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EFFICACY OF BACLOFEN IN REDUCING ALCOHOL CRAVING AND MAINTAINING ABSTINENCE
Baclofen is GABAB receptor agonist and it is effective in the treatment of patients with alcohol and other drug addiction. Administration of low doses of baclofen to alcohol-dependent patients is effective in inducing and maintaining abstinence from alcohol, reducing alcohol intake, suppressing alcohol craving in both its obsessive and compulsive features as well as reduces anxiety.
Within a week or two of baclofen treatment abstinence from alcohol or reduction in alcohol intake is achieved and is maintained throughout the treatment period. The increased efficacy of baclofen may be related to its suppressant effect on craving. Baclofen produces a rapid decrease in the compulsive and obsessive components of craving. It is to be noted that anti-craving effect of baclofen has already been observed with other substances of abuse like cocaine (cocaine users).
The anti-craving effect of baclofen may depend on its ability to interfere with the neuronal substrates mediating the reinforcing properties of ethanol. GABAB receptors are located in the ventral tegmental area (VTA) have been reported to control the activity of mesolimbic dopamine neurons, a major neural pathway in the regulation of the reinforcing properties of addictive drugs, including alcohol.
Pharmacological stimulation of VTA GABABreceptors has been found to inhibit the firing activity of these neurons as well as basal and alcohol-stimulated
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dopamine release from their terminals in the nucleus accumbens.
The suppressing effect of baclofen on alcohol withdrawal symptoms may have helped the patients to achieve and maintain alcohol abstinence. It is found that the decrease in state anxiety and the decrease in depression, observed by in alcoholics after 2- 3 weeks treatment with baclofen were secondary to the ability of baclofen to achieve both a rapid detoxification and a decrease in craving, resulting in a rapid reduction of physical and psychological symptoms.
Baclofen is devoid of serious side-effects in alcoholics. If any, most of side-effects are present only during the first week of the treatment.
Some studies suggest that baclofen might be liable to misuse since the
drug shares several pharmacological effects with the alcohol-mimicking (look alike) agent, γ-hydroxybutyrate (GHB), and craving for and abuse of GHB have been observed in different alcoholic patients. However, baclofen do not show euphorigenic effects and no patient consumed the drug above the prescribed dose. The lack of misuse liability of baclofen is an important factor in pharmacological treatments of alcohol and other substance addictions. No patient complained of euphoria or other pleasant effects caused by the drug. No patient showed craving for baclofen. At drug discontinuation, neither drug withdrawal syndrome nor side-effect due to drug suspension was observed
In short, baclofen, because of its anti-craving and anti-reward action on the one hand, and safety on the other
hand may have an very important role in the treatment of patients with alcohol problems.