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）：本申请涉及广泛的挑战领域 (01) 行为、行为改变和预防以及具体的挑战主题 01-DA-110：识别和/或评估可用于治疗物质使用障碍的膳食补充剂。在美国成年人中，12.8% 的人报告尼古丁依赖，而尼古丁依赖与各种 DSM-IV Axis I 和 II 疾病高度相关。病态赌博 (PG) 是一种严重的公共卫生问题，对个人和家庭造成不利影响，由于失业、债务、破产和监禁，每年给社会造成的损失估计达 50 亿美元，与尼古丁含量升高有关依赖（41% - 55%），并且病态赌徒临床样本中吸烟与赌博严重程度增加和更频繁的精神问题有关。此外，研究表明，持续使用尼古丁与接受行为治疗的病态赌徒的复发率较高有关。尽管人们越来越认识到尼古丁依赖与 PG 之间的关系，以及尼古丁依赖对赌博严重程度可能产生的影响，但之前没有研究关注尼古丁依赖的评估和治疗如何有助于成功治疗 PG 或戒烟。初步研究表明，使用想象脱敏和动机访谈 (IDMI) 的行为疗法在减轻 PG 症状方面显示出希望。尽管对 PG 和尼古丁依赖的治疗有效，但在患有尼古丁依赖和 PG 的个体中，复发很常见。临床前研究表明，伏核内的谷氨酸水平介导寻求奖励的行为，并可能是成瘾复发的基础。 N-乙酰半胱氨酸是一种膳食补充剂、氨基酸和半胱氨酸前药，似乎可以调节伏核内的谷氨酸，并显示出有助于减少可卡因依赖者和病态赌徒的寻求奖励行为。如果成功治疗尼古丁依赖性病理性赌徒，N-乙酰半胱氨酸可能成为接受行为治疗的尼古丁依赖性病理性赌徒的可行、低成本且易于获得的治疗选择。因此，我们建议研究膳食补充剂 N-乙酰半胱氨酸与行为疗法结合使用如何影响尼古丁依赖的病态赌徒的吸烟和赌博冲动以及吸烟和赌博行为。因此，我们建议对 80 名尼古丁依赖病理性赌徒进行 N-乙酰半胱氨酸或安慰剂的随机安慰剂对照试验，这些赌徒都将接受简短的标准化戒烟治疗（询问、建议和参考模型）以戒烟，并接受 6 次 IDMI 治疗 PG 。我们假设 N-乙酰半胱氨酸加行为疗法将在急性治疗阶段更大程度地减少尼古丁依赖和 PG 症状，并增强长期戒烟效果。我们的研究将有助于更好地了解尼古丁依赖的病理性赌徒的治疗以及同时发生的成瘾的治疗。如果我们的干预成功，将有可能为与尼古丁依赖同时发生的一系列精神疾病制定新的护理标准。 RC1 拨款相关性声明 全国多个社区的许多人都经历过尼古丁依赖和病态赌博，并与巨大的社会成本相关。本研究旨在研究膳食补充剂 N-乙酰半胱氨酸与短暂行为疗法结合使用将如何影响吸烟和赌博行为。由于该研究将重点关注非药物滥用治疗环境中的治疗，从而为那些可能无法获得帮助的人提供治疗，因此正在测试的干预措施有可能对公共卫生产生重大影响。