The Use of Baclofen as a Treatment for Alcohol Use Disorder: A Clinical Practice Perspective.

Alcohol use disorder (AUD) is a brain disorder associated with high rates of mortality and morbidity worldwide. Baclofen, a selective gamma-aminobutyric acid-B (GABA-B) receptor agonist, has emerged as a promising drug for AUD. The use of this drug remains controversial, in part due to uncertainty regarding dosing and efficacy, alongside concerns about safety. To date there have been 15 randomized controlled trials (RCTs) investigating the use of baclofen in AUD; three using doses over 100 mg/day. Two additional RCTs have been completed but have not yet been published. Most trials used fixed dosing of 30-80 mg/day. The other approach involved titration until the desired clinical effect was achieved, or unwanted effects emerged. The maintenance dose varies widely from 30 to more than 300 mg/day. Baclofen may be particularly advantageous in those with liver disease, due to its limited hepatic metabolism and safe profile in this population. Patients should be informed that the use of baclofen for AUD is as an "off-label" prescription, that no optimal fixed dose has been established, and that existing clinical evidence on efficacy is inconsistent. Baclofen therapy requires careful medical monitoring due to safety considerations, particularly at higher doses and in those with comorbid physical and/or psychiatric conditions. Baclofen is mostly used in some European countries and Australia, and in particular, for patients who have not benefitted from the currently used and approved medications for AUD.

[Effect of maintenance treatments on social life. A study with general practitioners]. / Impact des traitements de substitution aux opiacés sur la vie sociale. Une étude en médecine de ville.

The objective of this retrospective study was to describe drug maintenance treatments (DMT) in ambulatory care, and to evaluate their impact on social life. A convenience sample of 665 patients on DMT was recruited by 94 general practitioners in three geographic areas (Ile-de-France, Alsace, Aquitaine), and interviewed face to face by independent staff with a standardized questionnaire on three periods (one month before DMT, 6 months after beginning of DMT and 1 month before inclusion within the survey). Among the 665 patients, 76% were on buprenorphine, 20% on methadone, and 4% on morphine sulfate. Consumption of heroin and other psychoactive drugs was lower 6 months after DMT initiation. Patients were more likely to have relationships with people who did not have any problem with alcohol and drugs after DMT initiation than before treatment. They were also more likely to spend their free time alone after having begun DMT than before. All markers of social vulnerability evaluated through standardized questionnaires (employment, housing, social insurance, days of in-patient treatment related to drug consumption and number of condemnations) were improved after a six-month period with DMT. This research contributes to demonstrating the positive impact of DMT both on drug consumption and social life. Health professionals should include social support in their clinical practice.