A randomized, placebo-controlled trial of N-acetylcysteine plus imaginal desensitization for nicotine-dependent pathological gamblers

• Published in: The journal of clinical psychiatry Vol. 75; no. 1; p. 39
• Main Authors: Grant, Jon E, Odlaug, Brian L, Chamberlain, Samuel R, Potenza, Marc N, Schreiber, Liana R N, Donahue, Christopher B, Kim, Suck Won
• Format: Journal Article
• Language: English
• Published: United States 01.01.2014
• Subjects: Acetylcysteine - therapeutic use; Adolescent; Adult; Aged; Combined Modality Therapy; Comorbidity; Desensitization, Psychologic - methods; Double-Blind Method; Expectorants - therapeutic use; Female; Follow-Up Studies; Gambling - drug therapy; Gambling - therapy; Humans; Imagination - physiology; Male; Middle Aged; Psychiatric Status Rating Scales; Severity of Illness Index; Tobacco Use Disorder - drug therapy; Tobacco Use Disorder - therapy; Treatment Outcome; Young Adult
• ISSN: 1555-2101
• DOI: 10.4088/JCP.13m08411

Pathological gambling is associated with elevated proportions of nicotine dependence, and tobacco smoking in pathological gamblers has been associated with increased problem-gambling severity. This study examined the addition of N-acetylcysteine to imaginal desensitization in adults with co-occurring nicotine dependence and pathological gambling. Twenty-eight individuals with co-occurring DSM-IV nicotine dependence and pathological gambling who were receiving behavioral therapy were recruited from December 2009 to February 2012 and randomized to augmentation with N-acetylcysteine or placebo in an 12-week, double-blind trial. Subjects were assessed with measures of nicotine and gambling severity and followed for 3 months after treatment. The primary outcomes were the Fagerström Test for Nicotine Dependence and the pathological gambling adaptation of the Yale-Brown Obsessive-Compulsive Scale. During the first 6 weeks, there was a significant benefit of N-acetylcysteine treatment versus placebo on Fagerström Test for Nicotine Dependence total scores (t = -2.224; P = .031). After the initial 6 weeks, all subjects significantly (P < .001) benefited from imaginal desensitization. During the 3-month follow-up, there was a significant additional benefit for N-acetylcysteine versus placebo on measures of problem-gambling severity (t = 2.069; P = .043). N-acetylcysteine treatment during therapy facilitates long-term application of behavioral therapy techniques once patients are in the community after therapy has been completed. ClinicalTrials.gov identifier: NCT00967005.