There are many potential causes, and maybe even different types of the disease. I have argued elsewhere that our Toxic Alcohol Environment is a vitally important element in this massive increase in the number of sufferers. Addressing this factor will be essential if we are to control alcohol abuse across populations.
Over the years, many treatment modalities have been used to combat the disease in the individual. These have ranged from psychological, psychiatric and drug therapies; often used in combination. Few have met with significant success, i.e. long term abstinence.
It is becoming increasingly clear that many of us find ourselves abusing alcohol in order to curb what is for us an extremely disabling condition. Many alcoholism sufferers are now found to also suffer from varying degrees of chronic anxiety, occasionally mixed with obsessive / compulsive traits. For them, the rigours of a normal life seem to be exaggerated, blown out of all proportion. Many find it all but impossible to function at home or at work. To 'quieten' this chronic state of tension, anxiety, if not panic, they turn to a readily available 'anxiolytic'; alcohol. And, unfortunately, it works beautifully. At least for a while. And at what cost to the individual, their family, their work, their finances, and their health. To date, this has been underestimated and hence undertreated.
Baclofen is a long established drug, used for more than 70 years to treat numerous neurological conditions where spasticity (increased muscle tone), muscle spasms etc are troublesome; e.g. multiple sclerosis, spinal cord injuries, cerebral palsy etc. Some of these symptoms are not uncommon in chronic alcoholics, and when Baclofen was used to treat such symptoms in this group, it was reported that the cravings for alcohol were significantly diminished.
Baclofen is a synthetic analogue of GABA - a neurotransmitter that generally 'settles' or inhibits the nervous system.
Several preclinical (i.e. mostly experimental laboratory) studies, often in rats, have demonstrated that synthetic agonist analogues of GABA, especially Baclofen are likely to help in the promotion and maintenance of abstinence from a wide range of drug abuse.
In simple terms, laboratory rats don't have any concept of what drugs are, obviously. They're rats. So, if you make drugs available to them, they only take them if they need them, in the addictive sense. To use the technical language, they 'self-administer'. If you make them drug addicts by giving them drugs beforehand, you can test how effective drugs such as Baclofen might be in helping them to abstain, i.e. to not self-administer.
Such prevention of self-administration has been shown to occur with Baclofen, for rats addicted to (amongst others) cocaine, nicotine, heroin, methamphetamine and alcohol. Further, Baclofen appears to also have a beneficial effect in reducing the signs of opiate withdrawal in rats dependent on morphine.
What is currently known about how this might happen?
We need to very briefly consider two different, but related, concepts.
In positive reinforcement, the reward of feeling really great when the rat takes the drug obviously makes the rat want to do it again, and again.
In negative reinforcement, the drug is craved in order to prevent or alleviate signs and symptoms that are unpleasant or outright painful, ie the effects of withdrawal.
It seems that different bits of the brain might be involved in these different effects.
The important point is that Baclofen may have a valuable role in both of these reinforcement pathways. The details of the neurophysiology are far too complicated for this particular discussion.
The bits of brain that appear to be involved in the positive reinforcement pathway appear to be associated with a great sense of well-being (euphoria) for cocaine, heroin, nicotine and alcohol. Baclofen, through its action as a synthetic GABA analogue and agonist reduces this sense of euphoria.
Conversely, there is now evidence, in rats, that Baclofen also reduces the horrible, often painful signs and symptoms of withdrawal of opioid drugs, such as morphine.
There are fewer studies in humans, as yet, but the evidence of the benefit of Baclofen is becoming a little clearer.
Whilst the data needs further investigation, it does appear that Baclofen does have the same potential for ameliorating both the positive and negative in humans.
This therefore, was the background to why it was considered possible that Baclofen might have a potentially valuable role in the management of both the cravings for alcohol and other symptoms of alcohol withdrawal, and also the underlying chronic anxiety state that appears to be so common in alcoholics.chronic alcoholism
It is very early days, and much research is required. However, a French cardiologist with a long very problematic alcohol dependency used Baclofen on himself with amazing results. He has maintained very long term abstinence; feeling that his cravings have not been suppressed, but have been eliminated.
This has spurred many individual sufferers to adopt Baclofen as their preferred treatment option for their own alcohol problem. There are now thousands of anecdotal reports confirming Dr Ameisen's own experience. Both the cravings of alcohol withdrawal and the underlying chronic anxiety state are both reduced, if not very often, totally eliminated. Further Baclofen is safe, cheap, and free from all the dependency / withdrawal problems associated with many other anxiolytic drugs. Further, overdose has never been fatal, even with enormous doses.
Unfortunately, in spite of this ever increasing body of 'evidence', the medical profession is being extremely slow in recognising this potentially huge advance in this crippling disease.
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