Inside Rehab

Practical information about addiction treatment and recovery

Abstinence—The Only Way to Beat Addiction? Part 1

Some who struggle with addiction aren’t ready to commit to abstinence, yet they’re aware of their problem and want help. However, most treatment facilities require abstinence and see it as the only acceptable outcome. In fact, many of them will kick clients out of treatment for the very symptoms of their disorder—that is, using drugs or alcohol. Read More

Abstinence – The Only Way to Beat Addiction? Part 1

Great article and spot on.

We know the buprenorphine was found at Seymour’s apartment but apparently not in his system from autopsy report. Sadly this suggests that he was NOT practicing Harm reduction, which might have saved his life. HARMS is of course an anathema at AA/NA.

Abstinence is the key!

Abstinence can surely make one stay away from such dangers. It is all the matter of will and determination.

I agree completely with this

I agree completely with this article. My grandfather is an alcoholic and when tried to take the abstinence route the minute he "fell of the wagon" he was so ashamed that he became worse than he was before. Now he can have drink every once in a while, like in a social gathering and get along just fine.

total abstinence

Please check out my blog on Psychology Today as well, U.S. Moralism and the Death of Philip Seymour Hoffman,
Even among AA members, I see much more flexibility than formerly, and the 12 Step programs work wonders for many. But there must be treatment options.


I agree that those in recovery need to move away from the notion that if you relapse all is lost. But attitudes about relapse need to be nuanced. It's hard to reach the right balance between alarm (too many relapses end up with fatal overdoses) and acceptance that relapse is part of the disease.

In the October 3, 1997 special addiction issue of Science Magazine, Dr. Alan Leshner, then head of NIDA, wrote:"The occasional relapse is normal, and just an indication that more treatment is needed." That's because the structural and functional changes in the brain caused by drug abuse are long-lasting and it takes time (a lot of it)to attenuate the brain's expectation of drugs in response to drug-using triggers.

But the alterations evidenced in the addict brain aren't all alike for all addicts. Some have more pervasive change than others; they tend to relapse more. So some people (those with the least pervasive brain change) may be able to tolerate a drink here and there without it turning into a disastrous relapse.

Science-based recovery can help reach the right balance when approaching relapse. For a not-for-profit website that discusses the science of substance use and abuse in accessible English (how alcohol and drugs work in the brain; how addiction develops; why addiction is a chronic, progressive brain disease; what parts of the brain malfunction as a result of substance abuse; how that malfunction skews decision-making and motivation, resulting in addict behaviors; why some get addicted while others don't; how treatment works; how well treatment works; why relapse is common; what family and friends can do; etc.) please click on

Baclofen suppress the craving

Not "harm reduction" but "craving suppression" is the key.
Gabab agonists are the tools and a part of the medical community knows it really well.
Why Baclofen is not prescribed? We have to wait for an FDA approval while people continue to die?

There are proofs from at least 15 years that Baclofen works well for alcohol addiction, cocaine addiction and binge eating. Are medical community and researcher waiting for some new drug that can be patented? Yes, is really sad but they are simply doing.

Baclofen is a really good tool even because is not mandatory to be abstinent while taking it. Is metabolized 85% by kidneys (not liver as all the other drugs). In low doses (often) make drink less (harm reduction) while in high doses "suppress the craving" making even easier the eventual behavioral therapy.

Baclofen simply scares too many lobbies because is a safe drug that cures too many things at same time.
Think about it seriously.

Research should focus on how to make Baclofen easier scheduling, less SE not continuing to search for proofs.
There are so many studies and a lot of alcoholics that don't drink anymore (or just occasionally) thanks to this treatment.

In the meantime correct information should be distributed and physician have to start use it to treat their patient's disease.

Resources and news here:


I learned about this drug from Dr. Childress in a video I use in class and wondered why we don't use it. Thanks for the reminder to write about in the next edition of my book.

Jury out on baclofen

I am not familiar with the scientific literature on baclofen but former director of treatment and recovery division of the NIAAA, Mark Willenbring, MD is. He tweeted this:

"Jury still out on baclofen. No high quality evidence of safety/effectiveness. Topiramate best to date."

In other words, there are better data supporting the use of tompiramate for treatment of alcohol use disorders. (This would be an off label use in the U.S. It's discussed briefly in my book, Inside Rehab.)

Baclofen safety and effectiveness

Thanks a lot for reply.
Baclofen has been studied since the 70s and is daily used by thousands of patients with SM and similar disease (and alcoholics too, obviously). Nobody ever died of Baclofen overdose if used alone. Anyway is not even abused because it does not have any recreational value.

Starting from the 90s it starts to became "a promising novel drug that needs more investigation" and lot of studies have been done since.
In 2000s, Dr. O. Ameisen found that Baclofen completely suppress the alcohol craving (in himself), wrote an important book ("The end of my addiction") and start to prescribe it to alcoholics obtaining really good results. After that, more studies and clinical trials followed this re-discovery.

Recently (2012) Dr. R. de Beaurepaire made a really important study that fully confirms safety and efficacy of Baclofen:
"Suppression of alcohol dependence using baclofen: a 2-year observational study of 100 patients."

Why this study is quite unknown (or ignored) by most Drs that work in the field of addiction?
Why mainstream information don't open a debate about this treatment?
Why not to try a combined therapy of Baclofen and Topiramate?
Why we have to wait for more while people continue to die and there are enough "proofs" that Baclofen works?

Baclofen (as Topiramate) can be prescribed by Drs as off-label use. Is not any "miracle pill" but just fix the physical side of the alcohol addiction (and not only).
The global situation of the patients has obviously to be considered and behavioral therapy/groups can be an additional support in most cases.

Science seems only to be searching and waiting for a new "patentable" drug in place of use and "optimize" the tools that are currently available.

Here the link to the full

Here the link to the full study (the othe link is just the abstract).

"Suppression of alcohol dependence using baclofen: a 2-year observational study of 100 patients."

Thanks, steve69, will check

Thanks, steve69, will check it out.

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Anne M. Fletcher, M.S., R.D., is the author of Inside Rehab: The Surprising Truth about Addiction Treatment – And How to Get Help That Works.


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