Is Baclofen Addictive or a Treatment for Addiction?

What is baclofen used for?
Baclofen, also known by the brand names Kemstro and Lioresal, is a prescription drug used to relieve muscle spasms, primarily in the treatment of multiple sclerosis or spinal cord diseases.
According to the U.S. National Library of Medicine, this medication relieves spasms of the musculoskeletal system, relieves pain, and improves muscle movement.

In the past decade, baclofen has been used with increasing frequency in the treatment of drug and alcohol addiction. In this usage, baclofen functions to lessen the symptoms of withdrawal. Prescribing baclofen to treat addiction is still considered an “off-label” use of the medication, or a use outside of what is approved by the FDA, but this use has shown some success in clinical trials, according to a study published by Cochrane Database of Systematic Review.

The Issue of Addiction

baclofen Addiction is a problem that affects people from all demographics. The National Institute on Drug Abuse (NIDA) reports a 2.5-fold increase in total overdose deaths from the years 2001-2013, and overdose deaths relating to opioid pain relievers saw an even larger increase.

The Substance Abuse and Mental Health Services Administration (SAMHSA) reported in 2009 that 23.5 million people needed treatment for alcohol or drug addiction. In the face of this ever-growing prevalence of addiction, the medical field has increasingly begun to explore the possibilities of addiction recovery that is assisted by medication. According to SAMHSA, various medications are currently used for this purpose, including buprenorphine, methadone, and naltrexone. In addition to these medications, other medications like baclofen are often use in an off-label manner to assist in addiction treatment.

Baclofen was originally designed as a drug for the treatment of epilepsy. GABAb Receptor Pharmacology reports that after first being synthesized in 1962, the drug was only minimally successful in the treatment of seizures, but it was widely used to decrease spasticity caused by a variety of diseases. In 2009, a cardiologist named Olivier Ameisen published a memoir detailing his own recovery from alcoholism using baclofen, and this led to subsequent investigations into the efficacy of the drug as a treatment for addiction. While use of baclofen in addiction treatment is still considered experimental, it is gaining prominence in the field, and clinical trials continue to explore the possibilities of its use.

Dosage and Side Effects

According to the U.S. National Library of Medicine, side effects of baclofen may include the following:

  • Drowsiness
  • Dizziness
  • Muscle weakness
  • Confusion
  • Upset stomach

More severe side effects of this drug include difficulty breathing and seizures; medical help should be sought immediately if either of these side effects is experienced. Side effects are generally minimal and occur primarily when first starting treatment with this medication.

Some individuals may be more susceptible to side effects, including the elderly, and those with impaired renal function. Individuals with galactose intolerance, active peptic ulceration, and porphyria should not take this medication. Additionally, baclofen should be prescribed with caution to the following individuals:

  • Those with severe psychiatric disorders
  • Individuals with seizure disorders
  • Those already receiving antihypertensive therapy
  • Anyone suffering from sphincter hypertonia
  • Individuals with liver disease or diabetes mellitus

According to the Electronic Medicines Compendium, dosage of baclofen is increased and decreased gradually over time; initial high doses of baclofen, without tapering up to that amount, can cause side effects to be more severe. The maximum recommended daily dose of this medication is 100 mg unless careful medical supervision is provided. Small, frequent doses are generally prescribed rather than larger doses. It may take several days for baclofen to first take effect.

Sudden withdrawal from baclofen can lead to the following symptoms:

  • Anxiety and confusion
  • Psychosis
  • Convulsions
  • Tachycardia

To prevent these withdrawal symptoms, the dosage of baclofen should be decreased incrementally over a period of 1-2 weeks.

Baclofen may interact with other medications and substances, including alcohol, anesthetics, tricyclic antidepressants, antihypertensives, dopaminergics, lithium, memantine, and NSAIDS. Baclofen should be avoided during pregnancy, especially during the first three months of gestation, as the drug crosses the placental barrier. Very small quantities of baclofen can be passed to babies through breast milk, but amounts are minimal – low enough that no undesirable effects are typically expected.

Baclofen is absorbed quickly from the gastrointestinal tract, and peak concentration in the bloodstream occurs about 1-3 hours after oral administration of the medication. Baclofen’s half-life is 3-4 hours in plasma, and its shelf life is three years from the date of manufacture. Oral tablets of the medication also contain lactose, pregelatinised maize starch, maize starch, magnesium stearate, and water.

Use in Addiction Treatment

Baclofen may treat alcohol and drug addiction by altering the chemical processes responsible for substance addiction.
According to an article from Pacific University, the chemical makeup of this medication may mimic gamma-aminobutyric acid (GABA), which has a calming effect on mood. This calming effect leads to an increase in dopamine levels, thereby lessening cravings for the addictive substance.

Baclofen is well tolerated by most people. Since the drug has shown promise in the treatment of alcohol and opioid addiction when assessed through clinical trials, off-label use of baclofen in addiction recovery continues to gain prominence. Additional clinical trials are needed to assess the efficacy of the medication for this purpose before it can be approved by the FDA for the treatment of substance addiction, although prescription of the drug for off-label use is allowed.
The Substance Abuse and Mental Health Services Administration (SAMHSA) states that they do not currently recommend the use of baclofen in clinical patient settings due to a lack of sufficient data demonstrating the medication’s effectiveness for the purpose of addiction treatment. While some success has been shown in this area, use of the drug is still considered experimental by SAMHSA.

An analysis of recent studies exploring the efficacy of baclofen for the treatment of addiction, published by Cochrane Database of Systematic Reviews, found that baclofen showed limited success in treating alcohol withdrawal syndrome, equal to the success shown by other drugs, such as diazepam. Slightly more success was shown in the treatment of opioid dependence. Clinical trials published in BMC Psychiatry have shown promising results in the use of baclofen for maintenance treatment of opioid dependence.

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