Exploring Baclofen for Alcoholism Essay

Exploring Baclofen for Alcoholism

Alcoholism claims three hundred lives per day in the United States alone. Finding a cure could save more than one-hundred thousand people per year Alcoholism is a broad term for problems with alcohol and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker’s health, personal relationships, and social standing. Alcoholism is medically considered a disease, specifically a neurological disorder, sometimes medically called “alcohol abuse” or “alcohol dependence.” To date, there are some standardized treatments that work for alcoholics, but not for others, and a cure is not medically recognized (Ameisen, 2009). Many cures have been proposed over the years; this research centers on a brilliant cardiologist, Dr. Oliver Ameisen, who developed a profound addiction to alcohol, and will show controlled studies using Baclofen to reduce cravings for alcohol. Dr. Ameisen, an alcoholic himself, did the only thing that he could; he took his treatment into his own hands. Dr. Olivier Ameisen

Dr. Ameisen was born in 1953. He came to New York in 1983 to join the prestigious cardiology team at New York Hospital and Cornell University Medical Center. Here he became the associate professor of clinical medicine and an associate attending physician. Dr. Ameisen gained his U.S. citizenship in 1991. Dr. Ameisen had a thriving practice (Ameisen, M.D., 2009). He also suffered from Post Traumatic Stress Disorder from a childhood that was shadowed by his parent’s horrific experiences during the Holocaust. Dr. Ameisen’s life eventually was consumed by his drinking. He was on the edge of losing everything when he began to research treatments that may lead to a cure. Against medical advice, he began to administer himself low doses of Baclofen. He immediately saw a change in his cravings. He no longer had to continue to drink if he started and no longer had the overwhelming urge to drink in general. He slowly increased the dose of Baclofen over the next few months until the addiction seemed to be cured.
Today Dr. Ameisen devotes his efforts to the treatment of addiction; he now lives in both New York and Paris. To date he has ended his addiction (Ameisen, 2009). Dr. Ameisen was able to use Baclofen to end his addiction to alcohol because Baclofen adjusts the neurotransmitters and prevents alcoholics from craving alcohol.

How Baclofen Works
Addiction begins in the neurotransmitters of the brain. When a person drinks low doses of alcohol, it activates gamma-amino butyric acid (GABA) receptors and stimulates the areas of the brain devoted to thinking, pleasure seeking, and relaxing. High doses of alcohol stimulate the receptors for glutamate, thereby disturbing our learning and memory, as occurs in blackouts (Ameisen, 2009). The functions and characteristics associated with neurotransmitters and receptors determine how we respond physically, emotionally, and mentally to different substances (Ameisen, 2009). Thus, an imbalanced neurotransmission is highly subject to loss of control. The second factor that goes hand and hand with GABA receptors is gamma-hydroxybutyrate (GHB). The nature of the role of endogenous GHB in the body is somewhat of a mystery, but it is thought GHB’s sedative-hypnotic effects are involved in the body’s ability to relax and recover from stress. It is thought that a GHB deficiency may underline substance dependence through a GABA medicated dysphoric syndrome.

A biological deficit of GHB would thus be experienced as a loss of the sedative effect, leading to anxiety, muscular tension, insomnia, and depression. Alcohol would then serve as a replacement for the GHB when someone is in one of these uncomfortable states. Dr. Ameisen believes that his research shows that Baclofen bridges the gap between the GHB deficit and the GABA receptor, thereby suppressing the urge to have a drink (Ameisen, 2009). In a 2003 article in Synapse, a leading neurology journal, researchers reported that Baclofen reduces the dopamine release in animal studies. This report demonstrates the ability of Baclofen to modulate dopamine (Ameisen, 2009). Dopamine is another neurotransmitter associated with addiction (Ameisen, 2009). The side effects of Baclofen are minimal compared to similar medications to treat alcohol dependence. Side Effects

The only two notable side effects of high-dose Baclofen are somnolence and muscular weakness. Both only last for a day or two and are easily reversible by reducing the Baclofen dose (Ameisen, 2009). The side effects are minimal compared to similar medications, most highly addictive, that only reduce cravings; as opposed to Baclofen that suppresses cravings. It is also important to note that Baclofen has been used for decades in the treatment of seizures; Baclofen has no addictive traits associated with it (Ameisen, 2009).

Case Reports

The three case studies included here are a baseline for determining of the effectiveness of Baclofen. The first case report is a self-case report of Dr. Ameisen that documents the first case in medical literature of the complete suppression of alcoholism; the second case report will highlight Baclofen’s dose-dependent suppression of alcoholism in a person who has not shown any improvement through the use of alternative treatments. The third case report is especially interesting as it shows the treatment of alcoholism in a person who suffers from paranoid schizophrenic episodes (Ameisen, 2009). Case Report 1

Dr. Ameisen’s self-prescribed high dose oral Baclofen starting at 30mg/day, with 20mg increases every third day and an (optional) additional 20-40 mg/day for cravings. The results were the cravings became easier to combat. After reaching the craving-suppression dose of 270 mg/day (3.6 mg/kg) after five weeks, Dr. Ameisen became and has remained free of alcohol dependence symptoms effortlessly for nine consecutive months. His anxiety is controlled and somnolence disappeared with a dosage reduction to 120 mg/day in the second nine month period (Ameisen, 2005).

Case Report 2

To further test whether the Baclofen-induced suppression of motivation to consume alcohol in animals could be transposed to humans the following study was preformed: 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. The result was the patient reported dramatic reduction in cravings for, and preoccupation with, alcohol. Conclusion; high-dose Baclofen therapy was associated with complete and prolonged suppression of
symptoms and consequences of alcohol dependence (Bucknam, 2007).

Case Report 3

A 49 year old male was admitted to the Division of Psychiatry at the University of Cagliri, Italy. He had been drinking approximately 2L of wine per day for the past 20 years. He had been admitted to several hospitals over the years and diagnosed with alcohol dependence and paranoid schizophrenia. He had been treated with several different medications over the years, to no avail. Upon admission to the University of Cagliri in July of 2005, it was proposed to try Baclofen. Starting with 5mg of Baclofen, 3 times a day; the dose was slowly increased to 25mg, 3 times a day. Along with marked improvement in the patient’s overall mental status, he remained alcohol free over a 48 week period. It is important to note that he was inpatient for only 6 of the 48 weeks, which shows his ability to remain alcohol free in a real-world situation, as opposed to a controlled environment. (Baclofen suppresses alcohol, 2007). The Next Step for Baclofen

During this exploration of the drug Baclofen for alcoholism, we have narrowed the results down to a minimum of reducing alcohol dependence and a perfect outcome of total suppression of alcohol dependence. One of the problems researchers face right now is the pharmaceutical companies have no motivation to do research on a generic drug that has no potential for their financial gain (Ameisen, 2009). No medication works effectively for everyone, and Baclofen is no exception. The real world numbers are that if 10% of alcohol dependent people do not respond to Baclofen, that would still leave over ninety-thousand people who could be cured.

The general research shows that Baclofen needs more research and FDA approval as a treatment for alcoholism if the research confirms the early findings. Individuals who are interested in more reading material on this subject might read Dr. Ameisen’s continued research in the book Heal thyself: A Doctor at the Peak of His Medical Career, Destroyed by Alcohol, and the Personal Miracle that Brought Him Back, which gives additional information and case report updates (Ameisen & Hinzmann, 2010). The reality is that the skeptic in many of us would like to see more case studies done by third party organizations. However, the reality is that, without private funding (which can promote bias) the fact remains that there is no financial gain for unbiased third parties to invest in. As a human being, my hope would be that pharmaceutical companies would research this possible cure for a disease that has plagued modern, and ancient, society for thousands of years. Unfortunately, that is not how our present system works. As for Baclofen’s future; it may be a cure for alcoholism that is never properly researched in independent studies, not because there is not a need for continued research, but because of the return on investment.

References
(2007). Baclofen suppresses alcohol intake and craving for alcohol in a schizophrenic alcohol-dependent patient: a case report. Journal of clinical psychopharmacology, 27(3), 319-320. This is the third case report in “The end of My Addiction”. This has an interesting twist of complete alcohol suppression combined with keeping a paranoid schizophrenic mental illness under control (“Baclofen suppresses alcohol,” 2007).

Agabio, Marras, Addolorato. (2007). Baclofen suppresses alcohol intake and craving for alcohol in a schizophrenic alcohol-dependence patient: a case report. Journal of Clinical Psychopharmacology, 27(3). The (2007) article “Baclofen suppresses alcohol intake and craving for alcohol in schizophrenic alcohol-dependent patient: a case report” shows the fact that Baclofen can be used with underlying mental illness to suppress alcohol cravings. This is an interesting study as most alcoholics have an underlying mental illness (Agabio, Marras, Addolorato, 2007).

Ameisen. (2005). Complete and prolonged suppression of symptoms and consequences of alcohol-dependence using high-dose Baclofen: a self-case report of a physician. Alcohol and Alcoholism, 40(2), 147-150. In the (2005) article “Complete and prolonged suppression of symptoms and consequences of alcohol-dependence using high-dose Baclofen: Ameisen reveals his self administration of the drug Baclofen. He explains the pros and cons of using high dose Baclofen. The article explains the prolonged suppression afforded by Baclofen (Ameisen, 2005).

Ameisen, M.D., O. (2009). The end of my addiction. (First ed.). New York: Sarah Crichton Books, Farrar, Straus and Giroux.

Olivier Ameisen, M.D. (2009) book, “The End of My Addiction” centers on Dr. Ameisen’s lifelong fight with alcoholism. It details his life as a child of Holocaust survivors and the trauma that his childhood had imposed on his life. Almost losing everything he had worked for and being in and out of rehab with no good result; Dr. Ameisen decided to look for a cure for alcoholism himself. He discovered that Baclofen, originally a treatment for depression and muscular disorders, seemed to work to cure his personal fight with alcoholism. He then decided to do a self-case study, eventually followed by other case studies (Ameisen, M.D., 2009).

Ameisen, O., M. D. (2008). Are the effects of gamma-hydroxybutyrate (GHB) treatment partly physiological in alcohol dependence? The American Journal of Drug and Alcohol Abuse, 34(2), 235-236. In Ameisen’s (2008) journal article “Are the effects of gamma-hydroxybutyrate (GHB) treatment partly physiological in alcohol dependence?” we look into the effects of GHB possibly being physiological. It also points out the importance of GHB in alcoholics. There is a direct relationship to GHB levels and alcoholism, according to Ameisen (Ameisen, 2008).

Ameisen, Nava, M. D., P. D. (2008). “reply to the letter ‘are the effects of gamma-hydroxybutyrate (GHB) treatment partly physiological in alcohol dependence?'”. The American Journal of Drug and Alcohol Abuse, 34(2), 235-236. In this joint (2008) Ameisen, Nava article “reply to the letter ‘are the effects of gamma-hydroxybutyrate (GHB) treatment pertly physiological in alcohol dependence?’” we get a second opinion from Felice Nava, Ph.D. (Ameisen, Nava, 2008).

Ameisen, O. (2005). Complete and prolonged suppression of symptoms and consequences of alcohol-dependence using high-dose Baclofen: a self-case report of a physician. Alcohol and Alcoholism, 40(2), 147-150. (Ameisen, 2005) This is the first case report in “The End of My Addiction”. It outlines a self-study of Dr. Ameisen’s own self-medication with Baclofen
(Ameisen, 2005).

Ameisen with Hinzmann, O. A., H. H. (2010). Heal thyself: a doctor at the peak of his medical career, destroyed by alcohol, and the personal miracle that brought him back. (first ed.). New York: Sarah Crichton Books/Farrar, Straus And Giroux.

Olivier Ameisen and Hilary Hinzmann (2010) book “Heal thyself: a doctor at the peak of his medical career, destroyed by alcohol, and the personal miracle that brought him back” is a spin-off of the original book “The End of My Addiction”. This version gives up to date information on the progress of additional case studies and Dr. Ameisen’s personal progress. It basically is an update of the original book (Ameisen with Hinzmann, 2010).

Bucknam, W. (2007). Suppression of symptoms of alcohol dependence and craving using high-dose Baclofen. Alcohol and Alcoholism, 42(2), 158-160. This is the second case report in “The End of My Addiction”. It deals with the comparison of different treatments as compared to Baclofen (Bucknam, 2007).

Drake, Davis, Cates. (2003). Baclofen treatment for chronic posttraumatic stress disorder. The Annals of Pharmacotherapy, 37, 1177-1181. Drake, Davis, and Cates tackle one of the most popular underlying disorders that alcoholics suffer from in the (2003) article “Baclofen treatment for chronic posttraumatic stress disorder.” The interesting part of this article is that Baclofen can be used as a standalone treatment for PTSD and has the added beneficial side effect of suppressing alcohol cravings (Drake, Davis, Cates, 2003)