Abstract
Rationale
Baclofen has been shown to effect fMRI alcohol cue reactivity in alcohol dependence, but potential varying effects related to baclofen dose levels have not been examined.
Objective
This study investigated whether baclofen attenuates craving and alcohol cue–elicited activation in alcohol-dependent treatment seekers, and the relationship between this response and clinical outcomes (Morley et al. 2018; Morley et al. 2013).
Methods
Participants included 30 alcohol-dependent individuals who had received daily baclofen 30 mg (n = 11), 75 mg (n = 8) or placebo (n = 11) for at least 2 weeks. Using functional magnetic resonance imaging (fMRI), we examined alcohol cue–elicited neural activation during a visual alcohol cue reactivity task 120 min following treatment administration, and alcohol cue reactivity and percentage of heavy drinking days (% HDD) associations were assessed.
Results
Both baclofen-treated groups reported fewer post-scan % HDD when compared to the placebo-treated group, but no subjective craving group differences were found. Increased alcohol cue–elicited activation was seen in placebo compared to the 75 mg/day baclofen participants in two clusters spanning prefrontal regions implicated in cue reactivity, chiefly frontal regions (i.e., frontal and precentral gyri, anterior cingulate cortex), but no observed alcohol cue reactivity differences between placebo and 30 mg/day baclofen groups. Post-scan % HDD was positively correlated with increased alcohol cue–elicited activation in a cluster encompassing the bilateral caudate nucleus and dorsal anterior cingulate cortex when comparing placebo versus 75 mg/day baclofen groups, and several clusters including prefrontal and mesolimbic regions when comparing placebo versus 30 mg/day baclofen groups.
Conclusions
Baclofen administration attenuates alcohol cue–elicited activation and reduced the association in baclofen-treated participants between increased activity in key drug cue reactivity regions and higher post-scan % HDD observed in placebo-treated participants, suggesting a dose-specific response effect that may lead to reduced heavy drinking in chronic alcohol-dependent individuals.
Trial registration
ClinicalTrials.gov, NCT01711125, https://clinicaltrials.gov/ct2/show/NCT01711125
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Acknowledgements
We would like to thank Dr. Anne Beck and Prof Andreas Heinz for kindly supplying us with the alcohol images for the cue reactivity task.
Funding
This study was supported by a grant from the National Health and Medical Research Council of Australia (P.S.H., A.J.B., K.C.M.).
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The study was approved by the Human Ethics Review Committee of the Sydney Local Health District (X11-0154). The study involved off-label use of a registered medication in Australia and approval was given under the Clinical Trial Notification (CTN) scheme of the Therapeutics Goods Administration (TGA) (2013/0060). All participants included in this MRI substudy provided written informed consent after commencement of randomisation for the main trial.
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The authors declare that they have no conflict of interest.
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Logge, W.B., Morris, R.W., Baillie, A.J. et al. Baclofen attenuates fMRI alcohol cue reactivity in treatment-seeking alcohol dependent individuals. Psychopharmacology 238, 1291–1302 (2021). https://doi.org/10.1007/s00213-019-05192-5
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DOI: https://doi.org/10.1007/s00213-019-05192-5