N-acetylcysteine in substance use disorder: a lesson from preclinical and clinical research

Abstract

Substance use disorder (SUD) is a chronic brain condition, with compulsive and uncontrollable drug-seeking that leads to long-lasting and harmful consequences. The factors contributing to the development of SUD, as well as its treatment settings, are not fully understood. Alterations in brain glutamate homeostasis in humans and animals implicate a key role of this neurotransmitter in SUD, while the modulation of glutamate transporters has been pointed as a new strategy to diminish the excitatory glutamatergic transmission observed after drugs of abuse. N-acetylcysteine (NAC), known as a safe mucolytic agent, is involved in the regulation of this system and may be taken into account as a novel pharmacotherapy for SUD. In this paper, we summarize the current knowledge on the ability of NAC to reduce drug-seeking behavior induced by psychostimulants, opioids, cannabinoids, nicotine, and alcohol in animals and humans. Preclinical studies showed a beneficial effect in animal models of SUD, while the clinical efficacy of NAC has not been fully established. In summary, NAC will be a small add-on to usual treatment and/or psychotherapy for SUD, however, further studies are required.

Keywords: Alcohol; Cannabinoid; N-acetylcysteine; Nicotine; Opioid; Psychostimulant.

Fig. 1

Mechanism of action and summary of N-acetylcysteine effects in preclinical and clinical studies. ∅ no changed, ↓ decreased, GLT-1 glutamate transporter 1, GSH glutathione, system x_c⁻ cystine/glutamate antiporter