He’s been trying to get a study funded to see whether there’s solid evidence that high doses of the drug undo addictions, but there isn’t sufficient interest.
There are a few randomized trials of baclofen, if those count:
Addolorato et al. 2006. 18 drinkers got baclofen, 19 got diazepam (the ‘gold standard’ treatment, apparently). Baclofen performed about as well as diazepam.
Addolorato et al. 2007.61814-5) 42 drinkers got baclofen, 42 got a placebo. More baclofen patients remained abstinent than placebo patients, and the baclofen takers stayed abstinent longer (both results were statistically significant).
Assadi et al. 2003. 20 opiate addicts got baclofen, 20 got a placebo. (Statistically) significantly more of the baclofen patients stayed on the treatment, and lessened depressive & withdrawal symptoms. The baclofen patients also did insignificantly better on ‘opioid craving and self-reported opioid and alcohol use.’
Shoptaw et al. 2003. 35 cokeheads got baclofen, 35 a placebo. ‘Univariate analyses of aggregates of urine drug screening showed generally favorable outcomes for baclofen, but not at statistically significant levels. There was no statistical significance observed for retention, cocaine craving, or incidence of reported adverse events by treatment condition.’
Heinzerling et al. 2006. Just found this one: 25 meth addicts got baclofen, 26 got gabapentin, and 37 got a placebo. Going by the abstract, across the whole sample, neither baclofen nor gabapentin beat the placebo, but an after-the-fact statistical analysis suggested that baclofen had a significantly stronger effect than placebo among the patients who were stricter about taking the baclofen.
Franklin et al. 2009. Editing in this one too: 30 smokers who were thinking of quitting took baclofen, 30 took a placebo. Both groups smoked progressively fewer cigarettes a day during the trial, but the baclofen users had a significantly steeper decline than the placebo users. However, they did not report significantly less craving feelings.
Kahn et al. 2009. Last one, I promise: 80 cocaine addicts from around the USA got baclofen and 80 got a placebo. There were no statistically significant differences in treatment retention, cocaine use, measures of craving and withdrawal, or any of the other things the researchers tested for, except on a couple of post hoc tests. The researchers hint that the dose used (60mg) might have been too small.
Most of these studies are a few years old now, and there are also case reports, uncontrolled trials like this one and studies done on rodents. I’m kind of surprised no one’s tried doing a larger scale trial of baclofen for alcohol. I haven’t looked at these in detail—maybe the effect is only statistically significant and not clinically significant, or there’s some subtle methodological issue I’m missing.
(Edited this comment a few times because Chrome helpfully posted it prematurely for me.)
A It varies from patient to patient, depending probably on physical size, extent of dependency, and other factors. Studies have shown that animals lose all motivation to consume addictive substances when they are given baclofen in the range of 1 to 5 milligrams per kilogram (2.2 pounds) of body weight.
The evidence from my case and other patients is that the threshold dose needed to break the cycle of addictive craving, preoccupation, and obsessive thoughts is higher than the maintenance dose needed to keep a patient completely free from addiction.
Good point. I hadn’t read Ameisen’s FAQ; I just went running off to Google Scholar as soon as I read your comment. I might come back later and see what doses were used in each of those studies and see whether the studies with higher doses had more positive results.
There are a few randomized trials of baclofen, if those count:
Addolorato et al. 2006. 18 drinkers got baclofen, 19 got diazepam (the ‘gold standard’ treatment, apparently). Baclofen performed about as well as diazepam.
Addolorato et al. 2007.61814-5) 42 drinkers got baclofen, 42 got a placebo. More baclofen patients remained abstinent than placebo patients, and the baclofen takers stayed abstinent longer (both results were statistically significant).
Assadi et al. 2003. 20 opiate addicts got baclofen, 20 got a placebo. (Statistically) significantly more of the baclofen patients stayed on the treatment, and lessened depressive & withdrawal symptoms. The baclofen patients also did insignificantly better on ‘opioid craving and self-reported opioid and alcohol use.’
Shoptaw et al. 2003. 35 cokeheads got baclofen, 35 a placebo. ‘Univariate analyses of aggregates of urine drug screening showed generally favorable outcomes for baclofen, but not at statistically significant levels. There was no statistical significance observed for retention, cocaine craving, or incidence of reported adverse events by treatment condition.’
Heinzerling et al. 2006. Just found this one: 25 meth addicts got baclofen, 26 got gabapentin, and 37 got a placebo. Going by the abstract, across the whole sample, neither baclofen nor gabapentin beat the placebo, but an after-the-fact statistical analysis suggested that baclofen had a significantly stronger effect than placebo among the patients who were stricter about taking the baclofen.
Franklin et al. 2009. Editing in this one too: 30 smokers who were thinking of quitting took baclofen, 30 took a placebo. Both groups smoked progressively fewer cigarettes a day during the trial, but the baclofen users had a significantly steeper decline than the placebo users. However, they did not report significantly less craving feelings.
Kahn et al. 2009. Last one, I promise: 80 cocaine addicts from around the USA got baclofen and 80 got a placebo. There were no statistically significant differences in treatment retention, cocaine use, measures of craving and withdrawal, or any of the other things the researchers tested for, except on a couple of post hoc tests. The researchers hint that the dose used (60mg) might have been too small.
Most of these studies are a few years old now, and there are also case reports, uncontrolled trials like this one and studies done on rodents. I’m kind of surprised no one’s tried doing a larger scale trial of baclofen for alcohol. I haven’t looked at these in detail—maybe the effect is only statistically significant and not clinically significant, or there’s some subtle methodological issue I’m missing.
(Edited this comment a few times because Chrome helpfully posted it prematurely for me.)
Thanks for looking this up.
Unless I’ve missed something, only the third study might have used baclofen in high enough dosages to test Arneisen’s hypothesis.
From his FAQ:
Good point. I hadn’t read Ameisen’s FAQ; I just went running off to Google Scholar as soon as I read your comment. I might come back later and see what doses were used in each of those studies and see whether the studies with higher doses had more positive results.