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N-acetylcysteine (NAC) at 1200-2400 milligrams per day with or without food helped those who had quit cocaine stay away from trying it again and reduced the craving. Side effects were mainly gastrointestinal, GERD-like symptoms, especially at higher doses and on an empty stomach.
NAC is the treatment for acetaminophen overdose and as an agent that breaks up mucous in chronic lung disorders.
Addictive substances (foods and drugs) in general lead to increased dopamine and glutamate levels in the brain. NAC restores balance to glutamate transmission. NAC increases cystine which displaces glutamate in brain cells, bringing back glutamate balance, and reducing cravings and impulsivity.
NAC might also useful for marijuana dependence, people with compulsive disorders in general such as gambling, trichotillomania (hair pulling), PTSD and depression. NAC’s potential use is not getting people off an addictive substance, but once they have made the effort to get off, it may help them stay off by reducing the desire for compulsively trying the addictive substance again. People must make the attempt to stop their compulsive behavior. NAC is probably best thought of as something that helps prevent relapse by decreasing the power of compulsive thinking and urges (like cravings), and NAC works best if the person has started taking steps towards quitting.
Steven D. LaRowe, PhD, Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Center for Drug and Alcohol Programs Charleston, SC 29425, 843-324-4264 / 843-572-1931(FAX), larowe@musc.edu
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