title: A randomized, placebo-controlled trial of N-acetylcysteine plus imaginal desensitization for nicotine-dependent pathological gamblers.
abstract: 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.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00967005.
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 South Maryland Ave, MC 3077, Chicago, IL 60637 jongrant@uchicago.edu.
authors.forename: Jon E
authors.initials: JE
authors.lastname: Grant
authors.forename: Brian L
authors.initials: BL
authors.lastname: Odlaug
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Chamberlain
authors.forename: Marc N
authors.initials: MN
authors.lastname: Potenza
authors.forename: Liana R N
authors.initials: LR
authors.lastname: Schreiber
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Donahue
authors.forename: Suck Won
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D015897:Comorbidity; D003887:Desensitization, Psychologic / Q000379:methods*; D004311:Double-Blind Method; D005100:Expectorants / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005715:Gambling / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D007092:Imagination / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D014029:Tobacco Use Disorder / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005100:Expectorants; D000111:Acetylcysteine