The End of My Addiction

or other oral antispastic medications such as diazepam and dantrolene sodium.
    This brief chart review confirmed that use of high-dose baclofen is fairly frequent in a large MS center. The results also suggested that high dosages are not associated with discontinuation of the medication, although there is a reduction of dose from highest recorded levels for a significant proportion of patients using >80 mg (n = 5/15). On the basis of these data, no conclusions can be drawn concerning the safety or efficacy of high doses of baclofen. However, given that high dosing is frequent enough in MS, the results do strongly suggest that patient needs and response to therapy, and not some arbitrary maximum, should determine the optimal dose.
    References
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    2. Katz RT. Management of spasticity. Am J Phys Med Rehabil 1988; 67 :108–116.
    3. Feldman RG, Kelly-Hayes M, Conomy JP, Foley JM. Baclofen for spasticity in multiple sclerosis. Neurology 1978; 28 :1094–1098.
    4. Young RR. Treatment of spastic paraparesis. N Engl J Med 1989; 320 : 1553–1555.
    5. Delwaide P. Oral treatment of spasticity with current muscle relaxants. In: Marsden D, ed. Treating spasticity: pharmacological advances . Bern: Hans Huber, 1989:31–37.
    6. Whyte J, Robinson KM. Pharmacologic management. In: Glenn MB, Whyte J, eds. The practical management of spasticity in children and adults . Philadelphia: Lea & Febiger, 1990:10.1–10.26.
    7. Jones RF, Lance JW. Baclofen (Lioresal®) in the long term management of spasticity. Med J Aust 1976; 1 :654–657.
    8. Pedersen E, Arlien-Soborg P, Grynderup V, Henriksen O. GABA derivative in spasticity. Acta Neurol Scand 1970; 46 :257–266.
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    10. Penn RD, Savoy SM, Corcos D, et al. Intrathecal baclofen for severe spinal spasticity. N Engl J Med 1989; 320 :1517–1521.

Addiction and Preexisting Anxiety and Mood Disorders
    Abstract
    Grant, B. F., Stinson, F. S., Dawson, D. A., et al. (2004) Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61, 807–816.
    Background: Uncertainties exist about the prevalence and comorbidity of substance use disorders and independent mood and anxiety disorders. Objective: To present nationally representative data on the prevalence and comorbidity of DSM-IV alcohol and drug use disorders and independent mood and anxiety disorders (including only those that are not substance induced and that are not due to a general medical condition). Design: Face-to-face survey. Setting: The United States. Participants: Household and group quarters’ residents. Main Outcome Measures: Prevalence and associations of substance use disorders and independent mood and anxiety disorders. Results: The prevalences of 12-month DSM-IV independent mood and anxiety disorders in the US population were 9.21% (95% confidence interval [CI], 8.78%–9.64%) and 11.08% (95% CI, 10.43%–11.73%), respectively. The rate of substance use disorders was 9.35% (95% CI, 8.86%–9.84%). Only a few individuals with mood or anxiety disorders were classified as having only substance-induced disorders. Associations between most substance use disorders and independent mood and anxiety disorders were positive and significant ( P <.05). Conclusions: Substance use disorders and mood and anxiety disorders that develop independently of intoxication and withdrawal are among the most prevalent psychiatric disorders in the United States. Associations between most substance use disorders and independent mood and anxiety disorders were overwhelmingly positive and significant, suggesting that treatment for a comorbid mood or anxiety disorder should not be withheld from individuals with substance use disorders.

Possible GHB Deficiency in Alcoholism
    Hypothesis
    Ameisen, O. (2007) Gamma-hydroxybutyrate (GHB)-deficiency in alcohol-dependence? Alcohol and Alcoholism 42, 506.
     
    I wish to propose a hypothesis that could help explain some of the effects of baclofen in alcohol dependence that are described in Dr. Bucknam’s case study (Bucknam, 2007) and in my self-case report