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The treatment of alcohol dependence is essential as it has a great impact on mortality (about 6% of deaths worldwide), morbidity and the number of affected people (>200,000 in Belgium). Today, drug therapy has limited efficiency. Therefore, Dr. Ameisen considered usage of baclofen, a drug used to treat spasticity. With the drug, he managed to stay abstinent. Through the development of neurobiology, it was demonstrated that the dependencies' central mechanism consists in the release of dopamine in the reward system. Baclofen not only reduces that release but is likely to have a positive effect on craving and anxiety which can lead to alcohol relapse. In Bel giu m, baclofen is still used off­ label in alcohol dependence situations at a clinical level. As of March 2014, France delivers a temporary use recommendation to reduce consumption and maintain abstinence under certain conditions. Generally speaking, studies show encouraging results. Step-by-step increases in doses seem to be more efficient for an increasing number of patients. Some doses can be up to ten times higher than the recommended doses for spasticity. Despite those doses, safety and tolerance seem to be initially guaranteed. There are possible non typical side effects but they are difficult to foresee. For now, baclofen is on its way to be indicated in alcohol dependence situations. However, such future indication is only determined by the release of multiple randomized tests controlled with big samples. L'alcoolodépendance est essentielle à traiter vu ses conséquences en terme de mortalité (-6% des décès mondiaux) et de morbidités. Le nombre de personnes atteintes en Belgique dépasseraient 200 000 patients. A l 'heure actuelle, la thérapie méd icamenteuse n 'a qu'une efficacité modérée. C'est dans ce contexte que l'usage du baclofène, un médicament utilisé pour les états spastiques, a été exploité par le Dr A meisen. Grâce à ce médicament, il a réussi à maintenir son abstinence. Avec le développement de la neurobiologie, il a été montré que le mécanisme central des dépendances est une libération de dopamine dans le système de la récompense cérébrale. Le baclofène permet de diminuer cette libération. Il présenterait aussi une action positive sur le craving et l 'anxiété qui sont des facteurs de rechutes dans la consommation. Au ni veau clinique, le baclofène reste toujours en usage hors­ indication pour l'alcoolodépendance en Belgique. Depuis mars 2014, la France octroie une recommand ation temporaire d'usage pour la réduction de consommation et le maintien de l 'abstinence sous certaines cond itions. De manière générale, les études montrent des résultats encourageants. L'augmentation par paliers de doses montre une efficacité parmi un plus grand nombre de patients. Certaines doses peuvent atteindre dix fois celles recommandées pour la spasticité. Dan s un premier temps, l'innocuité et la tolérance semblent acceptables mais l'apparition d'effets secondaires atypiques est connue et difficilement prévisible. A l'heure actuelle, l'avenir du baclofène dans l'alcoolodépendance semble prometteur. Néanmoins, seule la publication de plusieurs essais randomisés contrôlés avec grand échantillon, comme les études Alpadir et Bacloville, pourra être déterminante pour une future indication.

Weaning --- Alcohol Abstinence --- Baclofen

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Baclofen --- Alcoholism --- Alcohol Withdrawal Seizures --- Weaning

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