Remarks y The term “alcohol dependence” refers to diagnosis according to The ICD-10 classification of mental and behavioural disorders (26) or the Diagnostic and statistical manual of mental disorders (27), 4th edition (DSM-IV) criteria or equivalent ICD-11 (28) and DSM-5 diagnosis (29). y Post-detoxification refers to completion of the management of withdrawal symptoms at least three days before starting treatment. Most included studies required participants to abstain from alcohol for at least three days (3–28) before beginning the pharmacological treatment. y Service providers should include appropriate psychosocial interventions in their treatment plan and should only consider medication alone for adults with alcohol dependence when psychosocial interventions are not available.

Implementation considerations y Baclofen is available in a generic form and is inexpensive but may not be available in all countries and is not registered for the treatment of alcohol dependence. The lack of formal approval for baclofen’s use for alcohol dependence places increased responsibility on the medical practitioner prescribing baclofen to inform people of the risks and benefits of its use for alcohol dependence. y Even though differences were not identified when compared with placebo, baclofen can have side-effects such as sedation, and cessation of baclofen treatment can be associated with a mild benzodiazepine-like withdrawal syndrome. Therefore, baclofen should be reduced gradually rather than stopped abruptly with service providers monitoring for these side-effects.