    I beleive a recovering addict is a mental car accident patient. The emotional centers of the brain are damaged. AA, therapists, and other support groups are the “physical therapy”. A severe car accident patient would not be able to go to physical therapy while in agonizing pain and neither can an addict. Likewise, some damage will never fully healed and will require maintenance medication.

  • guinevere

    @Matt, thanks for reading and taking the time to comment.

    Please read the comment in response to N.E. Riley above.

    Now toward a couple of your points: you write, “I believe a recovering addict is a mental car accident patient. The emotional centers of the brain are damaged.” Well, OK, that’s what you believe. We can all “believe” whatever we want. But where is your proof? NIDA likes to show sophisticated scans of “your brain on drugs,” but what about scanning folks who have achieved long-term sobriety/recovery and seeing what their brains look like? Are they in fact “scarred,” and if so, how are they still able to stay sober?

    You write, “A severe car accident patient would not be able to go to physical therapy while in agonizing pain and neither can an addict.” You gotta be kidding me, right? The best PTs are known as total fucking hardasses who put their patients through agonizing workouts in order to help them recover. They’re physical trainers. Car accident survivors (of which I am one) are not allowed to wait till they no longer have pain before they begin treatment. In fact, the earlier treatment begins, the better chances of fuller recovery. (To share some of my own experience: When I fractured and dislocated my elbow in a cycle fall, I wasn’t allowed to wait until the arm was no longer black from elbow to pinkie finger before beginning PT. I was forced to get it moving the day after the dislocation was reduced. Talk about agonizing pain.)

    You write, “Likewise, some damage will never fully healed [sic] and will require maintenance medication.” If you read this site regularly you’ll see that I don’t practice Sergeant Sobriety tactics, and I never take against the idea that some folks need medication (even chronic opioid therapy, otherwise known as “medication assisted treatment”) in order to help them get better. My problem is with the medical establishment (of which Dr. Amiesen is a highly visible member) and its focus on drug-related approaches often, if not always, to the exclusion of non-drug approaches. I was also giving some additional interesting information about baclofen that wasn’t provided in the news story that I critique.

    I agree that reducing anxiety helps us as addicts and alcoholics open ourselves to change. I just think there are additional ways to do it besides drugs. (Exercise, for one. In the U.S. we have an epidemic of obesity. People do not want to get off their asses and start moving their bodies. Or else they’re so busy making ends meet that they don’t have time to exercise and take care of themselves physically, and they don’t have the money to eat quality food. For more information watch the film Food, Inc.)

    Apart from your opinions, what is your experience? Please share it. I guarantee someone will be helped.

  • Mike Willard

    I Think your comments are valid regarding the Dutch Baclofen study. I currently
    attend AA as a probationary requirement. Initially I too felt that AA was an
    inadequate strategy for sobriety and that it really was just court- mandated
    group therapy. The first few weeks all I did was attend meetings and found them
    uncomfortable and unsatisfying. Finally after one meeting someone gave me a
    “Big Book.” Here is where I finally saw AA as a possible tool to not only
    stay sober, but change my outlook and reaction to life in general. This is only
    possible by finding out what the steps actually are all about and actively
    working them. I think this is where most people fail with AA. I think if you only
    attend meetings, you are not giving it a fair chance to be a viable possibility for
    your personal sobriety.
    I like you am also open minded to doing whatever it takes to get off the
    runaway train of addiction, but feel that pharmacological stategies should
    be a last resort.
    Best Regards,
    Mike

  • dave

    thank you so much for your blog-very engaging and informative.
    I read this post and the comments and then went back to reread to make sure I’m not misinterpreting what you are saying. but I’m not sure if I am. it seems you are anti-medication?
    thanks for introducing me to gabor mate. I really agree and relate to a lot of what he has to say. although he states that addiction is not a disease-he goes on to say that underlying trauma is what causes addiction and does in fact change the brain at a very young age. he states that although an addiction gene has not been found that genes could be involved and do in fact turn off and on according to environmental cues. his premiss seems to be to change the environmental cues and society. at least that is my interpretation of what I’ve heard on YouTube. perhaps you can help me with this. what exactly does he do for his patients. does he recommend AA. does he also have them on meds? he admits that he has less than 5% success rate. which I believe is about the long term success rate of AA from what I’ve read.
    I’m not AA bashing just trying to get at the truth. my experience is I have a little over 4 years sobriety after attending rehab and meetings. I recently had an injury and cannot do the heavy exercise that I’ve been doing over the last 4 years also. I am now in the middle of an incapacitating panic attack that I really don’t want to medicate but if it gets worse I don’t think I’ll have a choice. its either that, the hospital where ive been before(and all they do is give meds) or drinking. AA makes me feel guilty about this and I’m unsure what to do. meds or not.
    the big argument amieson uses is that you use insulin for diabetes, it’s not a cure but management of the disease. I guess it depends on whether you believe it’s a spiritual or medical disease. could it be both? trauma being the catalyst?
    I really like your post on higher power. dave
    I told myself I would wait 5 years before I would try baclofen and to see if the early studies of an 80% success rate are real in a double blind placebo controlled study.

  • guinevere

    @dave… I’m not against medication assisted therapy or doing whatever it takes to stay alive and be OK in your skin. I’ve explained my position in my responses to other commenters above.

    My issue with this baclofen story is the way it was written about in the first place, and the way Amiesen characterizes the 12 steps.

    As for Gabor Maté: I have an interview with him coming out soon in Renew Everyday. Maté’s experience (the 5 percent success rate you mentioned) is with a particular population of addicts and alcoholics—extremely poor, unemployed, and homeless, with concomitant problems such as HIV/AIDS, other STDs, and severe mental illness. He practices medication therapy when a client’s other problems are so overwhelming that the person has no chance of quitting injection-drug habits and other high-risk addiction behaviors—and when joblessness and poverty prevents them from escaping the environments that support those behaviors. He recommends counseling, 12 steps, and/or any other recovery support program that helps. Most of all he recommends healing the underlying pain that interacts with the addict’s genetic makeup to produce the neurological changes that produce addiction. One of his messages is, “It’s not ‘Why the addiction?’ but ‘Why the pain?’” He also believes there will never be a “cure” for addiction because it’s not strictly a biological problem—it’s also social.

    As for AA-guilt and doing what we need to do… I can only speak from experience. But my first sponsor in the 12-step program I do for my addiction told me that what I do to stay clean and sober was between me and God, and all the judgment is just noise. I do what I need to do for myself today. Some of what I do is unorthodox. I’d like to write more about this, and get others to write about it more.

    How are you doing today?

  • dave

    Guinevere,
    thank you for taking the time to respond to my questions.
    I’m doing a little better,thanks. I talked to my sponsor today about the meds and he basically said the same as you. nobody’s business. especially at the meeting level. just creates massive drama in my small town. talk to a professional, use as prescribed, be transparent with him, and throw them away when episodic anxiety goes away. not sure if I’ll go that route unless it gets severe enough that I can’t function. I am exercising as much as possible working around my injury and this helps me tremendously. perhaps you could do an article on exercise and the brain/addiction.
    can’t wait for the gabor mate interview. very interesting. I’ve read some studies that have said that the amygdala is damaged from childhood trauma and this has a great role in the fear response/anxiety and possibly alcoholism? I know the brain has plasticity but can it repair itself and self correct? guess I’ll have to wait for the interview.
    you are doing a great service with this blog. thank you.

  • Evan

    I was cured of my addiction to alcohol (and other substances) 2 years ago, using Amesien’s baclofen regimen. I drank 80-100 drinks a week for about 8 years, starting when I was 20 years old. I was suicidal, and really just wanted to end it all. I titrated up very quickly and was very lucky in the sense that I did not suffer any severe side effects that can so often happen when people try to take to much too soon. From the moment I reached “indifference” I went from not being able to even remotely fathom a life (or even a night) without alcohol to not understanding why I ever drank the vile stuff in the first place. It was a bizarre and immediate paradigm shift that saved my life and changed it forever.

    It has absolutely no power over me anymore. I’ve lived with family and roommates who drink like normal people (very sparingly) and as a consequence we always have alcohol in the house. I will have an odd drink every month or two and it appeals to me as much as does to any other normal person. I never have any compulsion to drink more.

    I still take 300 mgs of baclofen daily and plan to do so for quite a while before experimenting with dropping my dose. I have no side effects at this dose.

  • Rob

    This article is awful. Comparing Baclofen to a Benzo? They both work on GABA receptors, but other than that, they are nothing alike. You cannot quickly stop most medications which treat anxiety and mood — try taking paxil and stopping immediately. I was sober with AA after working the steps for five years. I do not put down AA, but I am an alcoholic through and through. I had to substitute meetings and calling people throughout the day for alcohol. This is because my brain and my anxieties never change. I worked all twelve steps. After five years I began to drink again and went up to a 750ml of Jager every night. I am now on Baclofen at 340mg a day. I am more at peace with life than I ever have been before and literally all of my anxiety has been removed. This is a godsend for me. To dismiss it without trying it simply because you believe it to be a “maintenance drug”? What about your maintenance meditation, maintenance meetings, maintenance phone calls, maintenance sponsor meetings that you do everyday? I went back to my old AA meetings and guess what I found. Out of about 100 people who went to my AA home group, after 5 years about 15 long timers had remained sober. Everyone else there was new. AA is a revolving door that keep about 10% of people sober. Like I said, AA is great for everyone, but that is a very low number.

    An alcoholic needs something to calm them down — whatever that is. Alcoholism and Addiction are, in my opinion, just like mental disorders in that they get passed from generation to generation and are written in a family DNA. If that is not a cause for medication I don’t know what is.

  • http://guineveregetssober.com Guinevere

    Rob, thanks for visiting. Glad you’ve found a solution that works for you. As I’ve said to other commenters: I am not against medication assisted therapy (i.e., “maintenance” drugs) or doing whatever it takes to stay alive and be OK in your skin. I’ve explained my position in my responses to other commenters below. My issue with this baclofen story is the way it was written about in the first place, and the way Amiesen characterizes the 12 steps.

    Stay well. /G

  • Photographybyderic

    The problem with AA is that it does nothing to mitigate the constant cravings. Baclofen does. I was a 10 beer per night drinker for twenty years, with only sporadic periods of sobriety while in AA. Along came Dr. Amiesen’s book and a new approach. I’ve been sober now for 2 1/2 years and couldn’t be happier. I am no longer locked in mortal combat with my cravings, making it easy to stay sober and enjoy life.

    The blogger states: “For me, using a chemical to fight chemical addiction is like using water to avert a flood.” This pretty much sums up the anti-Baclofen position. It’s absurd of course. Baclofen is not an addictive drug. And the claim that it augments the effects of alcohol is ridiculous (it’s actually the complete opposite). I take Aspirin for a headache, a Beta-Blocker for my blood pressure, and Baclofen for my alcoholism. They all work like a charm.

  • Guest

    I’ve been in AA/NA for 0ver 20 years and had 13 years of continuous sobriety/clean-time before relapsing. In the last 7 + years, I have never stopped going to meetings and hope to be going for the rest of my life. However, I’ve struggled to stay clean, one year, two years, six months etc. I’ve always had a sponsor and at one time had a few sponsees. I’ve worked the steps with sponsors and with sponsees and in my daily life as I was when I relapsed. I’ve got the complication of a number of physical health issues including cancer and major depression.

    I was put on Baclofen 10 years ago for Torticollis which I was born with. It really improved my quality of life but has a decidedly unpleasant effect I can only liken to largagtyl. Have never been tempted to abuse it, using it only when in real pain.

    However, following a recent relapse on alcohol and benzos and being aware of the various current world-wide interest in it’s use to treat addiction. I upped my dose from 10 mg at night to 30 mg. I have needed no detox and have no cravings. I’m back in meetings and as always hope it’s for good this time.

    I have experience of both scenarious and you don’t. Surely anything that helps a suffering addict should be considered with an open mind. You sound like an angry 12 step Nazi which I once was myself. All you’ll do is put people who might otherwise find the programme off for life.

    Maybe you need to speak to your sponsor about humility.

    Christine B

  • http://guineveregetssober.com/ Guinevere

    Thanks for reading. Glad you’re finding a path that works for you.

    Please read the post carefully, including the comments, before you file a flaming response designed to hurt me. … I have no issue with people who get help from baclofen, only an issue with the media, who consistently fail to report important facts about drugs and addiction that would help suffering addicts make more informed decisions. And with scientists, who continue to study illness instead of wellbeing.

    I find resentment a killer.

    with every good wish, G

  • Guest

    Thanks for posting my comment. I don’t intend to stay on the Baclofen higher dose just pointing that it does help with stopping. I don’t have a resentment. Resentment is from the French and literally means ‘re-feeling’. I don’t and I won’t because I’ve learned to deal with things I don’t like in the moment and then let go.

    As for my response being designed to hurt you – this wasn’t my intention. I googled Baclofen research and addiction and your blog came up 2nd on the list. I didn’t like the post so I dealth with it.

    I agree with fact that the media doesn’t cover 12 step followships fairly but feel that we bring that on ourselves a lot of the time in interpreting tradition 10 too literally. It’s not promotion to let the people know we exist and a little bit about how our programme works. A friend has recently set up a consultancy to liaise with the wider addiction field because he feels that addicts are suffering unnecessarily because of this. Sure he might make a little money out of this but I know he has done lots of PI work and his motives are good and he will never break the traditions. There’s also the issue of drug/alcohol workers fearing for their jobs if we don’t need them and they have a vested interest in preventing their clients from finding recovery our way.

    Finally, I HAVE subscribed to your blog. I need all the help I can get.

    Christine B