A Randomized, Placebo-Controlled Trial of N-Acetylcysteine Plus Imaginal Desensitization for Nicotine-Dependent Pathological Gamblers

Objective: Pathological gambling is associated with elevated proportions of nicotine dependence, and tobacco smoking in pathological gamblers has been associated with increased problem-gambling severity. This study examined the addition of N-acetylcysteine to imaginal desensitization in adults with co-occurring nicotine dependence and pathological gambling.

Method: Twenty-eight individuals with co-occurring DSM-IV nicotine dependence and pathological gambling who were receiving behavioral therapy were recruited from December 2009 to February 2012 and randomized to augmentation with N-acetylcysteine or placebo in an 12-week, double-blind trial. Subjects were assessed with measures of nicotine and gambling severity and followed for 3 months after treatment. The primary outcomes were the Fagerström Test for Nicotine Dependence and the pathological gambling adaptation of the Yale-Brown Obsessive-Compulsive Scale.

Results: During the first 6 weeks, there was a significant benefit of N-acetylcysteine treatment versus placebo on Fagerström Test for Nicotine Dependence total scores (t = −2.224; P = .031). After the initial 6 weeks, all subjects significantly (P < .001) benefited from imaginal desensitization. During the 3-month follow-up, there was a significant additional benefit for N-acetylcysteine versus placebo on measures of problem-gambling severity (t = 2.069; P = .043).

Conclusions: N-acetylcysteine treatment during therapy facilitates long-term application of behavioral therapy techniques once patients are in the community after therapy has been completed.

Trial Registration: ClinicalTrials.gov identifier: NCT00967005

J Clin Psychiatry

© Copyright 2013 Physicians Postgraduate Press, Inc.

Submitted: February 6, 2013; accepted May 21, 2013.

Online ahead of print: November 26, 2013 (doi:10.4088/JCP.13m08411).

Corresponding author: Jon E. Grant, JD, MD, MPH, Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 South Maryland Ave, MC 3077, Chicago, IL 60637 (jongrant@uchicago.edu).