Dear Dr. Eskapa,

I have been doing a lot of web research on naltrexone in general and TSM in particular. In the process I also came upon some interesting articles on baclofen, which is the antispasmatic drug that a French doctor prescribed for himself and which eliminated his cravings and anxiety (although he took fairly heavy dosages to achieve effect). Naltrexone does not help with anxiety.

Then I found a clinical study in progress looking at naltrexone and baclofen together.

http://clinicaltrials.gov/ct2/show/NCT00614328

First, I wanted you and Dr. Sinclair to know about it in case it wasn't on your radar screen. But second, I wondered what your thoughts were on the idea of somehow combining the two drugs and what the study will show (due out in March 2010).

For example, for participants who remained abstinent for the three months, the naltrexone + baclofen group should have results statistically insignificant that baclofen alone if there were no extinction.

And would you envision a situation where the two drugs together would be very effective: e.g. enough baclofen to reduce anxiety but not totally extinguish the desire to drink while the natrexone was working on extinction?

I ask this because many alcoholics reach a point where drinking + naltrexone for even a day is not a viable option. They simply drink too much from the first sip and become dysfunctional and destructive. TSM seems to be ideal when people are in their early stages of drinking and can go 3-6 months as they are.

But there are too many who are too far progressed. If baclofen could begin to work quickly (but maybe just enough to significant curb as opposed to eliminate drinking), then combining with naltrexone could deliver a one-two punch.

It would be most interesting to see the results of a subgroup of the study: those who tool bacloven and naltrexone who did not maintain abstinence at the outset. Because of abstinent biases, I don't suspect the researchers will be thinking in that vein. That is why it would be good if you and Dr. Sinclair were looking at this.

Jim