Baclofen to Reduce or Eliminate Heavy Alcohol Use
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. Baclofen can be a very useful drug for people who have difficulty controlling their alcohol use.
Baclofen mainly works at the GABA-B receptor site in the brain. This causes muscular relaxation, but also causes psychological relaxation, with relief of stress and tension. Alcohol has its primary action in the brain on the GABA-A receptor. In acting on the GABA-A receptor alcohol causes psychological relaxation, and temporary relief from stress and anxiety. In some patients, alcohol use is driven by anxiety, stress, and emotional issues. In this type of patient, taking a medication, like Baclofen, 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 drinking of large amounts of alcohol. It also can be the reason for relapse for patients who have been successful in achieving abstinence for a period of a few weeks, months or even years. Baclofen can be thought of as a “parallel agonist” to alcohol. Working on the GABA receptor system in a way different than alcohol, Baclofen can alleviate underlying stress, anxiety from alcohol withdrawal, and alcohol cravings.
Baclofen has a secondary action that limits or “attenuates” the brain neurotransmitter dopamine. 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. These side effects are usually mild and transient, resolving after a few days. The unwanted symptoms can be to a great degree avoided by starting the medicine at a low dose, and increasing the dose gradually, until alcohol cravings are reduced or eliminated. However, 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 prescribed baclofen stop drinking completely within a matter of several months of starting the medication. Other patients 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 medicine 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) program when appropriate and beneficial. Please contact our office directly at 833-4SINCLAIR to learn more about our comprehensive management program.