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特定的挑战主题，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，尼古丁依赖与各种DSM-IV轴I和II疾病高度相关。病理性赌博（PG）是一个严重的公共卫生问题，对个人和家庭产生不利影响，估计每年因失业、债务、破产和监禁而给社会造成50亿美元的损失，与尼古丁依赖比例升高有关（41% - 55%），在病理性赌徒的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复发率较高有关。尽管越来越多的人认识到尼古丁依赖和PG之间的关系，以及尼古丁依赖对赌博严重程度的可能影响，但以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，行为疗法，使用想象脱敏和动机访谈（IDMI）已显示出承诺，在减少PG的症状。尽管治疗PG和尼古丁依赖的疗效，复发是常见的尼古丁依赖和PG的个人。临床前研究表明，谷氨酸的水平内核内的介导奖励寻求行为，并可能在成瘾复发的基础。N-乙酰半胱氨酸，一种膳食补充剂，氨基酸和半胱氨酸前药，似乎可以调节丘脑核内的谷氨酸，并在减少可卡因依赖个体和病理性赌徒的奖励寻求行为方面显示出益处。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疗法的尼古丁依赖性病理性赌徒的可行、低成本且容易获得的治疗选择。因此，我们建议研究如何膳食补充剂，N-乙酰半胱氨酸，与行为治疗相结合，将影响吸烟和赌博尼古丁依赖的病理赌徒和吸烟和赌博行为的冲动。因此，我们提出了一个随机安慰剂对照试验的N-乙酰半胱氨酸或安慰剂与80尼古丁依赖的病理赌徒谁都将接受简短的标准化戒烟治疗（询问，建议，和参考模型）用于尼古丁戒烟和6个疗程的IDMI用于PG。我们假设N-乙酰半胱氨酸加行为疗法将导致在急性治疗阶段尼古丁依赖和PG症状的更大减少，并将增强更大的长期-术语禁欲。我们的研究将有助于更好地理解尼古丁依赖性病理赌徒的治疗，以及更好地理解共同发生的成瘾的治疗。如果我们的干预是成功的，它将有可能为一系列与尼古丁依赖同时发生的精神疾病制定新的护理标准。尼古丁依赖和病理性赌博在全国多个社区的广泛人群中都有经历，并与巨大的社会成本有关。本研究旨在探讨膳食补充剂N-乙酰半胱氨酸与简短的行为治疗相结合如何影响吸烟和赌博行为。由于这项研究将侧重于非药物滥用治疗环境中的治疗，从而为那些否则可能得不到帮助的人提供治疗，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。