The End of My Addiction

again and again…
    Without going into all the years of shame, fear, self loathing and suicidal thoughts, I truly believed I was losing my mind—not to mention my family, friends, jobs, and any sense of self.
    In my heart of hearts I knew there had to be more going on with my disease, but I didn’t know where else to turn…Many times I would say to my sons, “This may not happen in my lifetime, but someday there will be evidence of something more than just a psycho-social disease.”
    I finally took it upon myself to make an appointment with a neurologist…The night before my appointment my husband was on the internet and came upon your case report.
    To make a very long story short, and with the support of [my neurologist]…[I] slowly began the process of taking baclofen…I now take 60 mgs. 3x’s a day…I am happy to say that I have remained sober for the past six months!! Only once has that occurred and that was when I was in a rehab for 6 mos., back in 1993.
    I wrote the woman back with congratulations and with warm thanks for her willingness to tell me her story. I asked her to keep in touch, but because of some unknown glitch did not receive her next message, dated January 2007, in which she wrote that she continued to do well on 180 milligrams of baclofen a day. Then came her message of February 2008 with the subject heading I’ve quoted. What is very touching is that she was concerned that my not having replied to her second message might mean that I had relapsed because I had stopped taking baclofen. I quickly wrote back to reassure her that I continue to take baclofen and to be free of alcoholism.

    Exactly how baclofen produces craving suppression and alleviates underlying dysphoria must still be explained by further research. But important parts of the answer have been established. Baclofen affects the neurotransmitters dopamine, GABA, and glutamate. It enhances GABA activity, reduces glutamate, and through these effects reduces dopamine. 9 In so doing it seems to play a role in balancing the brain’s reward mechanisms.
    Dopamine release is stimulated by several drugs of abuse. In a 2003 article in Synapse , a leading neurology journal, researchers reported that baclofen “dose-dependently reduced the nicotine-, morphine-, and cocaine-evoked [dopamine] release” in animal trials. The abstract concludes, “Taken together, our data are in line with previous reports demonstrating the ability of baclofen to modulate…[dopamine] transmission and indicate baclofen as a putative candidate in the pharmacotherapy of polydrug abuse.” 10 (In the jargon of science, “putative” means “likely,” rather than “supposed” or “alleged.”)
    In addition to the fact that baclofen has been shown to dose-dependently suppress motivation to consume alcohol, cocaine, heroin, nicotine, and amphetamine in animals, low-dose baclofen has been shown in randomized trials with dependent patients to reduce craving for cocaine and opiates as well as alcohol, and, in an open trial, craving for food in binge eating and bulimia. As I pointed out in my paper in Alcohol and Alcoholism , these results suggest that baclofen’s craving-suppressing effects might be transposed to humans for addictions besides alcoholism. They indicate that high-dose baclofen should also be tested in randomized trials for nondrug addictions as well as a variety of drug addictions including smoking.
    Many drugs with sedative-hypnotic effects act on GABA. What distinguishes baclofen from all but one of them, however, is that it acts on the GABA B receptor as opposed to the GABA A receptor. For example, alcohol, barbiturates, topiramate, vigabatrin, and benzos like Valium all affect the GABA A receptor. Besides baclofen, the only other substance known to act on the GABA B receptor is gamma-hydroxybutyrate (GHB).
    GHB occurs naturally in small amounts in human beings and many other living organisms. Natural, or endogenous, GHB has many sites of action in the brain, including a recently discovered GHB receptor. Synthetic, or exogenous, GHB was a fairly common childbirth anesthetic and sleep medication for some years in Europe. Under the brand name Alcover, it is used in Italy to treat alcoholism. But its use is much more tightly controlled in most other countries because of its potential as a drug of abuse. It is highly addictive, and it has been used as a date-rape drug.
    The small amounts of endogenous GHB must perform a necessary role in the