Evidence supporting the use of: N-acetyl-cysteine (NAC)
For the health condition: Addictions (general remedies for)

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Synopsis

Source of validity: Scientific
Rating (out of 5): 3

N-acetyl-cysteine (NAC) is supported by emerging scientific evidence for use as an adjunct treatment in various addictions, including cocaine, cannabis, nicotine, and gambling disorders. NAC is a precursor to the antioxidant glutathione and modulates glutamatergic neurotransmission, which is believed to be dysregulated in substance use disorders. Several clinical trials and meta-analyses have investigated NAC's efficacy. For example, randomized controlled trials have shown that NAC can reduce craving and use in cannabis-dependent adolescents and may help reduce cocaine use and craving. Some studies on nicotine dependence have yielded mixed results, but there is evidence for reduced cigarette consumption and craving in some participants. The mechanism is thought to involve restoration of glutamate homeostasis in the nucleus accumbens, a key brain region involved in addiction pathways. However, the quality and size of studies are variable, with some trials showing modest or no benefit. Meta-analyses typically conclude that NAC is safe and well-tolerated, with a small-to-moderate effect size for reducing cravings and relapse in certain populations, particularly for stimulant and cannabis addiction. Because of this, NAC is not considered a first-line treatment but is sometimes used as an adjunct to standard therapies. As of 2024, more large-scale, high-quality studies are needed to establish NAC's role definitively in addiction treatment. Nonetheless, its use is based on scientific, not traditional, grounds.

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