N-Acetyl Cysteine Plus Behavioral Therapy for Nicotine Dependent Pathological Gamblers
Condition: Gambling; Tobacco Use Disorder
MeSH terms: Tobacco Use Disorder; Gambling
Study type: Interventional
Phase: Phase 2

Summary: 
      The objective of this application is to examine whether, given its mechanism of action, the
      dietary supplement, N-acetyl cysteine (NAC) will reduce both tobacco use and pathological
      gamblers (PG) symptoms in nicotine dependent pathological gamblers.
    

Detailed description: 
      Among US adults, 12.8% report nicotine dependence, and nicotine dependence is highly
      associated with a variety of DSM-IV Axis I and II disorders (Grant BF et al., 2004).
      Pathological gambling (PG), a serious public health problem with detrimental effects on
      individuals and families, and with an estimated yearly cost to society of 5 billion dollars
      due to lost jobs, debt, bankruptcy, and incarcerations, is associated with elevated
      proportions of nicotine dependence (41% - 55%), and tobacco smoking in clinical samples of
      pathological gamblers has been associated with increased gambling severity and more frequent
      psychiatric problems (Smart & Ferris, 1996; Crockfod & El-Guebaly, 1998; Shaffer et al.,
      1999; Petry & Oncken, 2002; Potenza et al., 2004; Grant et al., 2005; Falk et al., 2006;
      Fagan et al., 2007). In addition, research suggests that continued nicotine use is associated
      with greater rates of relapse among pathological gamblers who received behavioral therapy.
      Despite increased awareness of the relationship between nicotine dependence and PG, and the
      possible effects of nicotine dependence on gambling severity, no previous research has
      focused on how assessment and treatment of nicotine dependence may aid in the successful
      treatment of PG or smoking cessation. Preliminary research suggests that behavioral therapy
      using imaginal desensitization and motivational interviewing (IDMI) has shown promise in
      reducing the symptoms of PG (Grant et al., in press). Despite the efficacy of treatments for
      PG and nicotine dependence, relapse is common among individuals with nicotine dependence and
      PG. Preclinical studies have suggested that levels of glutamate within the nucleus accumbens
      mediate reward-seeking behavior and may underlie relapse seen in addictions. N-acetyl
      cysteine, a dietary supplement, amino acid and cysteine pro-drug, appears to modulate
      glutamate within the nucleus accumbens and has shown benefit in reducing the reward-seeking
      behavior in individuals with cocaine dependence and in pathological gamblers (Baker et al.,
      2003; LaRowe et al., 2006; Grant et al., 2006). If successful in treating nicotine dependent
      pathological gamblers, N-acetyl cysteine may serve as a viable, low-cost, and easily
      available treatment option for nicotine dependent pathological gamblers who receive
      behavioral therapy.

      We therefore propose to examine how a dietary supplement, N-acetyl cysteine, used in
      combination with behavioral therapy, will affect both the urge to smoke and gamble in
      nicotine dependent pathological gamblers and smoking and gambling behaviors. We therefore
      propose a randomized placebo-controlled trial of N-acetyl cysteine or placebo with 80
      nicotine dependent pathological gamblers who will all receive brief standardized smoking
      cessation treatment (Ask, Advise, and Refer model) for nicotine cessation and 6 sessions of
      IDMI for PG. We hypothesize that N-acetyl cysteine plus behavioral therapy will result in
      greater reduction in both nicotine dependence and PG symptoms during the acute treatment
      phase and will enhance greater long-term abstinence. Our research will contribute to an
      improved understanding of the treatment of nicotine-dependent pathological gamblers as well
      as a greater understanding of the treatment of co-occurring addictions. If our intervention
      is successful, it will have the potential to set a new standard of care for a range of
      psychiatric disorders that co-occur with nicotine dependence.
    

Intervention name(s): N Acetyl Cysteine; Sugar Pill
Intervention type(s): Drug; Other
Intervention description(s): N-Acetyl Cysteine, 1200mg-3000mg each day for 24-weeks; placebo control
Other intervention name(s): N-acetylcysteine, Acetylcysteine, NAC
Intervention MeSH terms: Acetylcysteine; N-monoacetylcystine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: N acetyl cysteine; Pathological gambling; Nicotine dependence