Day 2 :
Northern Sydney Drug and Alcohol Service, Australia
Keynote: An old drug with a new purpose. Baclofen in the management of alcohol dependent patients with psychiatric comorbidity
Time : 9:30 am
Dr Dore is a Consultant Psychiatrist and Clinical Director for the Northern Sydney Drug and Alcohol Service, and a Clinical Associate Professor for the University of Sydney Northern Clinical School. For over 20 years her clinical work, teaching and research have focused on the assessment and management of patients with comorbidity (co-existing substance use and mental health disorders). In 2011 Dr Dore published the first case series on patients with coexisting alcohol dependence and psychiatric disorders treated with baclofen.
The GABA-B receptor agonist, baclofen, is a muscle relaxant which was introduced in the 1960’s for the treatment of muscle spasticity. Recent randomized controlled trials have also found baclofen to be effective in treating patients with alcohol dependence because of its anticraving and anti-reward action. Clinical experience indicates that a large number of patients do not experience a satisfactory anti-craving response to the FDA-approved medications for alcohol dependence (acamprosate, naltrexone and disulfiram) and such medications are sometimes contraindicated, for example with significant liver disease. In contrast, baclofen appears to be relatively safe in liver disease and preliminary reports have indicated its potential usefulness in improving psychiatric symptoms, with reports of baclofen improving panic symptoms, PTSD and state anxiety. Published case studies have provided evidence of baclofen’s usefulness in treating complex patients with comorbid psychiatric disorders as part of a comprehensive treatment program including integrated psychiatric care. Case studies have also highlighted some of the more significant adverse effects related to baclofen treatment and the importance of patient selection and close monitoring when this drug is used.