Evidence supporting the use of: L-Acetyl n-Cysteine
For the health condition: Addictions (drugs)

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Synopsis

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

N-acetylcysteine (NAC) has been investigated as a potential adjunctive treatment for various substance use disorders, including cocaine, cannabis, nicotine, and alcohol use disorders. Its primary mechanism of action is thought to involve the restoration of extracellular glutamate levels in the nucleus accumbens by modulating the cystine-glutamate antiporter. This helps normalize the dysregulated glutamatergic signaling associated with drug addiction and craving.

Clinical trials and meta-analyses have yielded mixed but generally promising results. For cannabis use disorder, several randomized controlled trials (RCTs) have shown some benefit in reducing use and cravings, particularly in adolescents and young adults. Studies in cocaine and nicotine addiction also suggest possible reductions in cravings and relapse risk, but findings are less consistent. For alcohol use disorder, results are inconclusive. Overall, NAC is considered safe and well-tolerated, with few side effects.

Major guidelines do not currently endorse NAC as a first-line therapy for addiction, but research is ongoing. The evidence base is not yet robust enough to warrant widespread recommendation, but the mechanistic rationale and early clinical data justify further investigation. Thus, the use of N-acetylcysteine in supporting addiction treatment has a scientific basis, though the strength of evidence is moderate (3/5).

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