Treatment Of Alcohol-dependent Patients Research Articles

Evaluation of the success rate of various inpatient alcohol addiction treatment programs in the Czech Republic and their comparison

IntroductionHarmful alcohol use far exceeds other mental disorders in the proportion of patients who do not receive adequate treatment. Despite the long history of anti-alcohol treatment in Czech Republic, there is no published prospective study to this day, in which patients that underwent inpatient addiction treatment are compared to patients on the waiting list and only one prospective randomized study comparing two different medium-term inpatient programs was published.Almost all the studies published so far only bring results of particular hospitals. Differences in methodology, differences between cohorts of patients, absence of profiling and differences in therapeutic programs and historical changes makes comparison of results of those studies very difficult.ObjectivesThis work seeks to present and compare the data from studies that evaluate the success of medium-term inpatient treatment of alcohol dependent patients in the Czech Republic. Another aim was to identify problems that make such comparison difficult.MethodsBibliographia Medica Čechoslovaca and Pubmed was used to find studies published in professional medical journals since 1970, in which abstinence of patients who voluntarily completed medium-term inpatient treatment of alcohol dependence is evaluated.ResultsMedium-term inpatient treatment of alcohol addiction leads to one year abstinence in 34 to 76 % of patients. Such variance value is largely caused by different methodology of compared studies. In compared studies there are differences:1. in definition of abstinence2. if abstinence rate is assessed in all patients who have entered the treatment or only in those who have completed the treatment properly3. if abstinence rate is calculated using number of patients entering treatment or the number of patients who have been obtained by valid information (outpatient clinic, questionnaires)4. in the way the data was collected5. in the composition of patients6. in societal background, because there is large time gap present between compared studiesConclusionsThe comparison of individual studies presented many problems. Further steps should be taken to help compare treatment programs in the future, as they provide different therapeutic interventions in different intensity and length to different patients. Adequate patient profiling, detailed description of therapeutic interventions and identification of effective components of the therapeutic program is a way to support further research in this area, optimize existing programs and increase the overall efficiency of treatment.Disclosure of InterestNone Declared

Homeopathic potencies of Opium in alcohol dependence: exploratory open-label study

Background: The conventional pharmacological options for the treatment of alcoholism are limited, which led to the search for solutions in alternative or complementary medicine (CAM). Homeopathy is a CAM modality recognized as medical specialty in Brazil. According to the clinical experience of the early homeopaths, Opium was used to treat patients with alcohol dependence. Aim: to perform a preliminary assessment of the effectiveness and tolerability of fifty-millesimal potencies of Opium in the treatment of alcohol-dependent patients. Methods: exploratory, prospective, open-label trial, with pre-treatment measures as control. Confidence intervals were used to estimate the magnitude of the clinical differences. Results: a total of 14 patients were included, from which 12 were evaluated (intention to treat analysis - ITT). There was a significant reduction in the average daily alcohol consumption (-29.37 units of alcohol/day; 95% CI=10.63; 48.11) and in the severity of alcohol dependence, measured by the mean score of the Short Alcohol Dependence Data questionnaire (-10.17; 95% CI= 4.12; 16.22). No serious adverse events were reported. Randomized controlled studies with larger samples are needed.

Effectiveness of Psychoanalytic-Interactional Group Therapy vs. Behavioral Group Therapy in Routine Outpatient Treatment of Alcohol-Dependent Patients

ABSTRACTBackground: The cognitive behavioral therapy has been extensively investigated to assess relapse prevention rates in patients with alcohol dependence. In contrast, only little is known regarding the effectiveness of psychoanalytical psychotherapy in relapse prevention, although this treatment is widely used and especially so in Germany. The aim of this quasi-randomized study was to compare the effectiveness of these two group treatments’ approaches under the condition of routine outpatient treatment in a non-university hospital. Methods: After inpatient detoxification, patients with alcohol dependence were allocated either to combined behavioral intervention (CBI) or to psychoanalytic-interactional therapy (PIT). The group treatment was carried out weekly over a period of six months. Also, the clinical care package included both individual treatment sessions (e.g. every 4-6 weeks) and abstinence supporting medication. The main outcome criteria included retention rates and frequency of alcohol relapse. Results: Some 215 patients (mean age 49.6 years [standard deviation, 10], 56.7% males, with a mean duration of alcohol dependence of 16.5 years [range: 1-50 years]) were included in the study. Overall, CBI clients showed a retention rate of 66.7%, compared to 81.8% for PIT clients (p =.008). An intention-to-treat analysis of alcohol relapses showed a significant difference between PIT and CBI groups (PIT: 33.6%; CBI: 49.5%; p =.018). There were no statistically significant differences between the 2 groups in terms of prescription rates of disulfiram, naltrexone or acamprosate. Conclusions: Notwithstanding the study limitations, PIT seemed here to be at least as effective as CBI in terms of retention and relapse prevention rates' levels.

Nalmefene is effective at reducing alcohol seeking, treating alcohol-cocaine interactions and reducing alcohol-induced histone deacetylases gene expression in blood.

The opioid antagonist nalmefene (selincro®) was approved for alcohol-related disorders by the European Medicines Agency in 2013. However, there have been no studies regarding the effectiveness of nalmefene when alcohol is used in combination with cocaine. Using operant alcohol self-administration in Wistar rats and qRT-PCR, we evaluated (i) the dose-response curve for s.c. and p.o. nalmefene; (ii) the effects of nalmefene with increasing concentrations of alcohol; (iii) the efficacy of nalmefene on cocaine-potentiated alcohol responding; and (iv) the gene expression profiles of histone deacetylases (Hdac1-11) in peripheral blood in vivo and in the prefrontal cortex, heart, liver and kidney post mortem. S.c. (0.01, 0.05, 0.1mg·kg(-1) ) and p.o. (10, 20, 40mg·kg(-1) ) nalmefene dose-dependently reduced alcohol-reinforced responding by up to 50.3%. This effect of nalmefene was not dependent on alcohol concentration (10, 15, 20%). Cocaine potentiated alcohol responding by approximately 40% and nalmefene (0.05mg·kg(-1) ) reversed this effect of cocaine. Alcohol increased Hdac gene expression in blood and nalmefene prevented the increases in Hdacs 3, 8, 5, 7, 9, 6 and 10. In the other tissues, alcohol and nalmefene either did not alter the gene expression of Hdacs, as in the prefrontal cortex, or a tissue-Hdac-specific effect was observed. Nalmefene might be effective as a treatment for alcohol-dependent patients who also use cocaine. Also, the expression of Hdacs in peripheral blood might be useful as a biomarker of alcohol use and drug response.

Relay model for recruiting alcohol dependent patients in general hospitals--a single-blind pragmatic randomized trial.

BackgroundA large proportion of the Danish population consumes more than the officially recommended weekly amount of alcohol. Untreated alcohol use disorders lead to frequent contacts with the health care system and can be associated with considerable human and societal costs. However, only a small share of those with alcohol use disorders receives treatment. A referral model to ensure treatment for alcohol dependent patients after discharge is needed. This study evaluates the i) cost-effectiveness ii) efficacy and iii) overall impact on societal costs of the proposed referral model - The Relay Model.Method/DesignThe study is a single-blind pragmatic randomized controlled trial including patients admitted to the hospital. The study group (n = 500) will receive an intervention, and the control group (n = 500) will be referred to treatment by usual procedures. All patients complete a lifestyle questionnaire with the Alcohol Use Disorders Identification Test embedded as a case identification strategy. The primary outcome of the study will be health care expenditures 12 months after discharge. The secondary outcome will be the percentage of the target group, who 30 days after discharge, reports at the alcohol treatment clinics. In order to analyse both outcomes, difference-in-difference models will be used.DiscussionWe expect to establish evidence as to whether The Relay Model is either cost-neutral or cost-effective, compared to referral by usual procedures.Trial registrationhttps://register.clinicaltrials.gov/by identifier:RESCueH_Relay NCT02188043 Project Relay Model for Recruiting Alcohol Dependent Patients in General Hospitals (TRN Registration: 07/09/2014)

Relationship between emotional processing, drinking severity and relapse in adults treated for alcohol dependence in Poland.

Growing data reveals deficits in perception, understanding and regulation of emotions in alcohol dependence (AD). The study objective was to explore the relationships between emotional processing, drinking history and relapse in a clinical sample of alcohol-dependent patients. A group of 80 inpatients entering an alcohol treatment program in Warsaw, Poland was recruited and assessed at baseline and follow-up after 12 months. Baseline information about demographics, psychopathological symptoms, personality and severity of alcohol problems was obtained. The Schutte Self-Report Emotional Intelligence (EI) Test and Toronto Alexithymia Scale (TAS) were utilized for emotional processing assessment. Follow-up information contained data on drinking alcohol during the last month. At baseline assessment, the duration of alcohol drinking was associated with lower ability to utilize emotions. Patients reporting more difficulties with describing feelings drank more during their last episode of heavy drinking, and had a longer duration of intensive alcohol use. A longer duration of the last episode of heavy drinking was associated with more problems identifying and regulating emotions. Poor utilization of emotions and high severity of depressive symptoms contributed to higher rates of drinking at follow-up. These results underline the importance of systematic identification of discrete emotional problems and dynamics related to AD. This knowledge has implications for treatment. Psychotherapeutic interventions to improve emotional skills could be utilized in treatment of alcohol-dependent patients.

Placement matching of alcohol-dependent patients based on a standardized intake assessment: rationale and design of a randomized controlled trial.

BackgroundDespite considerable research on substance-abuse placement matching, evidence is still inconclusive. The aims of this exploratory trial are to evaluate (a) the effects of following matching guidelines on health-care costs and heavy drinking, and (b) factors affecting the implementation of matching guidelines in the treatment of alcohol-dependent patients.MethodsA total of 286 alcohol-dependent patients entering one of four participating detoxification units and having no arrangements for further treatment will be recruited. During the first week of treatment, all patients will be administered Measurements in the Addictions for Triage and Evaluation (MATE), European Quality of Life-Five Dimensions health status questionnaire (EQ-5D), and the Client Socio-Demographic and Service Receipt Inventory—European Version (CSSRI-EU). Patients who are randomly allocated to the intervention group will receive feedback regarding their assessment results, including clear recommendations for subsequent treatment. Patients of the control group will receive treatment as usual and, if requested, global feedback regarding their assessment results, but no recommendations for subsequent treatment. At discharge, treatment outcome and referral decisions will be recorded. Six months after discharge, patients will be administered MATE-Outcome, EQ-5D, and CSSRI-EU during a telephone interview.DiscussionThis trial will provide evidence on the effects and costs of using placement-matching guidelines based on a standardized assessment with structured feedback in the treatment of alcohol-dependent patients. A process evaluation will be conducted to facilitate better understanding of the relationship between the use of guidelines, outcomes, and potential mediating variables.Trial registrationGerman Clinical Trials Register DRKS00005035. Registered 03 June 2013.

SY21-2 * CAN ALCOHOL DEPENDENT PATIENTS REDUCE THEIR ALCOHOL CONSUMPTION?

Abstinence has been the predominant treatment goal in alcoholism. There is no doubt that this approach has helped very many people around the world to overcome their alcohol problems. On the other hand, the abstinence goal is a very high threshold which may be one reason why we reach only about 10% of patients in need for treatment. A large US survey shows that 42% of potential patients do not initiate treatment because they are not willing to quit alcohol completely. Against this background reduction of alcohol consumption is increasingly recognised as a valid and needed option. The presentation will review diverse studies which deliberately went for a reduction (or control) of drinking as well as other studies which did not pursue this specific goal but which report various drinking outcomes including reduced drinking. The overview contains controlled psychotherapy trials as well as pharmacotherapy studies. On the background of these data the European Medicines Agency (EMA) published guidelines in 2010 where the reduction of alcohol consumption is accepted as a valid goal in the treatment of alcohol dependent patients. So far several studies have been performed in this context, others are underway. DSM 5 has collapsed the dependence and abuse categories. Therefore the reduction of alcohol consumption will have to be an integrated part of the management of patients with “alcohol use disorders”.

Individualised Treatment of Alcohol Dependent Patients with Baclofen: A Clinical Observation

Abstract Objective: The objective of this observational study was to investigate the effectiveness, safety and tolerability of baclofen in individualised doses for the treatment of alcohol dependence in a sample of patients suffering from additional co-occurring mental disorders. Methods: Fifteen subjects requesting baclofen treatment to achieve abstinence from, or reduction of, alcohol consumption, were included in the study. Baclofen was titrated individually responding to the participants' reports of drug side effects and reductions in drinking and craving. At the start and the end of the observation period (24 weeks) patients self-reported their number of standard drinks per day and rated their alcohol craving by means of the Obsessive Compulsive Drinking Scale (OCD-S). Liver enzymes, Carbohydrate Deficient Transferrin (CDT) and Ethyl Glucuronide in Hair (HEtG) were measured twice. Results: At the end of the observation period eleven patients were abstinent or low-risk drinking. Mean baclofen dose was 116 mg/d (range 30-225 mg/d). Baclofen was well tolerated and did not interfere with pre-existing pharmacotherapy. Three patients did not benefit from the treatment. The clinical presentation of one patient improved although his alcohol consumption remained higher than the NIAAA recommendations. We observed indications of baclofen misuse in one patient. Conclusion: Baclofen treatment with individually titrated doses between 30 mg/d to 200 mg/d was associated with suppression of, or reduction in, alcohol consumption and craving in the majority of patients. In view of the small sample size, high motivation of the participants, and absence of a control group we caution against an over estimation of our findings.

Individualised Treatment of Alcohol Dependent Patients with Baclofen: A Clinical Observation

Individualised Treatment of Alcohol Dependent Patients with Baclofen: A Clinical Observation

SAT2 * SODIUM OXYBATE, A BREAKTHROUGH TREATMENT OF ALCOHOL WITHDRAWAL SYNDROME AND MAINTENANCE OF ALCOHOL ABSTINENCE (D&A)

SAT2 * SODIUM OXYBATE, A BREAKTHROUGH TREATMENT OF ALCOHOL WITHDRAWAL SYNDROME AND MAINTENANCE OF ALCOHOL ABSTINENCE (D&A)

Clinical efficacy of Naikan cognitive therapy in the treatment of alcohol dependent patients

Objective To explore the clinical efficacy of Naikan cognitive therapy(NCT) for alcohol dependent patients. Methods 64 cases of alcohol-dependent patients were randomly assigned to the study group (32 cases) and the control group (32 cases). The study group was treated with NCT for successive 7 days on the basis of taking original drugs; and the control group was only given the original drug therapy. The obsessive compulsive drinking scale (OCDS), self-report symptom inventory(SCL-90), nurses observation scale for inpatient evaluation(NOSIE) were administered to all subjects at pre-and post-treatment. Results ①After the treatments, the scores of OCDS in study group (49.51±1.63) were lower than that in control group(53.92±1.82), and the statistical difference had the significance (P<0.01). ②After the treatments, the total scores and some factor scores of SCL-90 in study group were lower than in control group (t=-2.413, P=0.019; t=-2.033, P=0.047; t=-2.065, P=0.044; t=-2.038 , 0.046), and the difference was statistically significant.③After the treatments, in the study group, the scores of the total estimated factor and total positive factor(187.10±18.80; 78.51±12.22)were higher than in control group(175.51±11.71; 68.22±11.87), total negative factor score(15.55±9.46)were lower than in control group(20.51±9.33), and the difference was statistically significant. Conclusion NCT can effectively inhibit alcohol craving, and reduce the drinking wine relevant questions. It can help to improve psychological symptoms in patients with alcohol dependence, especially depression and anxious symptoms. Key words: Naikan cognitive therapy; Alcohol dependence; Clinical efficacy

Efficacy of Acamprosate for Alcohol Dependence in a Family Medicine Setting in the United States: A Randomized, Double‐Blind, Placebo‐Controlled Study

Acamprosate has been found to enhance rates of complete abstinence and to increase percent days abstinent (PDA) from alcohol relative to placebo treatment. As most U.S. clinical trials of acamprosate have been conducted in alcohol and other drug specialty clinics, there is a need to examine the efficacy of acamprosate in generalist settings. This study tested the efficacy of acamprosate versus placebo on the primary study outcome of PDA in the treatment of alcohol-dependent patients in a family medicine setting. Secondary study outcomes included percent heavy drinking days (%HDD) and gamma glutamyltransferase level (normal or high). A randomized, double-blind, placebo-controlled, parallel group design of acamprosate was conducted in 2 family medicine settings (North Carolina and Wisconsin). One hundred volunteers were recruited primarily by advertisement, and participants were assigned to 666mg (2pills) oral acamprosate 3 times daily (1,998mg/d) or matching placebo over a 12-week period. All participants concomitantly received 5 sessions of a brief behavioral intervention from a family/primary care physician. No significant treatment effect of acamprosate was found on PDA or the secondary outcomes. Significant treatment goal by time interaction effects was found on PDA and %HDD. Participants who had an initial goal of abstinence versus a reduction in alcohol use improved on average over time in PDA and had less %HDD from baseline to the end of treatment. This clinical trial did not find evidence of efficacy for acamprosate compared to placebo among alcohol-dependent individuals recruited primarily by advertisement as studied in a primary care setting. Drinking outcomes significantly improved regardless of medication condition. A goal of abstinence was significantly associated with improved drinking outcomes, suggesting that alcohol-dependent patients with such a goal may do particularly well with counseling in a family medicine setting.

Wirkfaktoren einer tagesklinischen Behandlung aus der Sicht alkoholabhängiger Patienten - eine qualitative narrative Interviewstudie

Day treatment for alcohol dependent patients is still uncommon in Germany. The presented study aims to answer the question how patients experience this kind of treatment and which factors they perceive as important for their treatment success.7 interviews with alcohol-dependent patients were conducted. Data were analysed with qualitative methods and the help of a computer-supported coding system.We found several factors that are relevant for patients, especially important are factors concerning the therapeutical relationship as well as factors that are specific for day treatment.We can conclude that day treatment is seen as helpful to improve dependency symptoms by the patients.

PMH19 THE BUDGET IMPACT ANALYSIS OF NALTREXONE IN THE TREATMENT OF ALCOHOL-DEPENDENT PATIENTS IN POLAND

The purpose was to estimate financial consequences of naltrexone reimbursement in the treatment of alcohol-dependent patients in Poland. The budget impact analysis was conducted for two-years time horizon from the public payer perspective (National Health Fund) and, additionally, form the patient perspective. The target population consisting of the alcohol-dependent patients, who are treated in dependent treatment centres and are eligible for naltrexone therapy was estimated on the basis of epidemiological data and clinical expert's opinion. In the analysis two scenarios were compared: present, in which none of the drugs supporting psychotherapy in treatment of alcoholism is reimbursed, and new, in which naltrexone is reimbursed within the catalogue of guaranteed health services in the treatment of alcohol-dependent patients. The analysis presents the costs incurred by public payer and by patient associated only with drugs that support psychotherapy in the considered target population. The costs were not discounted. Consumption of resources was estimated on the basis of epidemiological data and recommended duration of pharmacotherapies. The effect of changes of key parameters and assumptions of primary analysis on the results obtained from the perspective of the public payer was examined in the one-way sensitivity analysis. If the reimbursement of naltrexone is introduced, the annual expenses from the budget of National Health Fund would increase by PLN 11.7 million in the first year, and PLN 11.8 million in the second year of reimbursement. On the other hand, from the patient perspective reimbursement of naltrexone will bring significant cost savings which will annually amount to PLN 28.8 million in the first and second year of the refund. Reimbursement of naltrexone in the treatment of alcohol-dependent patients in Poland will bring additional costs incurred by public payer (National Health Fund) and patient's significant cost savings.

PMH14 CLINICAL EFFECTIVENESS ANALYSIS OF NALTREXONE VERSUS ACAMPROSATE AND PLACEBO IN ALCOHOL DEPENDENT PATIENTS TREATED WITH PSYCHOTHERAPY

The objective of this study is to assess the clinical effectiveness of naltrexone versus acamprosate and placebo in alcohol dependent patients receiving psychotherapy. Analysis was conducted in accordance with the principles of systematic review, based on the Cochrane Collaboration guidelines and the guidelines of the Polish Agency for Health Technology Assessment. Calculations were performed using the StatsDirect® 2.6.8 statistical package. The extended evaluation of safety based on sources other than RCTs was performed. In the light of the analysis carried out it can be concluded that administered orally plus psychotherapy for alcohol-dependent patients results in a higher clinical effectiveness and comparable safety profile in comparison with acamprosate for a 1-year-long-observation treatment and placebo for both a short (12-16 weeks) and medium-term observation treatment. Statistical significances in favor of the intervention under evaluation were found both in the percentage of patients maintaining total abstinence as well as in the percentage of relapsed patients. Statistically significant in favor of naltrexone treatment when assessing too such endpoint as alcohol craving intensity assessment for the NAL/PSY vs ACA/PSY analysis in a long treatment period and for the NAL/PSY vs PL/PSY analysis in a short term.Long-term results (52 weeks) of the analysis quoted indicate on a comparable clinical efficacy (no statistical significance of results obtained) of the use of naltrexone and placebo in the group of alcohol-dependent patients undergoing psychotherapy.The adverse events related to naltrexone treatment are usually mild and transient. The most frequent ones are: headaches, sleep disorders, anxiety, nervousness, gastrointestinal disorders such as abdominal pain, nausea, vomiting. Summing up, the results of the analysis carried univocally prove that naltrexone administered in a 50mg dose a day is an effective and safe drug in the treatment of alcohol dependent patients who additionally undergo a psychotherapy.

Effect of Ethanol Deprivation and Re-Exposure on the Ethanol Drinking Behaviour of the High-Alcohol-Drinker (UChB) Rats

Alcohol addiction constitutes a major health problem in the general population, it is a complex pathology characterized by the development of tolerance, physical dependence and compulsive ethanol-seeking behaviour that often manifests as a chronic relapsing syndrome. 0ne of the major concerns in the treatment of alcohol-dependent patients is the prevention of relapse during periods of abstinence. The alcohol deprivation effect (ADE) is defined as a temporary increase in the voluntary intake of ethanol when it is reinstated after a period of alcohol deprivation and has been used as an animal model of relapse-like drinking. ADE can be used to evaluate the efficacy of possible pharmacological agents to prevent relapse drinking. The current study was undertaken to examine whether the high-alcohol-drinker UChB rats would display an ADE. Rats were given either continuous or periodic concurrent access to 10, 20% (vol/vol) of ethanol across deprivation cycles. UChB rats consuming ethanol voluntarily for two months, exhibit a robust ADE after a single deprivation period of two weeks. The increased alcohol intake during the early days of re-exposure, following a withdrawal phase, is attributed to a shift in preference towards the higher concentration of ethanol that might reflect an increase in craving for alcohol. Since an ADE is also observed in UChB rats, make this line of rats selectively bred for their high voluntary ethanol consumption, a useful model for study the efficacy of pharmacological agents for the treatment of relapse of alcohol consumption.

Medications Acting on the Serotonergic System for the Treatment of Alcohol Dependent Patients

Research suggests that alcoholics show comparatively lower levels of serotonin (5-HT) than non-alcoholics. Medications aimed at increasing synaptic 5-HT have long been studied as potential treatments for alcoholism. Studies with selective serotonin reuptake inhibitors (SSRI) in a heterogeneous population of non-depressed alcoholics have produced inconsistent results. Further exploration involved whether or not treatment of co-morbid alcoholism and depression was a more practical approach. However, even in the presence of co-occurring depression, antidepressants in general lack the power to demonstrate a significant reduction of alcohol use among alcohol dependent patients with carefully diagnosed major depression. Further statistical analysis has also determined that perhaps genotypic and phenotypic variations differ for persons with alcohol dependence including those with or without comorbid alcohol dependence and depression suggesting important subgroups might respond differently to treatments. Clinical trials have also used the anxiolytic buspirone, a 5-HT(1A) partial agonist, as many alcoholics suffer from anxiety. When controlling for baseline anxiety, buspirone was no more effective than placebo for alcoholic patients. Another serotonergic drug, ritanserin, did not demonstrate effectiveness in relapse prevention in alcohol dependence. However, research on the use of the 5-HT(3) antagonist ondansetron for alcohol dependence continues to provide promising results, particularly for patients with early onset alcoholism. As demonstrated by the studies with serotonergics, responses based on individual variables suggest that alcoholics may respond differentially based on various serotonin 5-HT subtypes. Of course, future studies need to further delineate and confirm the differences between these alcoholic subtypes.

Safety and Efficacy of Baclofen in the Treatment of Alcohol-Dependent Patients

Preclinical studies show that antagonism of the GABA(B) receptor may represent an effective neuropharmacological approach to treat alcohol dependence. Consistent with preclinical evidence, the majority of the human studies have demonstrated that the prototype GABA(B) receptor antagonist baclofen may represent an effective mediation to treat alcohol-dependent individuals. Specifically, baclofen has shown to reduce alcohol withdrawal symptoms, as well as to reduce alcohol craving and intake, and to promote alcohol abstinence. Notably, baclofen has shown a safe profile when administered to alcoholics, including those with liver cirrhosis. In summary, baclofen represents a safe and effective medication to treat alcohol dependence, thus holding promise as a new pharmacotherapy. However, large studies are needed to confirm the present findings.

Effectiveness and Safety of Baclofen in the Treatment of Alcohol Dependent Patients

Both preclinical and clinical research studies have shown the GABA(B) receptor agonist baclofen represents a promising treatment for alcohol dependence. Preliminary clinical studies indicate that baclofen is able to suppress withdrawal symptoms in alcohol-dependent patients affected by the alcohol withdrawal syndrome. Moreover, baclofen has shown efficacy and safety in promoting alcohol abstinence in alcohol dependent patients in two placebo-controlled trials including one in alcohol-dependent patients with liver cirrhosis. These trials also demonstrated that baclofen was associated with reductions in withdrawal-related anxiety and alcohol craving. However, more work is needed to clearly demonstrate the efficacy of baclofen and to ascertain whether efficacy is limited to certain subtypes of alcoholic patients. For example, a recent US trial failed to demonstrate a robust effect of baclofen in treating alcohol-dependent patients though the relative moderate severity of alcohol-dependence in that trial has been suggested as one factor that may have contributed to the finding. In the present review, the authors will summarize the published clinical studies on the role of baclofen in alcohol dependence and will also present some unpublished secondary analyses. Finally, the authors will discuss possible future directions to further investigate the role of baclofen in alcohol dependence (e.g., baclofen's biobehavioral mechanisms, different baclofen doses, differences in severity and in alcoholic subtypes, different formulations of baclofen, possible combination of baclofen with other medications).