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Author Topic: Practical Protocol for Prescribing Baclofen in Alcohol Addiction  (Read 143 times)

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Practical Protocol for Prescribing Baclofen in Alcohol Addiction
« on: September 28, 2019, 10:40:21 AM »
source: https://baclofentreatment.com/practice-guides/practical-protocol-for-prescribing-baclofen-in-alcohol-addiction/

Practical Protocol for Prescribing Baclofen in Alcohol Addiction

SECTION 1: INTRODUCTION:

This is a practical guide to Prescribing Baclofen in Alcohol Addiction.

All the information in this module is available in written form including protocols for prescribing and dose adjustment and an information pack to give patients (link).

We’ll go through:

1. The key effects of baclofen in alcohol addiction
2. The important practice points of baclofen treatment

SECTION 2: The key effects of baclofen on the Alcohol Addicted patient.

The key effects of baclofen on the Alcohol Addicted patient are:

* Anti-craving
* Anxiolytic

Baclofen’s main effect in the treatment of alcohol addiction is that it switches off alcohol cravings – the compulsion to drink.

The aim is to totally switch off cravings so that the patient experiences an effortless indifference to alcohol. This is a remarkable experience for the alcohol addicted patient – the ability to be in the company of others drinking alcohol and not feel tempted, the ability to pass blithely by liquor stores and not be “sucked” inside.

It’s such a powerful effect that the patient doesn’t need to stop drinking or go through detoxification to start baclofen treatment – once the cravings stop, the patient has the choice of whether to drink and generally their alcohol intake simply drops away.

Added to this is baclofen’s powerful anxiolytic effect. Anxiety is often the root cause of treatment resistant alcohol addiction so this is a very beneficial effect.

The common link between anxiety and alcohol addiction is explored in more detail in another section (link). I think of it as the missing piece of the puzzle as to why many alcohol addicted patients just can’t stop drinking.

Baclofen is the only medication widely used for alcohol relapse prevention which has inbuilt anxiolytic effects – acamprosate and naltrexone don’t have any.

There has been increasing interest in a couple of other medications with effects on anxiety and alcoholism, topiramate, gabapentin and pregabalin but none match the reliable effectiveness of baclofen.

Benzodiazepines like diazepam are very effective for anxiety, in the same way alcohol is but they’re not a great treatment. They share the same addiction risk because of the rapid onset of tolerance and the need for increasing doses. The result is often exchanging an alcohol addiction for a benzodiazepine one.

Importantly baclofen’s anxiolytic effect starts at low doses, often well before the anti-craving effect kicks in. This encourages patients to stay on the baclofen while it’s being titrated up because they can feel a beneficial effect on their anxiety from the start.

With baclofen having both anti-craving and anxiolytic effects, it can be hard to work out which is having the most effect on reducing alcohol consumption but, to my way of thinking, this is of intellectual rather than practical interest.

this continues at the source link ...
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