Rachel L. Tomko, PhD Research Assistant Professor Department of Psychiatry and Behavioral Sciences
Jennifer L. Jones, MD Resident Physician Departments of Psychiatry and Behavioral Sciences and Internal Medicine
Amanda K. Gilmore, PhD Research Assistant Professor College of Nursing and Department of Psychiatry and Behavioral Sciences
Kathleen T. Brady, MD, PhD Distinguished University Professor Department of Psychiatry and Behavioral Sciences
Sudie E. Back, PhD Professor Department of Psychiatry and Behavioral Sciences
Kevin M. Gray, MD Professor Department of Psychiatry and Behavioral Sciences
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Medical University of South Carolina Charleston, South Carolina
Disclosures The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products. This article was supported by National Institutes of Health grants from the National Institute of Drug Abuse (R25 DA020537, R01 DA042114, R01 DA038700, R01 DA026777, K23 DA042935, K02 DA039229, UG1 DA013727) and the National Institute on Alcohol Abuse and Alcoholism (T32 AA007474, R01 AA025086) and the Department of Defense (W81XWH-13-2-0075 9261sc).
Initial evidence suggests NAC may be helpful for treating patients with SUDs. A patient seeking SUD treatment who is treated with NAC may experience a decreased drive, craving, or compulsion to use. Notably, NAC may be particularly useful in preventing relapse after an individual has achieved abstinence. Evidence suggests that NAC may be useful in the treatment of adults with cocaine use disorders who have achieved abstinence, and adolescents with cannabis use disorders. Preliminary results for adult tobacco use disorder are also promising. Human data examining the efficacy of NAC for alcohol use disorder is limited. Researchers’ ongoing challenge is to identify which patients with which SUDs are most likely to benefit from NAC, and to create clear clinical guidelines for the provider.
Bottom Line
N-acetylcysteine is likely to have modest effects for some patients who have a substance use disorder, particularly adults who use cocaine and adolescents who use marijuana. It may be useful in preventing relapse to substance use after an individual has achieved abstinence.
