What Is Baclofen, and How Is It Used?
Baclofen is in a class of prescription drugs known as skeletal muscle relaxants. As the name suggests, it acts directly on spinal cord nerves to relax the spasms that cause the jerking, twitching and involuntary “jackknifing” caused by neurological orders. Baclofen also works on the central nervous system to relieve pain and muscle stiffness, which can be profound and even crippling in an MS spasticity attack.
How does baclofen work? Experts believe that baclofen activates the brain’s GABA receptors to inhibit the nerve impulses in the spine, which in turn relaxes muscle contractions. In addition, researchers have found that baclofen also works with GABA receptors to reduce anxiety. In doing so, it resembles the clinical activity of other anxiety-reducing drugs such as Xanax, Valium, Klonopin and other benzodiazepines. Because of this, baclofen is also considered to be an effective treatment for PTSD.
Likewise, this same clinical activity with GABA receptors is the reason why baclofen is increasingly being prescribed now for alcohol addiction.
Using Baclofen to Treat Alcohol Addiction
According to doctors who prescribe baclofen for alcoholism and drug addiction, a number of studies have shown that the drug can effectively suppress alcohol cravings and other withdrawal-related issues in some individuals.
However, as with all medications, researchers have added a number of caveats to these findings. Specifically, baclofen’s effectiveness could be limited by:
- The coexistence of certain diagnosed or undiagnosed mental disorders in the patient
- The chronic use of other benzodiazepines and psychotropic drugs by the patient (including antidepressants, stimulants, antipsychotics, mood stabilizers and anti-anxiety medications)
- Uncontrollable or severe side effects that prevent the patient from taking the optimum dosage of baclofen
- A lack of motivation in patients to stop drinking alcohol completely due to too much reliance on baclofen
Is Baclofen a Proven Treatment for Alcohol Addiction?
Baclofen addiction treatment has had its share of controversy. One of the biggest adherents of baclofen treatment was a French cardiologist, Dr. Olivier Ameisen, who, as an alcoholic himself, believed that baclofen had a profound effect in controlling his alcoholism. Toward that end, he spent the last decade of his life strongly promoting the treatment, and even wrote a bestselling book in 2008, The End of My Addiction, which chronicled his success with the drug. Subsequent drug trials in France found that Dr. Ameisen’s recommended treatment caused significant numbers of patients to either give up their heavy drinking or moderate it considerably.
While some members of the medical community have accepted his findings, others have criticized them, particularly because Dr. Ameisen’s treatment involves prescribing higher doses of baclofen — doses that go far beyond the medically accepted safety level.
In 2016, a team of Dutch researchers published a report revealing that these high doses of baclofen were unproven as to their effectiveness and that prescribing high doses of the drug could be irresponsible and potentially unsafe. Because of their concerns, doctors in the Netherlands conducted their own extensive studies, using volunteer patients from alcohol treatment centers throughout the country.
Their results differed considerably from those of their French counterparts, and they concluded that, with both high and low doses of the drug, baclofen was not proven to be effective in treating alcohol dependence. Ultimately, these Dutch doctors admitted that they didn’t want to close the door on baclofen — but they needed more research to determine how effective it really is.
The US continues to do its share of studies on baclofen addiction treatment as well. As of January 2019, there were 17 randomized controlled trials investigating baclofen in the treatment of alcoholism, with three of these trials utilizing large (more than 100 milligrams per day) doses. Just to give a gauge of the dosage involved, for people with neurological disorders such as MS spasticity, standard dosages don’t exceed the “safe” level of 80 milligrams per day. For these baclofen/alcohol treatment studies in the US, dosages ranged from 30 milligrams to more than 300 milligrams per day.
According to researchers, preclinical evidence on baclofen’s effectiveness was promising. Since then, however, subsequent studies have continued to yield conflicting results. For example, a study in 2002 showed that, compared to the placebo given, baclofen increased the number of patients who were able to achieve and maintain abstinence from alcohol, and also increased the number of days they remained abstinent. In addition, baclofen reduced their number of daily drinks and decreased patient anxiety levels as well. However, another similar study found baclofen to be comparatively ineffective — and since then, test results have continued to vary widely.
Why haven’t there been more clinical trials on baclofen addiction treatment? Experts have cited cost as a primary reason. For example, France’s Bacloville study, one of the world’s largest baclofen/alcohol addiction studies, cost around $1.4 million dollars for a year-long trial involving 320 patients. This equals about $4,375 spent for each patient, a not-inconsiderable sum for a fairly simple clinical trial. And as one expert speculates, baclofen has already been proven effective in a number of high-profile trials, making further tests seem unnecessary to some funding sources.
However, even the famed Bacloville study had inconclusive results. Ultimately, researchers concluded that baclofen proved to be more effective than the placebo in decreasing alcohol consumption. However, they also warned that the number of adverse events and serious side effects was greater with baclofen as well.
In case studies with positive results, patients say that, after taking baclofen, they simply no longer have the desire to drink. They claim that the craving is gone, as well as any attendant anxiety. These patient success stories greatly reflect the same results that Dr. Ameisen had when he began his baclofen journey.
For now, the US medical community has given the green light to proceed with caution on baclofen addiction treatment, especially given the concerns over the large doses recommended by Dr. Ameisen and his colleagues.
It’s also important to note that, in the US, baclofen is still considered to be an “off-label” prescription for alcohol addiction. This means that baclofen doesn’t yet have official FDA approval for usage in treating alcohol and other addictions. However, it’s still widely prescribed for these conditions not only throughout the country but throughout the rest of the world as well.
In addition to concerns about the high doses touted by some medical professionals, many doctors are also worried about the potential side effects of baclofen, which can increase substantially in larger doses.
Baclofen Side Effects
As with any medication, baclofen has its list of side effects — and while some are mild, others are quite severe and need to be taken seriously. Of course, not everyone who takes baclofen experiences these side effects, and for those that do, they can differ greatly from person to person.
These are some of the most commonly reported side effects for baclofen:
- Drowsiness, dizziness or a sedated feeling. One major downside is that this drowsiness can affect your ability to drive, operate machinery or perform other tasks considered hazardous. Taking other medications such as benzodiazepines and opiates, as well as drinking alcohol, can greatly increase these sedative effects.
- Fatigue and weakness
- Dry mouth
- Possible increased risk of getting ovarian cysts
- Nausea
- Insomnia
- Constipation (which is also a common side effect for many prescription pain medications and opioids)
- Low blood pressure
- Headaches
- Confusion
In addition, baclofen may not be suitable (or only suitable at a reduced dosage) for people with certain conditions, including:
- People with a history of strokes
- People with a history of kidney disease
- People with neurological conditions such as MS who rely upon muscle spasticity in order to maintain their balance in an upright position
- People with a history of epilepsy or seizures
- Pregnant women, unless it’s agreed that the benefits will outweigh the risks
Typically, as with any drug, these side effects (as well as the risks of having them) become more pronounced at higher doses of baclofen.
As with any medication, baclofen affects each individual differently. While some people may have no side effects at all, others may need to have their dosage decreased, or might even have to discontinue the drug completely. It’s also important to know that baclofen can interact with other drugs as well as supplements, so it’s crucial to let your doctor know about any drugs or supplements you’re currently taking.
For all its benefits, and regardless of why patients are taking it, baclofen usage can also come with some pretty dire control issues, both in terms of weaning off the drug and actually becoming too dependent on it.
The Risks of Weaning Off of Baclofen
As any physician will tell you, baclofen is definitely not a “self-prescribing” or “self-medicating” type of drug. Baclofen use needs to be monitored by a doctor, and dosages need to be closely followed according to the doctor’s instructions. This means that you should never try to take more because you feel you need it unless you have your doctor’s permission to do so.
Also, you can’t just quit baclofen “cold turkey.” If your doctor takes you off of baclofen, you’ll be put on a strict dosing regimen that slowly decreases the doses over a period of weeks and even months. The term for this is “titrating.” When you first start baclofen, doctors will recommend that you “titrate up” (start low and then increase per your doctor’s instructions). Likewise, when you discontinue baclofen, you’ll “titrate down” very slowly until you’re weaned off of it completely.
If you discontinue baclofen suddenly or too quickly, it can lead to hallucinations and seizures as well as increased spasticity, delusions, psychosis, hyperthermia, confusion, insomnia and agitation.
Can You Get Addicted to Baclofen?
One of the worst problems with medications used to treat addiction is that so many of them can actually become addictive themselves. The good news for baclofen is that, according to the National Institutes of Health (NIH), reports of baclofen addiction are relatively rare. However, there are reports of patients who abused baclofen by taking more than the prescribed dosage, which resulted in cravings for even more of the drug at dangerous levels. While the NIH report stresses the unusual nature of these cases, it also serves as a reminder that any drug that gives a heightened sense of well-being can subsequently be abused. This is particularly true for patients who start by taking a drug for addiction issues and find themselves becoming either psychologically or physically dependent on the very drug that’s supposed to treat the problem.
Is Baclofen a Cure for Alcohol Addiction?
Is baclofen the magic bullet for alcohol and substance addiction that everyone hoped it would be? Experts warn that, when it comes to substance addiction, there is no one treatment that’s going to make it magically disappear. This is because addiction itself is a complex disease, involving a multitude of factors in each individual. Because of this complexity, doctors typically recommend a combination of treatments involving counseling and behavioral therapies as well as medications. The important thing is that these treatments be customized for each patient’s needs because no two cases of addiction are alike.
If you’re suffering from alcoholism or drug addiction, or if you’re concerned about a loved one because of their drug or alcohol use, Windward Way Recovery can help. With just one phone call, you can get a free clinical assessment, with no obligation to enter our treatment program. When you’re ready, please call our 24/7 Free Admissions Helpline so that you can get the help you need, and deserve.
