Treating Alcoholism: Can Abstinence Be Replaced with a Pill?

Time magazine poses an important question this week regarding alcoholism treatment: Can a pill replace abstinence? Maia Szalavitz writes that alcoholics who take an anticraving medication called baclofen say the drug allows them to resist powerful relapse triggers such as a favorite bar, former drinking buddies, the sight of alcohol, and even having a single drink

She tells the story of Bob, 62, who battled alcohol dependency for several decades, regularly drinking at least 35 beers per week. Two years ago, after taking baclofen for two weeks, he found himself drinking soda water at a dinner party and, for the first time, not thinking about needing a drink.

“I realized I wasn’t having that nagging feeling in my head, ‘I should really get a drink,'” said Bob. “It never appeared during the dinner either so that was the eureka moment.” He continues to take baclofen and now drinks about two or three times per week, no more than a beer or two at a time.

Dr. Olivier Ameisen had a similar experience, which prompted him to write his memoir The End of My Addiction. A longtime alcoholic, Ameisen had been to rehab at least eight times and had attended nearly 5,000 Alcoholics Anonymous meetings without being able to maintain sobriety.

He began taking baclofen more than five years ago, and has since been able to abstain from drinking altogether. He occasionally drinks moderately in social situations but doesn’t have cravings or other addiction-related problems.

“I never understood how people could leave liquor in a glass,” said Ameisen. “Now you could give me a sip of champagne and I could leave it. That was impossible in my wildest dreams. And it’s effortless. Complete suppression, not reduction of cravings. I’m indifferent to it.”

But despite some anecdotal success, there is little scientific data to support the efficacy of baclofen. Previous animal studies have suggested that it does have a powerful anticraving effect, however, and two large studies are under way. But even if the apparent anti-addiction benefits of the drug—which is currently approved by the government to treat muscle spasms—are proven in human trials, it might do little to persuade most American addiction-treatment providers to use it.

For many people, successful treatment of addiction involves complete abstinence; for some, this includes abstaining from drugs that would help fight cravings. For decades, experts have debated whether drug addicts who cannot or will not quit should even be offered ongoing treatments that would reduce harm related to their drug abuse.

Baclofen might also be able to reduce cravings for nicotine, binge eating, or even heroin or cocaine, because it seems to intercept the drugs at their roots. Researchers think that by binding to the GABA-B receptors in the brain, the brain’s reward system is modulated, preventing the release of excess dopamine (the chemical that creates a sense of euphoria).

But not all research has been conclusive. A recently published multisite trial of the drug in cocaine addicts did not produce significant results, which could be due to the dose, according to Teri Franklin, a professor of neuroscience at the University of Pennsylvania. Franklin noted that most alcoholics who have reported success with the drug tend to take at least 80 mg per day, whereas the cocaine trial used 60 mg.

However, at high doses, baclofen can cause drowsiness and muscle spasms—though Franklin suggests that these side effects can be prevented with gradual exposure. Patients must also be gradually weaned off the medication to avoid muscle problems and anxiety. In addition, it seems that baclofen must be taken indefinitely, since cravings can return once the drug is stopped.

Regardless of the potential success of baclofen, most addiction experts would continue to encourage abstinence. “There are always some patients who can [cut down] to drink small amounts, but they are the exception,” says Dr. Nora Volkow, director of the National Institute on Drug Abuse, which is funding several ongoing trials of baclofen.

Although Volkow thinks baclofen shows promise in helping patients quit drinking altogether, she says the idea of controlled drinking is unwise: “My advice to patients is, don’t risk it.”