There's a fair bit of clinical nuance and context that one needs to consider here. Whilst Naltrexone has emerged as the go-to drug in AUD with ALD and compensated cirrhosis, it can produce a non-specific dysphoric affect. Those with co-existing major depressive disorder may not be the right candidates for Naltrexone. Baclofen does take care of the co-existing anxiety symptoms. AUD has co-existing mood, psychotic, behavioural and cognitive symptoms that mandate a thorough mental state examination. Without addressing these, the treatment outcomes will not be optimal. I extensively use naltrexone in my practice. Baclofen is a strict no in those with decompensated cirrhosis given the risks for hepatic encephalopathy. My hunch is that the GABAergic effects and constipation produced by baclofen complicate the pre-existing altered mental state in decompensated cirrhosis. Lactulose should be literally dosed in such individuals.