Effect of N-acetylcysteine on Neural Alcohol Cue Reactivity and Craving in Adolescents Who Drink Heavily: A Preliminary Randomized Clinical Trial

Overview

Journal Alcohol Clin Exp Res (Hoboken)

Specialty Psychiatry

Date 2024 Jul 3

PMID 38960894

Authors

ReJoyce Green

Anna E Kirkland

Brittney D Browning

Pamela L Ferguson

Kevin M Gray

Lindsay M Squeglia

Affiliations

Soon will be listed here.

Abstract

Background: Alcohol craving is related to problematic alcohol use; therefore, pharmacotherapies that modulate alcohol craving are of interest. N-acetylcysteine, an over-the-counter antioxidant, is a candidate pharmacotherapy for adolescent alcohol use with the potential to impact craving. Cue-reactivity paradigms using functional magnetic resonance imaging (fMRI) can identify neural regions implicated in craving and serve as a screening tool for novel pharmacotherapy options.

Methods: This preliminary study examined the effect of N-acetylcysteine on neural reactivity to alcohol cues and subjective craving among 31 non-treatment-seeking adolescents (17.6-19.9 years old, 55% female) who use alcohol heavily. In a randomized cross-over design, participants completed three fMRI sessions: baseline and after a 10-day course of N-acetylcysteine (1200 mg twice daily) and matched placebo. The primary outcome was neural response to alcohol versus non-alcohol beverage cues after N-acetylcysteine versus placebo, with a secondary outcome of self-reported subjective craving.

Results: In the full sample (n = 31), there was no effect of N-acetylcysteine versus placebo on neural alcohol reactivity (ps ≥ 0.49; s = 0.00-0.07) or self-reported acute alcohol craving (p = 0.18, = 0.06). However, N-acetylcysteine did reduce self-reported generalized alcohol craving (p = 0.03, = 0.15). In a subsample of youth who met criteria for past-year alcohol use disorder (n = 19), results remained unchanged.

Conclusions: N-acetylcysteine may not alter neural reactivity to alcohol cues or acute craving; however, it may reduce general subjective alcohol craving among adolescents who consume alcohol heavily.

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