Has anyone tried adding baclofen (apparently an effective anti-urge treatment discovered by Dr. Oliver Ameisen) to naltrexone, in order to get a faster response? The baclofen doses Dr. Ameisen experimented with seem huge, and I wonder how that would interact with TSM?

Any opinions or experiences with trying this--and if so, considering the use of naltrexone, I imagine the baclofen dosage would have to differ from Ameisen's but wonder how much.

Or is it best just to to hang in there for the long haul on naltrexone alone? So far, 104 days in, I don't seem to be getting anywhere. I know, I know, patience for at least four to six months. But I've got to get this in check before embarking on an approximately two month journey beginning Oct. 22, sailing double-handed from South Africa to Brazil.

Mike

It took me 146 days. A month from now, you'll either be there or darn close.

Regarding Baclofen, that was my next backup plan. I liked the idea that it could substitute for my Valium as an axiolitic - maybe, but it also means that once you start taking it, you have to take it every day for the rest of your life. With Naltrexone, you only take it before you drink, so eventually when you drink as infrequently as I do now, you only take 1 or 2 pills per week max (and maybe zero in a few more weeks). Personally, I'm glad I waited out the treatment. I was going to give it 9 months, before going to Dr. Ameisen's method. Thankfully, "the cure" manifested itself way before then.

Bob

Thanks for the inputs.

I think I'll hold off on baclofen for now. Don't want too many potentially conflicting and possibly dangerious meds at once, especially as noted, without medical supervision. My doc. definitely will not Rx me baclofen--I asked. He was dubious about the naltroxone but I talked him into it to help me cut down on drinking; gave him Jane Brody's article from the NYT, a summary of the Combine Study, some JAMA abstracts, and the chapter from Dr. Eskaba's book for Medical Professionals.

He wrote a script for an initial three months' worth, however, so since I'm going to be away for two months after that runs out (unless he agrees to renew it), I have ordered and received 2 months worth of Naltima-50 (same thing) from alldaychemist. It passed through customs with no hassles. It's $99.00 for two month's worth but the shipping adds another $25 so it obviously pays to order larger amounts at a time. It took about 3-4 weeks from the time I placed the order online until it arrived.

The reason I considered adding baclofen is that like many others, I drink for social-axiolitic reasons as well as pleasure. The naltrexone should extinguish the pleasure (in fact it already has in part--I'm starting to actively dislike the buzz effect of my daily wine--but find it hard to cut down because of its immediate calming and socializing actions. Hence I'm a GABA drinker as well an opioid one and eventually the GABA component may have to be addressed separately. It is possible, though, from what I've read in these posts, and from Dr. Eskaba, that naltrexone may take care of both things.

I'm reluctant to take baclofen, especially in large amounts on top of naltrexone a unless under the watchful eye of a knowledgeable practitioner which are far and few between.

Another question: why do you have to stay on baclofen for life? I thought you could taper it like benzos.

One positive note: I obviously can't stock a sail boat with enough wine to feed my habit for 6 - 8 weeks (only four ports of call during that time), nor would I want to for safety's sake, so I'll have no choice but to drastically curtail or even abort the habit. Fortunately, the social anxiety issue will not be a factor with only one other person, a good friend, on board for the estimated 40 days actually at sea.

Mike

You can taper it like benzos, you do not have to take it for life. However, once you do stop taking it, your alcoholic cravings (otherwise left untreated) come back.

Yes, I have been simultaneously using Bac with the Nal since Feb 09.

I only have taken the Bac in the middle of the night as I find it very useful as a sleep aid, for night time anxiety. In the past I had been using a very low dose of Zanax two to three times a week BUT because it is a benzo, I have diligently reduced my use. I hardly ever use Zanax any more except in extreme emotional emergencies.

I had been taking 20 mg Bac every night, and having very good sleeps and nice dreams. Recently I have titrated back to 10 mgs and I am having a like experience.
The reason I am trying to eliminate the Bac is I have a feeling it is interfering with my emotional, depressed state and perhaps hampering my progress with TSM.

It is difficult to really diagnose, as I do have extreme relationship problems, so I am unable to discern what exactly is helping or hindering my emotional health.

I did in the early days of using Nal and Bac have good results together and I believe the Baclofen helped me stay calm and able to keep my thoughts emotionally balanced.

I do wonder if the use of the Bac with the Nal has hampered my progress in the reduction of AL intake.

Time will tell, and I am continuing my titration off the bac, so we shall see what difference this new program will bring to me.

That's my experience and I hope it is helpful for you.

Yes. That is what I learned from Dr. Ameisen's book. The baclofen treats the original cause for over-drinking in the first place and that is a need for a release from anxiety. Unfortunately, we get addicted to the alcohol and eventually develop a resistance to its initial anxiolytic qualities and succumb to the daily withdrawal anxiety which compounds to our original anxiety. So, alcohol does not adequately treat anxiety effectively beyond the short term. Baclofen, Benzos (when used correctly) do reduce anxiety to a tolerable or even comfortable level. So, baclofen gets rid of the cause and thus the craving. Naltrexone kills the craving by blocking the brains reward center and the alcohol becomes undesirable because it produces no positive affect for the brain. However, the anxiety (chronic or otherwise) must be addressed or the desire to treat it will return. Personally, I have chosen to go back to my Valium (oddly at much lower doses) to treat my chronic anxiety created by my hypomania.

Bob

Thanks all for the dialogue. I've been giving this a great deal of thought for a while now. Here's my two cents.

Mikeone -- I'm not sure I agree with your use of the term "GABA drinker." I take that specifically to mean those of us who have GABA deficits. Those of us who have been on benzo's have GABA deficits, because benzo's make our brain use GABA more efficiently and the brain's response is gradually to produce less GABA. Alcohol does act as a GABA agonist, but not nearly to the extent of benzos. Those of us who use alcohol as an anxiety-reducer would be close to 100%. The sad irony is that we all know that alcohol causes a rebound effect that exacerbates anxiety. It's worse with benzos and, in fact, as we develop tolerance to them it gets worse still; most benzo users need a higher dose over the years just to stave off tolerance withdrawal. Having said all this, I've noticed that benzo users on this board seem anecdotally to be progressing at about the same pace as the group as a whole. Just look at bob3d!!

When first titrating off benzos I was on a benzo board and posted that I had fallen into the habit of drinking a glass of wine or . . . four to take the edge off side effects. I was told I needed to "lose the booze" and found to my surprise that I couldn't and the drinking just got worse. I had been a heavy drinker for years but never found I "couldn't" stop. Then of course many of us remember the comment on this board by Dr. Eskapa that benzo's "might hamper" TSM progress. Hence the term "GABA drinkers". Eskapa's educated guess that benzo users are "lazy" GABA producers jibed with what I had learned, but again I noted many benzo users have had TSM work for them.

Eskapa also once made note of the benzo-like symptoms caused by baclofen withdrawal and I put baclofen in the same category as benzos. Those of us who have got free of benzos would not relish jumping into the fire just as we were getting out of the frying pan. A little something to help me sleep, started years ago, landed a big monkey on my back and I did not relish the thought of going there again. And at first blush it appeared to me that baclofen could slow TSM progress.

That said, I've kept a watchful eye on the baclofen threads on MyWayOut.org. It certainly was the Next Big Thing for a while, and has literally saved the life of at least one dear soul whom I had followed who went into a nose dive following a rehab stint. She checked in with us but was drinking near-lethal amounts regularly and baclofen stopped her in her tracks. I know that some have mentioned it here, either as a Plan B or as adjunct therapy. Baclofen has its drawbacks. The hard science is not there, although anecdotally it is a great performer. I've not read Dr. Amieson's entire book, but have read parts and it is a compelling story.

For the uninitiated, Dr, Oliver Amieson is a prominent New York physician (born in France) who was a hopeless alcoholic. He suffered from lifelong anxiety and hypothesized that if he could treat the anxiety he could overcome alcohol addiction. He started to self-administer baclofen, an antispasmodic, and when he reached high doses he found he lost all desire for alcohol. He could enjoy an occasional drink without falling back into excess. He wrote a book called (in English) "The End of My Addiction". I read about one study that found baclofen reduced alcohol consumption in rats. That caught my attention. The precise mechanism of baclofen on alcohol craving is unknown, but is thought to be related to the complex alcohol/anxiety nexus (my lay interpretation).

Baclofen is not a panacea. Thankfully the attitude at MyWayOut has been level-headed, even in light of the exciting early results. Some users have reported the gamut of yucky side-effects -- some to the point that they could not tolerate the drug. Our Zman is one of those. Some seem unable to tolerate any drinking at all while on baclofen, which of course would preclude the more permanent solution offered by TSM. I've been frankly a bit concerned about the fact that some users do not seem to grasp the implications of being on a high dose of a muscle relaxant; one member posted she fell asleep at the wheel during rush hour and had a (thankfully) minor accident. And Dr. Amieson himself intends to remain on a daily dose of baclofen for life, although he did titrate down to a dose far lower than his peak. Some baclofen users have stated their intention to titrate completely off the drug in due time, but the jury's out on this. Given the absence of scientific study of what is an off-label use of this drug, this leaves one of the biggest questions unanswered. For me, this is the biggest drawback. Next is the dearth of clinical trials studying baclofen as an alcoholism treatment. Still, many members have posted that baclofen has truly miraculously stopped their alcohol craving.

A person on MyWayOut who calls himself "Bill P" has posted a wealth of information about baclofen. One could infer from his posts that he himself is a physician. He has his own "miracle" story. A piece of information he posted caught my eye, although keep in mind the source is an anonymous, albeit obviously intelligent, poster. He said baclofen is a GABA b agonist, while alcohol [and benzos -- me] is a GABA a agonist. Assuming this is accurate, this would have several implications: It would explain why Baclofen users do not seem to develop tolerance (and hence no tolerance withdrawal)unlike benzo users, so even Muscular Dystrophy patients who take it as an antispasmodic may remain on the same dose for many years; baclofen ***MAYBE*** would not produce the same "lazy" GABA production as benzos; baclofen COULD be a viable long-term solution for the few among us with true anxiety disorders (not resulting from alcohol abuse, which virtually all of us have), because of the advantage of no tolerance withdrawal issues; a cocktail of naltrexone and baclofen MIGHTprovide short-term relief from truly toxic levels of drinking while in pursuit of a permanent cure.

So, MAYBEthose on benzos not seeing results could do a slow crossover titration from benzos to baclofen, while continuing to take nal before drinking. MAYBE those who drink dangerous amounts could reduce their consumption while continuing TSM.

The whole thing is dicey, because baclofen, unlike naltrexone, is a psychoactive drug and a CNS depressant. As I've mentioned before, few of us could convince our m.d. to prescribe this cocktail with the stated intention to continue to drink through it. It's a risky DIY proposition, that's for certain. It requires a great deal of self-education and willingness for accepting responsibility for venturing into uncharted waters. This is definitely not a subject upon which to be making decisions lightly based on, "I heard . . . ."

I'm always impressed at the thoughtfulness and depth of TSM posts. This is obviously not a group of drunken slackers but a highly intelligent cohort of HFAs. Unfortunately, intelligence is not sufficient to avoid being caught in the web of this insidious stuff. Hopefully, though, it will provide the tools to help escape it.

Mike

Hmm, from memory I had thought that Dr Ameisen had dealt with the GABA b agonist properties and the implications of that in his book, but perhaps I am confusing it with something I read elsewhere (I seem to have lost my copy of Ameisen's book somewhere so I can't check right now unfortunately.

DITTO!