Can Baclofen Be Used for Addiction Treatment?
Baclofen goes under the brand names Gablofen and Lioresal (as well as the discontinued brand Kemstro). Baclofen is a central nervous system depressant that is structurally related to the neurotransmitter gamma-aminobutyric acid (GABA). GABA is the primary inhibitory neurotransmitter in the central nervous system, and its function is to decrease the firing rates of other neurons. When GABA is released in large amounts, it results in calming, sedating, and relaxing effects, and it may even lead to issues with coordination in reflex actions.
Baclofen is believed to have an affinity for the GABA neuronal receptor, and its use results in feelings of relaxation and sedation. Baclofen is believed to block the activity of the neurons in the brain that assist in the control of the contraction of skeletal muscles.
Its FDA-approved uses are primarily to treat:
- Muscle spasms
- Rigidity in the muscles
- Pain associated with several neurodegenerative disorders, such as multiple sclerosis
- Muscle clonus (involuntary muscle contractions)
Baclofen is available in a pill or injectable form. A number of research studies have investigated the effectiveness of baclofen in the treatment of certain substance use disorders. This research has been presented for the treatment for alcohol use disorders, stimulant use disorders (primarily cocaine abuse), and opiate use disorders.
Alcohol Use Disorders
- In animal models, there is evidence that baclofen may have efficacy in reducing alcohol intake; however, the results of animal models do not always transfer to human participants.
- For example, a recent randomized, double-blind, placebo-controlled study (the most stringent form of experimental study used with actual participants) reported in the journal Alcoholism: Clinical Experiment Research indicated that baclofen was no more effective than placebo in controlling cravings for alcohol, the amount of alcohol consumed, and days of abstinence in individuals diagnosed with alcohol use disorders. This was consistent with a similar study performed in 2010. These studies contrast with earlier double-blind studies where baclofen was shown to reduce cravings for intake in alcohol-dependent participants. In double-blind studies, neither the researchers nor the participants in the study are aware who actually gets the medication and who gets the placebo. Finally, the prestigious Cochrane Review reports that the evidence for baclofen’s efficiency in treating alcohol use disorders is of low quality.
- The results of open label trials, where researchers and participants both know who is getting the medication and who is getting the placebo, generally suggest positive results for baclofen’s ability to reduce cravings and alcohol in participants. The results of open label trials are generally considered to be weak evidence for the efficacy of the medication. Randomized, double-blind, placebo-controlled studies like the ones mentioned above are the gold standard in determining the efficacy of any type of treatment.
- A large observational study performed in 2012 followed 100 patients who are resistant to other forms of treatment for their alcohol use disorder. Improvements in abstinence and cravings were measured at intervals of three months, six months, one year, and two years with treatment for baclofen. Significant rates of improvement occurred at each interval, suggesting that baclofen may have utility in the treatment of alcohol use disorders; however, observational studies like this have very little ability to actually claim that a causal relationship exists between their independent variable (in this case, treatment with baclofen) and the outcome (in this case, improved response to treatment).
- There is research to suggest that baclofen may be useful as a withdrawal management medication for individuals who are recovering from alcohol use disorders. However, more studies need to be performed.
The last factor is perhaps the most telling. It appears that the utility of baclofen in reducing cravings, reducing alcohol intake, and helping individuals maintain abstinence is similar to other drugs designed to be used in the treatment of alcohol use disorders, such as Antabuse. In individuals with little or varying motivation to remain abstinent, these drugs do not seem to be efficacious; however, in individuals with strong motivation to adhere to their recovery program, the medications may have better utility. Such issues may explain the contradictory findings in the research mentioned above.
Baclofen is not approved by the FDA at the time of this writing for the treatment of alcohol use disorders.
Thus, the bottom line is that the research on baclofen’s utility in the treatment of alcohol use disorders is mixed. Conclusions from these studies suggest that the effectiveness of baclofen in reducing cravings and alcohol intake may be attenuated by individuals who:
- Have a co-occurring psychological disorder
- Use other psychotropic drugs (e.g., antidepressants, benzodiazepines, antipsychotics, etc.)
- Are unable to tolerate high doses of baclofen
- Are not motivated to stop drinking
Addiction to Stimulants
Stimulant use disorders comprise a number of different drugs of abuse and include prescription drugs like Ritalin and illicit drugs like cocaine and methylphenidate (crystal meth). There are a number of studies with animals, such as a recent study presented in The European Journal of Pharmacology that suggest that baclofen may be useful in treating cocaine addiction, including for relapse in individuals recovering from cocaine abuse. Studies with animals are preliminary studies to build a case for using human participants and to eliminate drugs that have obvious dangers associated with the use or that are totally ineffective. The findings from animal studies do not always generalize well to human participants.
A preliminary study reported in the journal Neuropsychopharmacology in 1998 using 10 individuals with cocaine abuse issues reported that the group’s overall use of cocaine was diminished and cravings were reduced with the use of baclofen; however, nine of the 10 individuals did use cocaine at least once over the course of study, and the study was of limited duration.
A randomized placebo-controlled study performed in 2003 indicated that individuals using baclofen tested positive for cocaine significantly less often than individuals not using the drug. A larger randomized placebo-controlled study in 2009 found that baclofen was no more effective than placebo in controlling cocaine use or cravings.
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Opiate Abuse Treatment
There are some reports online that suggest that baclofen may be useful in the treatment of opiate use disorders. A good deal of this information is based on anecdotal evidence and a few case studies. For example, in 2015, the International Journal of Research and Reports reported on a case study of an individual recovering from an opiate use disorder as a result of heroin abuse who was administered baclofen and Clonidine and suffered no serious withdrawal symptoms. Case studies represent the weakest form of observational evidence with respect to determining whether or not a specific type of treatment is efficacious.
Many sites tout baclofen’s efficacy in the treatment of substance use disorders, and there even several books that claim it is an effective treatment for cravings, withdrawal symptoms, and relapse for a number of different substance use disorders. However, the research regarding the efficacy of baclofen appears mixed at best, and more targeted research needs to be performed in order to determine under which conditions and for which substances baclofen can best be utilized.
Currently, baclofen is used in a number of a clinical settings. It is unclear if the drug is effective in these settings and at what rate its effects are produced. It does appear that baclofen is most useful for individuals who are not suffering from other co-occurring mental health disorders and who are highly motivated to be abstinent.
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