A Proof-of-Concept Trial of N-Acetylcysteine for Adolescent Alcohol Use Disorder

摘要 青春期标志着酗酒问题发展的关键时期，约15%的人 符合酒精使用障碍(AUD)标准的18岁。治疗青少年AUD的努力只是 适度有效，高达86%的年轻人在治疗后12个月内重返使用。不足之处 青少年的治疗是一个重要的公共卫生问题，因为在这段时间里饮酒是非常重要的 预示着长期的酗酒问题。虽然一些药物在治疗成人AUD方面是有效的， 最低限度的药物治疗研究集中在青少年身上。评估替代方案和更有效的方案 对患有AUD的青少年进行治疗是必要的。拟议的第二阶段的主要目标是证明- 概念研究是评估N-乙酰半胱氨酸(NAC)与安慰剂在减少酒精方面的效果 用于寻求治疗的患有AUD的青少年(N=120)。鉴于NAC对成瘾行为的影响，通过 谷氨酸调节，作为非处方补充剂的可及性，青少年的安全性和耐受性， 这种药物价格低廉，有望成为青少年AUD的潜在治疗选择。在……里面 响应国家酒精滥用和酒精中毒研究所关于加快研究酒精滥用和酒精中毒的倡议 为了开发有效的药物治疗AUD，我们将(1)进行为期8周的意向治疗， NAC(2400 mg/d)的双盲、平行组、随机、安慰剂对照试验；(2)检查 在基线、整个治疗过程和治疗后对临床结果进行标准化的、重复的依赖测量 治疗跟踪；以及(3)使用移动技术来改进数据收集、参与度和用药 坚持不懈。确定一种耐受性良好的有效药物治疗将代表着 取得重大进展，并可能产生巨大的公共卫生影响。拟议的试验将提供关键数据 评估NAC作为青少年AUD的药物疗法，而不考虑NAC与安慰剂的结果 将为未来的药物治疗随机对照试验提供关键的方法学指导 青少年澳门氏症。

ABSTRACT Adolescence marks a key period in the development of problematic alcohol use, with approximately 15% of 18 year olds meeting criteria for alcohol use disorder (AUD). Efforts to treat adolescent AUD have been only modestly effective, with up to 86% of youth returning to use within 12 months following treatment. Inadequate treatment for adolescents is an important public health concern given that alcohol use during this time is highly predictive of long-term problematic drinking. While several medications are efficacious in treating adult AUD, minimal pharmacotherapy research has focused on adolescents. Evaluation of alternative and more efficacious treatments for adolescents with AUD is warranted. The primary objective of the proposed Phase II proof-of- concept study is to evaluate the effect of N-acetylcysteine ( NAC), compared to placebo, in reducing alcohol use among treatment-seeking adolescents with AUD (N=120). Given NAC’s effect on addictive behaviors via glutamate modulation, accessibility as an over-the-counter supplement, safety and tolerability with adolescents, and low cost, this medication holds great promise as a potential treatment option for adolescents with AUD. In response to the National Institute on Alcohol Abuse and Alcoholism’s initiative to accelerate research on the development of effective pharmacologic treatments for AUD, we will (1) conduct an 8-week, intent-to-treat, double-blind, parallel-group, randomized, placebo-controlled trial of NAC (2400 mg per day); (2) examine standardized, repeated dependent measures of clinical outcomes at baseline, throughout treatment, and at post- treatment follow-up; and (3) employ mobile technology to improve data collection, engagement, and medication adherence. The identification of a well-tolerated, effective pharmacological treatment would represent a significant advance and could yield tremendous public health impact. The proposed trial will provide critical data to evaluate NAC as a pharmacotherapy for adolescent AUD, and regardless of NAC versus placebo outcomes will provide key methodological guidance for future randomized controlled trials of pharmacotherapies for adolescent AUD.