The End of My Addiction

having persecutory and referential delusions, visual hallucinations, affective flattening, and avolition. Details provided by his relatives revealed an early onset of heavy alcohol drinking and schizophrenic symptoms at approximately the age of 28 years.
    Daily alcohol intake, as reported by both the patient himself and his relatives, averaged approximately 2 L of wine (approximately 16 drinks per day). After frequent episodes of alcohol intoxication and/or exacerbation of schizophrenic symptoms, he had been admitted several times to medical and psychiatric hospitals with a diagnosis of alcohol dependence and paranoid schizophrenia (in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) and treated with haloperidol and benzodiazepines. He had also been treated with disulfiram and had attended Alcoholics Anonymous meetings, without any apparent beneficial effect in terms of reduction of alcohol intake. From 1999 to 2005, he was admitted to the hospital approximately once a year because of severe episodes of acute alcohol intoxication. In July 2005, we proposed to the patient and his family a new pharmacological treatment to decrease his alcohol consumption. Specifically, the possibility of using baclofen was discussed. Written informed consent was obtained. Before the first baclofen administration, a blood sample was collected for evaluation of the following indicators of heavy alcohol drinking: mean corpuscular volume of red blood cells, aspartate aminotransferase, alanine aminotransferase, and g-glutamyl transpeptidase. A schedule was drawn up providing for patient examination once a day for the first 3 days, once a week for the first 4 weeks, and subsequently once every 2 weeks. A breathalyzer test, using the Alco-Sensor IV breathalyzer apparatus (Syen Elettronica, Gardigiano di Scorzè, Venezia, Italy), was administered at each visit to evaluate the patient’s breath alcohol concentration. At each visit, the following rating scales were administered to the patient: Zung Self-rating Depression Scale, Spielberger State Anxiety Inventory, Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI)–Improvement and–Severity Scales, a visual analog scale (VAS) of craving severity and Obsessive Compulsive Drinking Scale (OCDS 15 ) in its validated form in Italian. 16 Alcohol intake was self-reported by the patient and confirmed by a family member. Possible side effects related to baclofen therapy were also recorded. Treatment with baclofen started with the dose of 5 mg, per os, 3 times a day for 3 days; starting from day 4, the dose was increased to 10 mg, 3 times a day. The patient attended all scheduled visits and regularly took the baclofen pills as indicated by counting the returned tablets. He did not report any side effect, with the sole exception of a mild degree of sedation at the very beginning of the treatment. He stopped drinking from the first week of treatment; breath alcohol concentrations were negative throughout the treatment. OCDS and VAS scores were virtually suppressed from the first 4 weeks of treatment (Table 1). Indexes of severity of schizophrenic symptoms tended to decrease during treatment (Table 1). Conversely, anxiety and depression severity scores were not modified by baclofen administration.
    In line with the reduction in alcohol intake, value of mean corpuscular volume decreased from 101 to 94 fL over treatment with baclofen. The patient reported the consumption of 1 drink in week 18. Subsequently, taking into account the recently reported beneficial effects induced by relatively high doses of baclofen (up to 270 mg/d) on alcohol consumption and craving for alcohol, 7 the dose of baclofen was increased to 25 mg, 3 times a day. After 1 year of treatment, the latter remains the only episode of alcohol drinking, as the patient demonstrated near-complete suppression of alcohol drinking and craving for a 48-week period.

    TABLE 1. Scores of Different Rating Scales for Psychiatric Disorders and Alcohol Craving in an Alcohol-Dependent Schizophrenic Patient Treated with Baclofen
    Values in week 0 are baseline values (before the start of treatment with baclofen). Weeks 1 to 24 are time elapsed from the start of the treatment with baclofen.
    BPRS indicates Brief Psychiatric Rating Scale, CGI-S, CGI-Severity; CGI-I, CGI-Improvement; OCDS, Obsessive Compulsive Drinking Scale; VAS, visual analog scale; ZUNG, Zung Self-rating Depression Scale;