"No medication works effectively for everyone, and baclofen is surely no exception... So far it seems to work in all types except for one, and that’s people who turn up once and don’t come again. But it’s not one size fits all; you have to refine it. Not to say that I’m a great doc, but every time I’m on the case I’ve yet to find a patient where it’s not a success. I’ve been playing with this medication for 10 years."

- Dr. Olivier Ameisen

Baclofen, like any medication, induces a variety of different responses in every new person that takes it. Some people report life-changing differences even at small doses, while others see no discernible changes; some people have intolerable (yet temporary) side effects, while most have none; some people don’t even notice that they’re drinking less and less and find themselves shocked at how much they’ve naturally reduced over time. Everyone’s reaction to baclofen is unique to their own biology and lifestyle.

Although baclofen has been used extensively for decades for muscle spasticity, so we have a lot of data on its potential side effects, it is now off-patent and its use for alcohol treatment is off-label, so there’s little financial incentive for pharmaceutical companies to fund studies into its effectiveness. This means that, until recently, there were very few legitimate, large-scale studies into baclofen’s efficacy as an addiction treatment. Luckily, alongside baclofen’s surge in popularity in Europe, Australia, and numerous other countries, there has been a marked increase in the amount of research being done.

The first randomized, placebo-controlled study of baclofen titrated using the Ameisen Method was the BACLAD study, published in 2015. Even though this study treated anything but total abstinence as a failure, the baclofen group still achieved a remarkable 68% success rate, almost three-times the 23% rate of the placebo group. In 2018, another French study, OBADE-ANGH, reported 70% success in reducing to safe drinking levels and 44% success in maintaining complete abstinence among its 214 participants.

The Bacloville study, presented in 2016 at the Berlin World Congress on Alcohol and Alcoholism, analyzed 320 high-risk drinkers (averaging 13 standard drinks per day), and is praised for its inclusiveness and realistic methods, spanning 60 general practices with no exclusions for pre-existing medical conditions. Excluding drop-outs who didn’t complete the study, 81% of participants in the baclofen group (non-placebo) had succeeded in reducing to at least low-risk drinking levels (2/day for women, 4/day for men).

In 2012, Dr. Renaud de Beaurepaire analyzed 100 alcohol-dependent high-risk drinkers for two years as they were treated with baclofen in a non-randomized, non-placebo-controlled trial. 84% of participants showed a reduction in drinking (from high-risk to at least moderate-risk) 3 months in, and 62% maintained that reduction all the way to the 2-year mark. By the end of the two year study, half of the participants had reduced from high- to low-risk drinking, with 70% of the remaining half of participants having discontinued treatment.

On the other hand, however, there are studies that found baclofen’s effectiveness to be minimal. Almost all of these studies had one or more obvious flaws that led to this conclusion, but they’re worth discussing nonetheless. Two other, smaller studies presented alongside the Bacloville study at the Berlin World Congress on Alcohol and Alcoholism concluded that baclofen showed little difference with placebo. Both studies required 20 weeks total abstinence as the criterion for success, counting any reduction short of long-term abstinence as a failure. One of these, the Alpadir study, funded by European pharmaceutical giant Ethypharm, had a 40% drop-out rate and ambiguous methodology and sample; it found no difference between baclofen and placebo. The other study, led by Dutch researchers, somehow achieved an incredible 65% success rate for achieving continuous abstinence in the placebo group who received no meaningful treatment, matching the 65% success rate of the baclofen group and leading the researchers to conclude no difference against placebo.

The results of baclofen treatment studies over the past few years have been remarkable, but skepticism is natural: can a simple pill really cure a problem that has plagued mankind for millenia? It’s important to recognize what baclofen is and isn’t capable of; baclofen suppresses cravings, urges, and subliminal trigger responses for alcohol in the human brain. While cravings are usually the primary symptom of AUD, baclofen has no control over the original cause: your environment. The root cause of excessive drinking almost always lies in environmental factors: maybe you learned as a teenager that alcohol can make you more confident and sociable, or you formed a habit of drinking every night to unwind from a stressful work environment. The key to highly effective baclofen treatment is to take advantage of baclofen’s suppression of subconscious urges to work on unwinding your habit loops, dealing with environmental stressors, and getting better acquainted with your brain’s habit and reward circuits.

While the results discussed above are certainly remarkable, there are still a minority of baclofen users who either fail to significantly reduce their drinking, or choose to prematurely stop treatment. Let’s go over some of the most common reasons baclofen doesn’t work.

The most common reason for stopping baclofen treatment prematurely is side effect management. Baclofen’s most common side effects are nausea, dizziness, tiredness, and insomnia, although more severe effects like paresthesia (tingling), tinnitus, hallucinations, and mania have been reported in very rare cases. For the vast majority of people, side effects are very mild and only occur on dose increases; slowing down titration will usually mitigate side effects. Unfortunately, because baclofen treatment in the U.S. is often done independently, and people with AUD are very likely to also suffer from anxiety, people are much more likely to be scared off of baclofen after experiencing mild side effects at low doses, and they’re much less likely to understand that adjusting their titration can end their experience of unwanted side effects. Here at LifeBac, we pay close attention to the appearance of side effects, especially in the early stages of treatment, and can almost always solve the issue of unwanted side effects with slight titration schedule adjustments. You can call us at 888-959-8858 if you need assistance or would like to talk with one of our providers. Please call 9-1-1 if you are experiencing a medical emergency.

Another surprisingly widespread cause of failed baclofen treatment is people just not taking their baclofen. With Alcohol Use Disorder especially, it’s quite common for people to be “forced” into treatment by an ultimatum from their partner or family, usually with the traditional expectation of total lifelong abstinence as the goal. In these cases, the user is not internally motivated to continue treatment, and might actually have the opposite motivation; this is just another reason that self-empowerment, goal-setting, and personal control over treatment are core principles of the LifeBac program. People who aren’t genuinely motivated to improve themselves might purposely fail their treatment — whether consciously or subconsciously — so that they can rationalize returning to excessive drinking. People who are forced into treatment are also likely to be unsuccessful. IIn addition, it is quite common for people who aren’t used to taking regular medication, take a wide range of medications, or are frequently intoxicated, to simply forget to take their baclofen or accidentally dose themselves incorrectly. Other people may have a psychological issue with having to take medication at all. At LifeBac, we make your comprehensive titration plan readily available to you through the app and web portal. We also encourage you to track your medication doses taken in the app’s Agenda View and regularly check in with semi-weekly Progress Reports.

The other major cause of baclofen treatment failure is when AUD is heavily enforced by environmental factors — even more so than internal urges or cravings. If alcohol is an important part of your culture, family, or social and professional lives, it can seem impossible to cut down even with baclofen suppressing your cravings. Baclofen can only affect you; it has no power over your family, home life, or external pressures to drink.

Failed baclofen treatment can also stem from unrealistically high expectations of the medication. Baclofen takes time—it won’t cure you overnight, and as previously mentioned, it can’t change your environment. The neurological processes within which AUD entrenches itself often take many months to repair, and some patients (for various reasons) don’t give the medication enough time. At LifeBac, we address many of these reasons that baclofen treatment doesn’t work from the beginning. We work with clients to handle side effects (which can often be overcome by adjusting dosage), provide strategies for fighting cravings with healthy habits and preventative action, and lay out the entire process of baclofen treatment so everyone knows what to expect. Finally, in the Titration Phase (the first 1-3 months of the program) we emphasize the need for patience. Patience has to be part of the recipe in order to realize such a life-defining change.

Failed baclofen treatment can also stem from unrealistically high expectations of the medication. Baclofen takes time—it won’t cure you overnight, and as previously mentioned, it can’t change your environment. The neurological processes within which AUD entrenches itself often take many months to repair, and some patients (for various reasons) don’t give the medication enough time. At LifeBac, we address many of these reasons that baclofen treatment doesn’t work from the beginning. We work with clients to handle side effects (which can often be overcome by adjusting dosage), provide strategies for fighting cravings with healthy habits and preventative action, and lay out the entire process of baclofen treatment so everyone knows what to expect. Finally, in the Titration Phase (the first 1-3 months of the program) we emphasize the need for patience. Patience has to be part of the recipe in order to realize such a life-defining change.