Baclofen has been suggested as a potential pharmacotherapy for alcohol use disorder, but the clinical data are conflicting. Here we investigated the biobehavioral effects of baclofen in a sample of anxious alcohol-dependent individuals. This was a randomized, double-blind, placebo-controlled, human laboratory study in non-treatment seeking alcohol-dependent individuals with high trait anxiety (N=34). Participants received baclofen (30 mg per day) or placebo for at least 8 days, then performed an experimental session consisting of alcohol cue-reactivity followed by alcohol administration procedure (alcohol priming, then alcohol self-administration). Total amount of alcohol self-administered was the primary outcome; alcohol craving, subjective/physiological responses and mood/anxiety symptoms were also evaluated. There was no significant medication effect on the total amount of alcohol consumed during the alcohol self-administration (P=0.76). Baclofen blunted the positive association between maximum breath alcohol concentration during priming and the amount of alcohol consumption (significant interaction, P=0.03). Ratings of feeling intoxicated were significantly higher in the baclofen group after consuming the priming drink (P=0.006). During the self-administration session, baclofen significantly increased ratings of feeling high (P=0.01) and intoxicated (P=0.01). A significant reduction in heart rate (P<0.001) and a trend-level increase in diastolic blood pressure (P=0.06) were also detected in the baclofen group during the alcohol laboratory session. In conclusion, baclofen was shown to affect subjective and physiological responses to alcohol drinking in anxious alcohol-dependent individuals. These results do not support an anti-craving or anti-reinforcing effect of baclofen, but rather suggest that baclofen may act as a substitution medication for alcohol use disorder.
Objective-Behaviorally based therapies for the treatment of perpetrators who initiate intimate partner violence (IPV) have generally shown minimal therapeutic efficacy. To explore a new treatment approach for IPV, we examined the effects of a selective serotonin reuptake inhibitor on the irritability subscale score of the Modified Overt Aggression Scale. This score served as a surrogate marker for the anger and physical aggression that characterize perpetrators of IPV.Method-A 12-week, double-blind, randomized, placebo-controlled intervention study employing fluoxetine, alcohol treatment, and cognitive-behavioral therapy was performed. Sixty (46 men) non-court-mandated, DSM-IV-diagnosed alcoholic perpetrators of IPV with a history of at least 2 episodes of IPV in the year prior to participation in the study were evaluated. The primary outcome measure was the score on the irritability subscale of the Modified Overt Aggression Scale. Secondary measures included anxiety, depression, and ratings by the perpetrator's spouse/significant other. The study was conducted from January 2002 through December 2007.Results-A repeated-measures analysis of variance using the irritability subscale scores obtained from perpetrators who completed the 12-week study (n = 24) showed a significant drug effect (F 1,21 = 12.09, P = .002). Last observation carried forward (F 1,32 = 4.24, P = .048) as well as intent-to-treat analysis (F 1,54 = 5.0, P = .034) also showed a significant drug effect. Spouses'/ significant others' physical and nonphysical Partner Abuse Scale ratings showed a significant reduction of abuse over time (F 1,11 = 10.2, P = .009 and F 1,11 = 24.2, P = .0005, respectively).Conclusion-This is the first controlled study to show that a pharmacologic intervention employing a selective serotonin reuptake inhibitor, in conjunction with alcohol treatment and Publisher's Disclaimer: Disclaimer: The work was performed in accordance with the official duties as government employees, and, therefore, the contents of this manuscript are considered to be within public domain. Descriptive studies show that individuals with high trait anger are the most likely to exhibit alcohol-associated aggression. [8][9][10] Anger is an emotion that is associated with both verbal and physical aggression and is typically treated with behaviorally based initiatives. 16 could result in the perpetrators' heightened sensitivity to environmental stimuli and affect the neuro-connections between the cortex and the amygdala. NIH Public AccessIn this study, we examined a group of perpetrators of IPV with diagnosis of alcohol dependence, who demonstrated significant levels of physical aggression toward their significant others. The perpetrators were randomly assigned according to a double-blind, placebo-controlled design to receive either fluoxetine or placebo treatment. A selective serotonin reuptake inhibitor was chosen due to serotonin's ability to modulate the processing of environmental stimuli, 18,19 to increase orbital frontal cortex function...
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