N-Acetyl Cysteine plus Behavioral Therapy for Nicotine Dependent Pathological Gam

N-乙酰半胱氨酸联合行为疗法治疗尼古丁依赖性病理性游戏

• 批准号: 7822653
• 负责人: JON E GRANT
• 金额: $ 47.56万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7822653
• 关键词: Abstinence; Acetylcysteine; Acute; Addictive Behavior; Address; Adult; Affect; Aftercare; Amino Acids; Area; Awareness; Bankruptcy; Behavior; Behavior Therapy; Behavioral; Cessation Research; Clinical; Cocaine Dependence; Cognitive; Communities; Country; Cysteine; DSM-IV; Data; Decision Making; Disease; Emotional; Family; Gambling; General Population; Glutamates; Grant; Hour; Imprisonment; Individual; Intervention; Mediating; Mental disorders; Modeling; Morbidity - disease rate; Nicotine; Nicotine Dependence; Nucleus Accumbens; Occupations; Pathological Gambling; Persons; Phase; Placebos; Population; Prevention; Prodrugs; Public Health; Punishment; Randomized; Relapse; Reporting; Research; Rewards; Sampling; Secondary to; Severities; Site; Smoke; Smoking; Societies; Substance Use Disorder; Symptoms; Task Performances; Techniques; Testing; Time; Tobacco; Tobacco smoking; Tobacco use; Treatment Efficacy; Treatment outcome; Withholding Treatment; addiction; brief intervention; burden of illness; cigarette smoking; cognitive control; cost; dependence relapse; desensitization; dietary supplements; evidence base; experience; follow-up; improved; motivational enhancement therapy; placebo controlled study; preclinical study; randomized placebo controlled trial; response; satisfaction; smoking cessation; standard of care

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (01) Behavior, Behavioral Change and Prevention and specific Challenge Topic, 01-DA-110: Identify and/or evaluate dietary supplements that could be used in treating substance use disorders. Among US adults, 12.8% report nicotine dependence, and nicotine dependence is highly associated with a variety of DSM-IV Axis I and II disorders. Pathological gambling (PG), a serious public health problem with detrimental effects on individuals and families, and with an estimated yearly cost to society of 5 billion dollars due to lost jobs, debt, bankruptcy, and incarcerations, is associated with elevated proportions of nicotine dependence (41% - 55%), and tobacco smoking in clinical samples of pathological gamblers has been associated with increased gambling severity and more frequent psychiatric problems. In addition, research suggests that continued nicotine use is associated with greater rates of relapse among pathological gamblers who received behavioral therapy. Despite increased awareness of the relationship between nicotine dependence and PG, and the possible effects of nicotine dependence on gambling severity, no previous research has focused on how assessment and treatment of nicotine dependence may aid in the successful treatment of PG or smoking cessation. Preliminary research suggests that behavioral therapy using imaginal desensitization and motivational interviewing (IDMI) has shown promise in reducing the symptoms of PG. Despite the efficacy of treatments for PG and nicotine dependence, relapse is common among individuals with nicotine dependence and PG. Preclinical studies have suggested that levels of glutamate within the nucleus accumbens mediate reward-seeking behavior and may underlie relapse seen in addictions. N-acetyl cysteine, a dietary supplement, amino acid and cysteine pro-drug, appears to modulate glutamate within the nucleus accumbens and has shown benefit in reducing the reward-seeking behavior in individuals with cocaine dependence and in pathological gamblers. If successful in treating nicotine dependent pathological gamblers, N-acetyl cysteine may serve as a viable, low-cost, and easily available treatment option for nicotine dependent pathological gamblers who receive behavioral therapy. We therefore propose to examine how a dietary supplement, N-acetyl cysteine, used in combination with behavioral therapy will affect both the urge to smoke and gamble in nicotine dependent pathological gamblers and smoking and gambling behaviors. We therefore propose a randomized placebo-controlled trial of N-acetyl cysteine or placebo with 80 nicotine dependent pathological gamblers who will all receive brief standardized smoking cessation treatment (Ask, Advise, and Refer model) for nicotine cessation and 6 sessions of IDMI for PG. We hypothesize that N-acetyl cysteine plus behavioral therapy will result in greater reduction in both nicotine dependence and PG symptoms during the acute treatment phase and will enhance greater long-term abstinence. Our research will contribute to an improved understanding of the treatment of nicotine-dependent pathological gamblers as well as a greater understanding of the treatment of co-occurring addictions. If our intervention is successful, it will have the potential to set a new standard of care for a range of psychiatric disorders that co-occur with nicotine dependence. RC1 Grant Relevance Statement Nicotine dependence and pathological gambling are experienced by a broad range of individuals in multiple communities throughout the country and are associated with substantial societal costs. This study proposes to examine how a dietary supplement, N-acetyl cysteine, used in combination with brief behavioral therapy will affect both smoking and gambling behaviors. Because the study will focus treatment in non-substance abuse treatment settings and thereby offer treatment to those who may not otherwise be helped, the interventions being tested have the potential to make a substantial public health impact.

描述（由申请人提供）：此申请解决广泛的挑战领域（01）行为，行为改变和预防和特定挑战主题，01-DA-110：识别和/或评估可用于治疗药物使用障碍的饮食补充剂。在美国成年人中，有12.8％的人报告尼古丁依赖性，尼古丁依赖性与多种DSM-IV轴I和II疾病高度相关。病理赌博（PG），这是一个严重的公共卫生问题，对个人和家庭有害影响，并且估计每年的成本是由于失业，债务，破产和监禁而导致的50亿美元成本与尼古丁依赖的比例升高有关（41％ - 55％），以及与临床范围内的较高的疾病相关的疾病范围（41％ - 55％），并且与临床范围相关的群体相关。此外，研究表明，持续的尼古丁使用与接受行为疗法的病理赌徒之间的复发率更高有关。尽管对尼古丁依赖性与PG之间关系的认识提高了，以及尼古丁依赖对赌博严重程度的可能影响，但以前的研究都没有集中于评估和治疗尼古丁依赖性如何有助于成功治疗PG或戒烟。初步研究表明，使用想象中的脱敏和动机访谈（IDMI）的行为疗法在减少PG症状方面表现出了希望。尽管治疗对PG和尼古丁依赖性具有功效，但在具有尼古丁依赖性和PG的个体中，复发还是常见的。临床前研究表明，伏隔核内的谷氨酸水平介导寻求奖励的行为，并可能是成瘾中看到的复发。 N-乙酰基半胱氨酸是一种饮食补充剂，氨基酸和半胱氨酸前药，似乎在伏伏核中调节谷氨酸，并在减少可卡因依赖性和病理赌徒的个体的奖励寻求行为方面显示出好处。如果成功治疗依赖尼古丁的病理赌徒，则N-乙酰半胱氨酸可以作为接受行为疗法的尼古丁病理赌徒的可行，低成本且易于获得的治疗选择。因此，我们建议研究与行为疗法结合使用的饮食补充剂N-乙酰半胱氨酸如何影响吸烟和赌博依赖尼古丁的病理赌徒的冲动，以及吸烟和赌博行为。因此，我们提出了N-乙酰半半胱氨酸或安慰剂的随机安慰剂对照试验，其中80种尼古丁依赖的病理赌徒将接受简短的标准化戒烟治疗（询问，建议和参考模型），以获取尼古丁戒烟，而PG的IDMI则6次。我们假设N-乙酰半胱氨酸加行为疗法将导致急性治疗阶段尼古丁依赖性和PG症状的降低，并提高长期的禁欲。我们的研究将有助于改善对尼古丁依赖性病理赌徒的治疗，以及对同时发生成瘾的治疗方法的更多了解。如果我们的干预成功，它将有可能为与尼古丁依赖性共同发生的一系列精神病疾病设定新的护理标准。 RC1赠款相关声明尼古丁的依赖和病理赌博是由全国多个社区中广泛的个人经历的，并且与大量的社会成本有关。这项研究建议研究与短暂行为疗法结合使用的饮食补充剂N-乙酰半胱氨酸如何影响吸烟和赌博行为。由于该研究将集中在非实质性滥用治疗环境中，从而为可能没有帮助的人提供治疗，因此所测试的干预措施有可能产生重大的公共卫生影响。