S07-2DOCUMENTED EXPERIENCE WITH DIHYDROCODEINE, BUPRENORPHINE, BACLOFEN AND CLOMETHIAZOLE IN THE TREATMENT OF ALCOHOL DEPENDENCE

Abstract

For a relevant number of alcohol dependents, an only psychosocial treatment without medication is virtually like effectively no treatment at all. The effects of mainly antagonistic substances like Acamprosate, Naltrexone, Nalmefene and even Disulfiram remain marginal. None of these could reach real historic importance like Methadone in the treatment of Opioid addicts. We could almost never develop a sustained perspective of a clearly better life, or even healing, with any of these substances. The results with agonistic substances are much better. Italian studies with GHB as well as our experience with opioids, the GABAergic Clomethiazole and Baclofen give us quite a different impression. We can adjust the disease like most other chronic diseases e.g. diabetes and are able to develop long term perspectives of a clearly better life and even healing in many more patients. As practitioners, we cannot perform real clinical studies. But because of the lack of such studies, the extreme misery and desperation of the patients force us to try largely unproven medication. We have done this very carefully with a systematic documentation for decades. We mainly prescribed Dihydrocodeine as opioid, in singular cases also Buprenorphine. Both, and in one single case slow release oral Morphine, were successful on quite a new level. Colleagues, who prescribe Diamorphine, give similar reports. Clomethiazole was inexpertly marketed for a long time. Its standing is, therefore, a lot worse than our systematic experience, and it's not available in all countries. But it's an essential drug, if we prescribe it with due diligence. Baclofen is successful less frequently. Treatment fails more often because of side effects. Its great advantages are 1. No induction of an own addiction and 2. Its possible application for a tapering alcohol dose without preceding withdrawal. The more we know the substances, the more we can prescribe and combine them individually, partly with different indications. All of these substances signify the entry into a really effective, pharmacological treatment of alcohol dependence. If we prescribe them in a specialized clinic or practice we get the impression that there is no further development of any clearly better treatment possibility without this new onset based on agonistic substances.