The End of My Addiction

C., Lehert, P. et al . (2002) The European NEAT program: an integrated approach using acamprosate and psychosocial support for the prevention of relapse in alcohol-dependent patients with a statistical modeling of therapy success prediction. Alcoholism: Clinical and Experimental Research 26 , 1529–1538.
    Roberts, D. C. and Andrews, M. M. (1997) Baclofen suppression of cocaine self-administration: demonstration using a discrete trials procedure. Psychopharmacology (Berlin) 131 , 271–277.
    Shoaib, M., Swanner, L. S., Beyer, C. E. et al . (1998) The GABA B agonist baclofen modifies cocaine self-administration in rats. Behavioral Pharmacology 9 , 195–206.
    Shoptaw, S., Yang, X., Rotheram-Fuller, E. J. et al . (2003) Randomized placebo-controlled trial of baclofen for cocaine dependence: preliminary effects for individuals with chronic patterns of cocaine use. The Journal of Clinical Psychiatry 64 , 1440–1448.
    Smith, C. R., LaRocca, N. G., Giesser, B. S. et al . (1991) High-dose oral baclofen: experience in patients with multiple sclerosis. Neurology 41 , 1829–1831.
    Xi, Z. X. and Stein, E. A. (1999) Baclofen inhibits heroin self-administration behavior and mesolimbic dopamine release. The Journal of Pharmacology and Experimental Therapeutics 290 , 1369–1374.

 
    Case Report 2
    Alcohol and Alcoholism vol. 42, no. 2, pp. 158–160, 2007
    Suppression of symptoms of alcohol dependence and craving using high-dose baclofen
    William Bucknam
    Abstract
    Aims: To further test whether the baclofen-induced suppression of motivation to consume alcohol in animals could be transposed to humans. Methods: A patient who had neither tolerated nor benefited from other alcohol treatment modalities was put on trial with baclofen on a dosage up to 140 mg/day. Results: The patient reported dramatic reduction in cravings for and preoccupation with alcohol. Conclusions: High-dose baclofen therapy was associated with complete and prolonged suppression of symptoms and consequences of alcohol-dependence.
    Introduction
    In the past decade, scientists have made important progress toward understanding the neurobiology underlying drug and alcohol addiction. Consequent development of new pharmacotherapies has been shown to substantially improve the outcomes of patients treated with standard alcohol therapies (individual and/or group supportive psychotherapy, cognitive behavioral therapy; 12-step programs). FDA approval has been granted for three agents thus far. Listed in order of FDA approval dates, these are disulfiram, oral naltrexone, acamprosate, and recently an extended release (30 day) injectable suspension of naltrexone. The latter, having just been released, has not yet had widespread use in clinical settings. Although Garbutt et al . (2005) did associate injectable naltrexone with a lower number of heavy drinking days per month in alcohol-dependent individuals, the number did not continue to diminish over the long duration of the trial. This may be because naltrexone has never been shown to completely eliminate craving for alcohol. Craving has been shown in some studies to predict drinking behavior (Bottlender and Soyka, 2004). Craving remains, nonetheless, an ill-defined concept. Clinical assessment of craving remains of unclear value. Reduction of heavy drinking days has been previously established in randomized trials with the oral naltrexone (Balldin et al ., 2003), topiramate (Johnson et al ., 2003), baclofen dosed 10 mg t.i.d. (Addolorato et al ., 2002), and in an open-label trial of acamprosate (Soyka and Chick, 2003).
    In validated animal models for craving for alcohol (Koob, 2000), one of these agents, baclofen, which is a GABA B receptor agonist, has been shown in high dose to completely suppress motivation to consume alcohol. The suppressing effect is dose-dependent (Colombo et al. , 2003). Acamprosate has also been shown to reduce self-administration of alcohol in alcohol-preferring rats (Cowen et al ., 2005). Naltrexone reduced but did not eliminate self-administration of alcohol. Animal data are not available for topiramate (Ameisen, 2005a).
    Anxiety disorders (Breslow et al ., 1989; Drake et al ., 2003) and anxiety associated with affective disorders (Addolorato et al ., 2002a,b, 2006) have been shown to be ameliorated by baclofen. Clinically significant anxiety is commonly comorbid with alcohol dependence (Grant et al ., 2004). Efficacy on anxiety has not been shown for other agents used for alcohol dependence