All About Addiction

Helping addicts get their lives back

Finally, the Addiction Cure Is Here, Right?

A "new" promising pill for addiction, baclofen gets a look

If you care about addiction you've seen the television commercials promising the "addiction cure" via a book that has supposedly solved all problems for addicts. While most people scoff at the suggestion and I don't know a single person who takes this suggestion that addiction has been cured seriously. Such facilities who tout this have no problem filling up their $80,000 a month facility with clients.

But while it's relatively easy to make fun of a group rich Malibu socialites, the promise of one addiction cure or another keeps coming from another, more well regarded source as well - the pharmaceutical complex. We've had naltrexone since the 1970s, anatabuse to make alcoholics sick if they relapse, opiate replacement medications for at least as long (methadone and the more recent buprenorphine), buproprion (Zyban) for smoking and more, and the list goes on (varenicline, topiramate, etc.).

One of the more recent additions to this list is baclofen.

Mind you, those of use in the addiction field have long been told that there's not a lot of monetary potential in addiction medication unless we're talking about treating those addicted to smoking cigarettes or drinking alcohol. It takes a lot of money to develop medications and users of hard drugs just don't come in big enough numbers to support that kind of investment. That is unless they need to take large quantities of a drug over many years or if the medications are actually recycled meds that have already been developed and are on the market. Either of those models might support the interests of big pharma and the former would also support the idea of addiction as a chronic disease. Not surprisingly, many of the medications I listed above were originally developed either for other conditions (Zyban is also the antidepressant Wellbutrin) or for other addictions (naltrexone was originally developed for opiate addicts and is now used for alcoholism).

*note - I should say here that I personally believe that at least some addicts do conform to a chronic disease version of addiction although many probably do not (see more on that idea here).

Importantly, the medications themselves have been offering significant, but limited, help when it comes to helping addicts quit. The effects have been significant both statistically (important for researchers) and because it has sometimes been found to help specifically those most disadvantaged (like helping fast-metabolising smokers). But as evidence is accumulated we are learning that the effects are probably dependent on the patient's biology and that even the most staggering results don't eliminate relapse or create "addiction cures."

Which leads us back to baclofen. The drug is currently FDA approved to treat spacticity (uncontrolled mucle tension or spasms), and falls into that latter category of already approved drugs people are researching for addiction treatment "off label." Some recent research and popular attention has been paid to this GABA-B agonist for its apparent ability to dampen neural activity by activating GABA receptors and producing promising results in cocaine and somewhat more recently alcoholic patients in treatment (this following earlier research with rats). Some of the studies show impressive effects - as much as a 68% reduction in the number of daily alcohol drinks during a 12 week study (2) - while others show more modest effects equal to a 20% reduction in cocaine use. Sample sizes and retention rates in essentially all studies were not great, although baclofen did seem to reduce treatment drop-out.

As usual, baclofen is showing equivocal promise as a good adjunct to behavioral treatment for addiction - far from THE addiction cure and more like another addiction treatment tool. That's great, we need more of those.

But what worries me almost every time these sort of results come out is the repeatedly over-reaching response from the media . For instance, that scienceline article linked to above quotes a source, Dr. Mark Willenbring, as saying that he is waiting for addiction's "Prozac moment." While I agree with Dr. Willenbring that we need to bring addiction treatment back towards science, the statement is puzzling, especially in light of recent research showing that all the antidepressant precribing psychiatrists have been doing might have been for naught - antidepressants seem to be truly helpful for individuals suffering with the most extreme, debilitating forms of the disorder. They don't seem to do much more than act as an expensive placebo fr those with low to moderate depression levels. That's what the good Dr. is waiting for?

Like depression, addiction is likely going to get some help from pharmaceuticals but my guess is that THE cure, whatever that may be, will not come in the form of a pill. I am personally more optimistic about new advancements in creating non-addictive opiate pain medication than I am about a pill correcting errant learning, behavioral patterns, and related underlying issues.

This is going to be about the tool-box not any individual tool.

http://www.nytimes.com/2006/06/25/magazine/25addiction.html?pagew...

http://alcalc.oxfordjournals.org/content/46/3/312/T3.expansion.html

http://alcalc.oxfordjournals.org/content/46/3/312/T4.expansion.html

http://alcalc.oxfordjournals.org/content/46/3/312.full

http://www.josephmatta.com/baclofencocaine.pdf

Adi Jaffe, Ph.D., is the executive director of Alternatives Behavioral Health and a lecturer at UCLA and California State University Long Beach.

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