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  1. #1
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    Where are the doctors?

    I am starting this thread as a place to discuss the role of doctors in baclofen treatment, specifically, and in alcoholism, in general.

    I do so in the belief, generally accepted here I believe, that the purpose of this forum is not only mutual support in dealing with the day to day pain of alcoholism, but also in providing as much general and specific information as we can about treatments for, and the availability of treatments for, alcoholism.

    It seems that there are far too many "horror stories" out there of doctors who will not treat alcoholism, notwithstanding the existence of several FDA approved medications (here in the US), who will not and do not make referrals to specialists in alcoholism and addiction medicine, and who are unaware of the existence of medications in general, and baclofen in particular. As we know, baclofen is a compound which dozens of members here, and probably thousands of alcoholics around the world, have successfully used to find relief from their alcoholism.

    But baclofen, as we also know, and have increasingly become aware in recent days, is a powerful medication which can have a profound impact on the working of our brains, both for better, and in connection with side effects, interactions and co-morbidities, for worse.

    So I would ask: What are your doctors saying to you when you ask for help with alcohol? Are there any doctors out there who are compassionate, concerned and engaged? Do you even trust your doctor to help with your drinking?

    Who has a doctor who has read up about baclofen? Who has a doctor who will prescribe baclofen for alcoholism?

    And if your doctor won't prescribe baclofen, is s/he aware of other therapies and treatments? What does your doctor say when you ask for help with alcohol?

    And if s/he won't prescribe baclofen, is s/he aware of the risks of self-prescribed baclofen so that you are informed regarding what to expect during titration, from side effects and interactions with alcohol and other drugs, and from withdrawal?

    In sum, what are your impressions of the role and performance of your docs in treating your alcoholism?

    I am very hopeful that we can get a robust discussion going for the benefit of all who come here.

    Thanks,

    Cassander

    EDIT: 8 August 2013 and 27 October 2013--While this thread was started to protest the disinvolvement of the medical profession in the medical treatment of alcoholism, there are some doctors who do prescribe baclofen. Below is a copy of the list of doctors, hospitals and rehab centers which are prescribing or may have in the past prescribed baclofen for alcoholism -- the same list is also posted at #47 in this thread. The list also includes the names of some mwo members who may be helpful finding resources in certain places.

    Cassander;1532699 wrote: Notwithstanding the more than five years that members here have been exploring Baclofen treatment, both with and without the knowledge and/or support of a physician, the accumulated knowledge on this board regarding professional support for Baclofen treatment is fairly sparse.

    Some of the resources below may, in fact, not currently be treating patients with Baclofen. And reaching some of the indicated resources may require you to PM (private message) an mwo member, who may or may not still be looking at his/her mwo messages or otherwise be in a position to help.

    If you are an mwo member and I have referred to you incorrectly in this post or you would like me to remove the reference to you, please let me know and I will do so.

    Here is what I have been able to find by combing through the pages of mwo. A lot of the information comes from this thread: nity/f20/doctors-prescribe-baclofen-addiction-47247.html">http://www.mywayout.org/community/f20/doctors-prescribe-baclofen-addiction-47247.html, which Ne/Neva Eva started and led and which many long time members, including RedThread12, Lo0p, bleep, Cinders, Sunnyvalenting, Otter and others have contributed to. A big thank you to them.

    Please let me know if I have missed relevant information. I am sure newbies and lurkers, and in fact all of us, would be grateful for more information.

    Please post here on this thread and I will update.

    Thanks,

    Cassander

    USA

    Many members on mwo have contacted Dr. Fred Levin in the Chicago area for help. He is an Associate Professor at Northwestern University in Chicago and a practicing psychiatrist. He has prescribed Baclofen to patients for alcoholism throughout the US. His home telephone number is 312-642-5803. He can be reached between 7 and 9pm Central USA time at his home number, which is his preference. He is not much of an email user. EDIT (as of 10/27/2013): Unfortunately Dr. Levin is no longer prescribing.

    Georgia, USA

    An mwo member, Spiritwolf333, was an inpatient resident at Assisted Recovery Center in Savannah, Ga, where he underwent a Baclofen course of treatment under a doctor’s supervision.

    Here is the contact info: Owner: Terry Bruce; Phone: (912) 352-2425; Web: Contact | Assisted Recovery Centers of Georgia, Inc. Or you can pm Spiritwolf333.

    An mwo member, Sunnyvalenting, has reported that a doctor in Atlanta, Dr Tommy Richardson, is familiar with Baclofen.

    Another member here, Cinders, lives in the Atlanta area and may have a recommendation if you PM her.

    Texas, USA

    An mwo member, PbarE, may have information regarding doctors who treat with Baclofen in Austin and Dallas

    Arizona, USA

    An mwo member, JustJill, may have information regarding doctors who treat with Baclofen in Arizona.

    SF/Bay Area, USA


    An mwo member, Suneeleca, has information regarding a doctor in the Bay Area who is familiar with Baclofen.

    Dr. Lawrence Doyle of the Plymouth branch of Family Practice at Sutter Amador Hospital -- Laurence L. Doyle, NP - Phone & Address Info ?€“ Jackson, CA - Nursing (NP) was at one time responding to questions about Baclofen.

    An mwo member, Want2BWell, has posted a link to a doctor in San Francisco CA who will prescribe Baclofen for Alcohol Addiction. He requires an initial visit of 1 - 1.5 hours (at $400 an hour) with him, followed by a monthly visit with him at the same rate, and weekly or bi-weekly visits to a therapist in his practice at the rate of 200 an hour. He is an out of pocket doctor aside from some possible reimbursements via PPO health care providers. His contact info is: Addiction Treatment | My Doctor Medical Group

    Boston, USA


    Otter has posted that the McLean Hospital (affiliated with Harvard) is familiar with Baclofen treatment. Here is a link to McLean’s website: McLean Hospital | Patient Care : Adult. For further information, call 1.800.333.0338, 24 hours a day, seven days a week. For outpatient services, call Intake at 617.855.2300, Monday through Friday.

    Twin Cities, MN USA


    Dr. Mark Willenbring, a former NIH official who practices in St. Paul, MN with Allina Health Care, is familiar with Baclofen, although some of his public comments have been skeptical. It is not clear if he is currently prescribing. He can be reached at 651-241-5959.

    Oklahoma, USA

    An mwo member, redthread12, may have information regarding availability of Baclofen treatment in Oklahoma. You may be able to PM her for more current information.

    Los Angeles/SoCal USA

    Stuckinla has reported a lead for a doctor in Los Angeles who has prescribed up to 80mg Baclofen. You may be able to PM him for more current information.

    Colorado, USA

    An mwo member, skullbabyland, has information regarding availability of Baclofen and naltrexone treatment in the Denver and Boulder areas.

    PeeDee, South Carolina, USA

    PM mwo member billyb for the name of a doctor in the Darlington County area in the PeeDee region of South Carolina

    United Kingdom and Ireland

    Professor Jonathan Chick in Edinburgh has prescribed Baclofen and works with general practitioners in the UK and, apparently, Ireland. Here is his Internet contact information:
    Professor Jonathan Chick Psychiatry Consultant, Edinburgh, private hospital specialist.

    A member, chelsea98, also reports that Dr Chick will see patients in London and he can be contacted via email at: jonathan.chick@gmail.com. chelsea98 further reports: "When I first saw him a few years back I think the fee was ?250 but my most recent appointment with him was when he was in London on Harley Street for a day. He saw me for half an hour and the fee was ?100" .

    It has also been reported in this forum that Dr. Susan Cooper of Fenwick Road Surgery, Giffnock, Glasgow, prescribes Baclofen for alcoholism and that The Royal Alexandra Hospital and the Dykebar Hospital in Paisley treat alcoholism with Baclofen.

    In Liverpool, an mwo member, Robbiel, reported that he was prescribed Baclofen through the Alcohol team (LCAS) at the Liverpool Royal Hospital.

    An mwo member, Longshot, may have information regarding Baclofen treatment in Ireland.

    Canada


    The Addiction Medicine Clinic of the Centre for Addiction and Mental Health in Toronto has prescribed Baclofen for alcoholism.

    Western Australia


    Dr George O’Neil of the Fresh Start Recovery Programme has been recommended as someone familiar with baclofen. His ABN is: 84 106 876 019 and his contact information is 65 Townshend Road, Subiaco, Western Australia 6008. Telephone: (08) 9381 1333 and fax: (08) 9388 7073. Email: info@freshstart.org.au

    Aruba


    For information regarding possible assistance in Aruba, PM mwo member, Xadrian.

    The Netherlands


    PM mwo member joanna_d regarding an Eindhoven based psychiatrist who prescribes baclofen and has patients throughout Holland and two doctors in Dordrecht and Rotterdam who are in the know.

    Zimbabwe


    Should you find yourself at the ends of the universe in Zimbabwe, and in need of a doctor to prescribe Baclofen, or need help for practically any other reason, PM mwo member, bleep.

  2. #2
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    Where are the doctors?

    While waiting for this thread to get some traction, I am going to copy some relevant posts from others. (If I post something you have written and you wish I hadn't please let me know and I will delete.)

    BetterAndBetter;1523546 wrote: ... I've recently started a regular medical relationship with a Nurse Practitioner who is pretty damned thorough and attentive (her husband is an MD and runs the clinic). I think I feel okay, and almost obligated, to reveal my baclofen use to her. She knows I want to quit, or radically reduce, my drinking. She seems openminded and I think if I can support "my case" it could help her in her medical treatment of me and hopefully, help others... in the way that another recent thread advocated a little more aggressive education regarding baclofen for alcohol addiction. I've got Olivier Ameisen's "The End Of My Addiction" and the documents he provides, but even that is a little dated already. I can point to France, very recently, approving baclofen as a medical treatment for alcoholism. What other routes toward health provider education can you all think of? (Sorry about the "you all"... I'm from the south in USA). Scientific studies? Medical establishment accolades? There may already be a consolidated thread for this and feel free to point me to it. It wouldn't hurt to be able to put together a printable, uhm... database? of supporting proof for the efficacy of bac for beating the bottle. I think, conscientious, capable health care specialists would welcome the information. If we could get together to create a regularly updated and edited "infopak" to present to the medical community that would be a proactive way to expedite the process of making bac a first line treatment for what is not, IMO, a moral failing, but a physical addiction. It wouldn't hurt to have some sympathetic medical professionals involved in order to be sure that what is edited down to said "infopak" is as concise and informative as possible.
    BetterAndBetter;1530967 wrote:
    Just to follow up (and thanks for your help, responders) I had an appointment with my NP yesterday where I revealed to her my baclofen use. I guess I'm glad I did tell her I was using 80mgs/day bac and had achieved two weeks of sobriety, but her response wasn't what I wanted. Basically it was something about not wanting to replace one substance with another. 80 mgs is a high dose and don't want that compromising my liver (I've had some high enzyme readings which is why I'm quitting the sauce... after the appointment I confirmed that bac is mostly excreted, as is, through the kidneys and not significantly metabolized through the liver). She wants me to begin tapering down the bac and believes that although it may help with withdrawal.. it helping to reduce my cravings is psychological. I gave her a couple of studies to read and she said "Maybe I'll learn something." She gave me a "packet" full of local AA numbers/meetings blah, blah, blah. "Maybe you'll get the chance to help someone else", etc. Well... I might act as an undercover evangelist for bac but that's about it. My addiction is not a moral failing. It's a frickin' addiction and if I can end it by taking a benign medication... why not? The ironic thing is that she put me on, recently, a low dose high blood pressure med that has only brought my readings down to borderline, when I measure it in the mornings. I've charted how an hour after my morning bac dose my blood pressure goes down to a very healthy reading. So... it reduces my cravings, won't hurt my liver (but will help heal it through abstinence) and brings my bp into a good normal range. Now I'm supposed to quit the bac before she can "really" treat my blood pressure. I understand, but it's a little wacky. Gonna stick with the bac and either try to educate the nice lady or find a new doc.

  3. #3
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    Where are the doctors?

    From bleep, replying to better

    bleep;1523587 wrote: I don't get it from your post, but a lot of people have a nervous and embarrased approach to informing their doctor about baclofen use, as if it were something shady and underhanded. This is so wrong on so many levels. People should be kicking their doctor up the backside for not being pointed to it in the first place, instead of feeling ashamed for taking the initiative and plunging into what is a very big unknown.

    To make the old cancer analogy again - if you had heard of a revolutionary new treatment, you wouldn't feel obliged to research the shit out of it, and take all sorts of documentation to your doctor - you would tell him about it, and expect him to go and look it up himself. Then you ask him why he hadn't heard about it, and why he wasn't out there doing the best possible job for you, and then you would indignantly change doctors, and feel righteous about it.

    It's time they got their fucking act together, if you ask me.

  4. #4
    Registered User. kronkcarr's Avatar

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    Where are the doctors?

    When I decided to start baclofen a friend told me of an internist who was compassionate and leaned toward alternative therapies. I called, asked if he would prescribe baclofen so that i could quit drinking alcohol. He agreed. I took Dr Ameisen's book to my first appointment. The dr said he'd had the book, never read it and donated it.

    I was scripted 30 mgs and could go up 10 mgs every 4 days to 50 mgs.

    At my second visit I loaned him the book. Ultimately he let me go up to 80 mgs and then, because he didn't read the book, he said I could stay on baclofen for a few more months and would need to titrate down and come off it. He also didn't understand that I could have a drink while on baclofen. He was not really interested in treating with baclofen. He didn't offer any other options for my drinking.

    I stopped seeing him and called Dr L who did script for me. At this point I was also using liquid baclofen and I had reached my switch. I don't have an ongoing patient relationship with Dr L.

    I feel fortunate that I switched low, at 80 mgs, and didn't need much guidance other than that offered by the experienced posters here.

  5. #5
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    Where are the doctors?

    kronkcarr;1531076 wrote: I took Dr Ameisen's book to my first appointment. The dr said he'd had the book, never read it and donated it... At my second visit I loaned him the book. Ultimately he let me go up to 80 mgs and then, because he didn't read the book, he said I could stay on baclofen for a few more months and would need to titrate down and come off it. He also didn't understand that I could have a drink while on baclofen. He was not really interested in treating with baclofen. He didn't offer any other options for my drinking.
    ...
    Hi kc

    I honestly cannot understand how a doctor who is willing to prescribe baclofen and does so, and is handed the book, can not read it. Or read the summaries on amazon, ffs. Is he too busy playing golf? Day trading? Seeing 35 patients a day? I wish a doctor would come on here and (try to) defend this behavior.

    I found the book riveting. I read it front to back in one sitting. I couldn't put it down. I had never read such a persuasive explanation for the connection between anxiety and alcohol abuse and dependence. It made his explanation of how baclofen works 100% convincing. Doctors may know something I don't but OA's book has the distinct ring of truth to it (at least to me).

    By comparison (and fwiw) I have picked up the Big Book a dozen times and can't get through five pages before my BS alarm is going off...its like (and I mean no offense to anyone - just my personal opinion) trying to read the Book of Mormon...

    Cass

    PS (edit): I too gave the book to my big-shot psychiatrist and so far as I know he never read it...or offered to give it back.

  6. #6
    Registered User. Ne/Neva Eva's Avatar

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    Where are the doctors?

    I've given the book to 3 docs, 2 parents and countless other relatives and friends. Just about everyone who cares about me, or should care about alcoholism. My aunt read it. That's it.

    My doc stories are this:

    Tell the doc
    Doc says go to shrink
    Shrink says go to AA

    Last shrink said, "Baclofen? Never heard of it." I explained it. He smirked and said, "And what other supplements do you take?" (I told him I'd ordered bac online.) I had NO idea what he was referring to, which is basically that addicts will take stuff randomly to try to get better.

    His suggestion? AA.

    Even thought I've been to rehab 3 times, and started in AA more than 20 years ago. AND his practice, made up of 3 pdocs, and several counselors, are the only addiction specialists in the city of Portsmouth, VA.

    Yep.

  7. #7
    Registered User. Ne/Neva Eva's Avatar

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    Where are the doctors?

    My husband just had a physical. The doc (internist and really nice guy) asked him if he was still taking baclofen. He said, yes. The doc said, "Aren't you concerned about taking such a high dose?" (140mg) (Shouldn't the doctor be answering that question???) And of course Ed said, "I'm more concerned about drinking everyday."

    grrrr.

  8. #8
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    Where are the doctors?

    It wasn't easy, but I for one was able to find a doctor who was willing to think outside the box and prescribe baclofen (and before that, naltrexone).

    After going through frustrating experiences with doctors that had no interest in doing any reading I'd found (the TSM book and then the Dr. Amiesen book), I just straight up dropped those doctors, cuz to me, a doctor showing disinterest in keeping current on cutting edge practices s a dealbreaker, especially when those practices could help people and save lives.

    I ended up searching for a doctor in my area who was TSM-friendly via the forums over on the TSM boards. She'd read the TSM book and had some success using it with patients.

    I'm not sure if there's a similar thread here on MWO regarding bac-friendly doctors, maybe someone can chime in on that.

    Anyway regarding my MD, when I urged her to read Dr. A's book, which I loaned her, she did. She was optimistic enough and scripted low-dose bac for me with checkins every month. She's happy with my current progress at 80mg and is becoming more enthusiastic about baclofen and may script it to other patients.

    I've got more details over on my own thread if anyone's interested.
    Best to all.

  9. #9
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    Where are the doctors?

    Shouldn't there be a standard emergency room protocol for baclofen overdose (accidental or otherwise and with or with out alcohol) and for baclofen withdrawal? Its not like its never happened before or won't happen again...Seriously...wtf?

    This from Diver on another thread:

    Diver;1531149 wrote: A couple Don't Do This, that I learned from accidently double dosing myself.

    Number one Don't ever ever double dose yourself. I had been writing down each dose as I took it, but has I became more comfortable after a couple of months I stopped recording. Stupid ... Stupid ... Stupid.

    I was at 330 and on this day I took 440! I woke up early in the morning praying to the porcelain god with some serious tremors and unable to think clearly. My wife freaked out and insisted that I go to the emergency room. Which brings me to my second Don't Do This

    Don't Think that the ER Doc is going to have a clue about HDB. The compassionate doctor's whole demeanor changed to Queen Bitch, when I mentioned alcohol and Baclofen. She told me that it wouldn't help and immediately checked my liver which she said was "enlarged" and ordered a CT scan. She then assumed that I was having withdrawals from alcohol and treated me for that. Even though I told her that I just had completed 5 days AF, and had 4 glasses of wine the night before. I had my liver scanned, however she never came back to tell me the results. Obviously my liver was fine, so she couldn't come in and lecture me and my wife. She sent a nurse in to release me with orders to go to a Detox Center. Which I had no interest in doing since it was bullshit, but my wife insisted and since she is a medi-phobe to begin with I went. During my interview there I told them I was taking baclofen for alcohol cravings, and to my surprise they understood. They told me properly that if I wanted to stop taking Bac that I needed to titrate down slowly and offered me inpatient to help me or outpatient where a doctor could supervise. Of course I told them outpatient and left. I wasn't about to stop baclofen, but I did contact Dr. Levin to get a legitimate prescription and also for him to talk to my wife to get her back on board. A side note here, I was due for my annual physical so I went two weeks ago and my liver panel was within the normal range. I am thinking about getting a copy of the CT scan and report from the ER hospital and if as I suspect it is normal, lodging a complaint against that Bitch Doctor.

    That was a month ago and I continue to take 330 and baclofen has changed my life. If anyone is interested in the gory details you can read about it on my progress thread.

  10. #10
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    Where are the doctors?

    I want to come back to something bleep said, in his inimitable way:

    bleep;1523587 wrote: ...a lot of people have a nervous and embarrased approach to informing their doctor about baclofen use, as if it were something shady and underhanded. This is so wrong on so many levels. People should be kicking their doctor up the backside for not being pointed to it in the first place, instead of feeling ashamed for taking the initiative and plunging into what is a very big unknown.

    To make the old cancer analogy again - if you had heard of a revolutionary new treatment, you wouldn't feel obliged to research the shit out of it, and take all sorts of documentation to your doctor - you would tell him about it, and expect him to go and look it up himself. Then you ask him why he hadn't heard about it, and why he wasn't out there doing the best possible job for you, and then you would indignantly change doctors, and feel righteous about it.

    It's time they got their fucking act together, if you ask me.
    I read this earlier today, went out and about my way, and thought about it, and thought about it some more, and finally said to myself, "You know, bleep is fucking right". Several docs have told us that they don't know fuckall about baclofen but that doesn't matter because... you can't treat substance dependence with a substance or ...its a dangerous narcotic or... just shut up and go to AA.

    Why isn't it medical malpractice to not be up to date on what is known by many leading physicians here and in Europe? What has been reported and confirmed in numerous studies and articles by Adolorato, Leggio and deBeaupaire, among others.

    And bleep is right: why should WE feel bashful and ashamed for suggesting to our doctors that there might be a cure for our disease which is...medical...and which actually works.

    I am now imagining this new scenario...

    Cassander goes to his doctor's office. He is sick and tired of being drunk.

    There is a long wait to see the doc. After a half hour Cassander spies the doc pulling into the space reserved for him in the parking lot in his black Mercedes.

    Another 15 minutes passes and Cassander is called into the doc's office.

    It goes like this:

    Cassander: Hello, Doc. How's it going?

    Doc: Just fine, Cass...what brings you here?

    Cassander: Well doc, I know you've been seeing me for 10 years, but you have never asked me about my alcohol intake.

    Doc: (Looking at notes in doctor scrawl.) Yes?

    Cassander: Well Doc, the truth is, I've been drinking a lot for over 10 years and the time has come to stop.

    Doc: (Looking at palms.) Yes?

    Cassander: Yes. I have been reading a lot on the Internet about a drug called baclofen. It seems to absolutely suppress craving for alcohol. Some people swear by it.

    Doc: (Staring at wall.) Well, Cassander, I am very sorry you have been drinking too much. Here is a pamphlet the local Alcoholics Anonymous has put out. I suggest you give them a call.

    Cassander: Doc...are you kidding? AA was thought up by a bunch of guys in the 1930s who were hurting drunks and didn't know what else to do. Before penicillin was discovered. Before insulin and antibiotics. Before radiation and chemotherapy. Before we knew shit about anything, let alone how the brain really works.

    Doc: Why...Cassander! I won't have you insult me or my profession. AA is a proven methodology for ...well...achieving abstinence.

    Cassander: (thinking, there is a hell of a big difference between abstinence and indifference) Right, Doc. A proven methodology with a success rate of somewhere between 5% and 30% if you give them the benefit of the doubt.

    Doc: (looking at shoes). Why, of course, Cassander, if you say so. I have not reviewed the statistics recently.

    Cassander: (Thinking, but not saying, "or ever, Doc"). And why not, Doc? How many of your patients have an alcohol problem? Do you know? You are a family doctor. Do you ask your patients about substance or alcohol abuse?

    Doc: I really think this discussion has gone far enough, Cassander. My discussions with my other patients are private and confidential and none of your business.

    Cassander: Ok. So let's talk about me. I have tried AA. It didn't work for me. In fact I hated it. The AA oldtimers who run the room think alcoholism is a moral failing and an incurable spiritual malady. What the hell does that mean? They want me to rehash all the mistakes I have made drinking. Over and over. As if I don't already think about it enough. They want me to pray that I become strong enough to overcome it. Its bullshit, Doc. Its like voodoo.

    Doc: I think we have spent enough time on this, Cassander. I have patients waiting in four different rooms.

    Cassander: I don't think we have spent enough time, Doc. Look, I shouldn't have to be telling you this, Doc, but I've got a disease and its curable. My disease is alcoholism and it is a disease of the brain. It results from some chemical imbalances in my brain. It can be treated. The FDA has approved three compounds for alcoholism. What do you think about them? Wait, don't tell me because I know you haven't given any thought to them.

    Doc: Why, Cassander!

    Cassander: But here's the thing, Doc. There is another drug, a GABA b agonist called baclofen which works better than any of them. Its an old drug which has been safely used for decades for muscle spasticity. A French doctor, Olivier Amiesen, himself an alcoholic, discovered that baclofen suppresses craving in alcoholics and makes them indifferent. He wrote a book. Its all there. You should buy it and read it.

    Doc: Cassander, you can't be suggesting that I prescribe a drug off-label based on one person's self-report...You know, I could be sued!

    Cassander: Yup, I sure am, Doc. Do you have a computer? I bet you do...do me a favor, please. Go home tonight and google: "baclofen and alcohol". Google "Amiesen and baclofen" and "my way out and baclofen". Google "Leggio" "Chick" "Addolorato" and "de Beaurepaire" and "baclofen". The truth is, Doc, this medicine works. But, do I have to tell you? Its not candy. It is a powerful medication and it has side effects. It can affect mood. It isn't addictive, but like many drugs, there are risks in too rapid withdrawal. You have to get with the program and offer support to your patients who want to be relieved of their alcoholism. Comprendo mi amigo?

    Doc: Cassander, i don't speak Spanish and we have run 15 minutes over. I have patients stacked up in my examination rooms and in my waiting room. Do you know how hard it is to make a living what with medicare and medicaid and obamacare? I am afraid our time is up.

    Cassander: Yeah, I saw your Mercedes outside is two years old. Tough life. See ya, Doc.

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