Exberliner Issue 138, May 2015

withdrawal symptoms and tolerance rather
similar to substance abuse addiction. There are
actually people who stand next to a gambling
machine and sweat and shiver if they can’t play.
When it comes to social media, like relentless
posting or chatting, I’m not really convinced
that this should be called an addiction. There
is a strong desire to not be lonely and to stay in
contact with friends, and with all these internet
connections we can do that faster and with
more people at the same time. It’s very typical
of our time, but I don’t think it’s an addiction
– there would have to be some tolerance development
and withdrawal symptoms, otherwise
you’re not talking about the same concept.
So social media might not be an addiction,
but gambling is? We can say gambling
resembles alcoholism in certain ways, but
there are lots of differences with respect to the
reward system. One thing is important: I don’t
think addiction is a thing in the brain. Addiction
is a concept one uses to describe similarities
among behaviours, but these behaviours
are very heterogeneous. There’s no symmetry
in that every addiction alters dopamine in the
same measurable way. Everything that interests
us, as far as we know, interferes with our
neurotransmitter systems, including dopamine.
It’s a question of degree – it’s not a categorical
difference where you can say, okay, now the
addiction has started.
But are we all equal before substances?
Does alcohol work in the same way for
everyone, for example? We do know that all
addictive drugs activate dopamine transmission,
but the degree to which they alter it is different.
Many alcohol-dependent patients look like
the normal controls – it’s just a few that really
stick out. Again, you can understand patterns
and alterations, but people are different from
one another. Some people might profit from an
anti-alcoholism medication, while others won’t.
It’s the same with anti-depressants – they work
in about one out of six to eight patients.
Baclofen: Magic pill on trial
Touted by medical professionals
and recovering alcoholics
since 2009 for its ability to reduce
cravings, the muscle relaxant
baclofen still isn’t approved
to treat alcohol abuse disorder
in Germany. The results of Andreas
Heinz’s trial of the drug
(Baclofen for the Treatment
of Alcohol Dependence, or
BACLAD), released too much
anticipation at the end of April,
could change that.
The first clinical trial of baclofen
as a treatment for alcoholism in
Germany, BACLAD was initiated
by Heinz after Dr. Olivier Ameisen,
the French cardiologist who first
recognised the potential of the
drug, came to Berlin to present his
findings in 2009. The three-year
study at Berlin’s Charité hospital, a
rigorously conducted double-blind
placebo trial, might pave the way
for recognition of baclofen as a
regular treatment for alcoholism in
Germany – in the wake of France,
where the drug has already been
granted temporary approval by
health authorities and is currently
being widely prescribed (with reported
success) to alcoholics.
As devised by Dr. Christian Müller,
who led the study, 56 patients
suffering from alcohol dependence
were administered either the drug
(30-270mg) or a placebo at random.
Patients with “side disorders” such
as depression were excluded. “Our
trial was the first one whereby the
dosage was varied. We’ve gone
up to about 270mg based on the
report by Ameisen,” says Heinz.
This was crucial as many previous
trials used dosages far below
Ameisen’s recommendation, which
according to baclofen supporters
explained the poor results. In the
Charité study, the success rate was
unexpectedly high: 68 percent of
patients who were given baclofen
maintained total abstinence during
the high-dose phase compared to
23.8 percent of those who received
a placebo. Reduction of alcohol
intake – an objective supported by
Ameisen, who continued drinking
moderately while taking his maintenance
dose – was not accounted for.
“It was clearly positive. Patients
on baclofen drink less than on
placebo. And it appears that higher
doses have a tendency to be more
effective,” concludes Heinz. According
to Müller, no serious side
effects were observed and there
is no evidence of baclofen addiction.
Supporters of the drug hope
the results will convert Germany’s
sceptical medical establishment to
the new medication, and two major
pharma firms (French Ethypharm
and UK Indivior) are already working
on cashing in with new, patented
formulations of the old generic.
Müller, however, calls for caution:
“I think the most important thing
to communicate is that nobody is
promising anything to alcohol dependent
patients,” he says. “After
the release of Ameisen’s book, it
was like a religion for some patients
who called us and said ‘Help me,
this is the medication that will solve
my problem.’ There is no Wunderpille.”
But then again, whatever
works... n
What about the genetics? The genetic
component explains about 50 percent of what
goes on. But the most clear-cut genetic finding
is that people who can drink a lot, do drink
a lot. In Asia, a lot of people get these flush
reactions because their alcohol metabolisation
is genetically different. In Europe, genetic variation
in serotonin neurotransmission influences
how much alcohol you can drink before you
get intoxicated. If you don’t have strong side
effects, then you tend to drink more. It doesn’t
make you an addict automatically, but it helps
you drink too much. Then neuroadaptation and
tolerance development starts – at that point,
some patients could drink a bottle of vodka and
not be comatose, while I would be. n
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