Recovery Michigan

N-acetylcysteine, when combined with group cognitive behavioral therapy (CBT), reduced symptoms of posttraumatic stress disorder (PTSD), cravings, and depression significantly more than CBT alone in veterans with co-occurring PTSD and substance use disorder, a particularly difficult-to-treat population, according to the findings of a randomized controlled pilot trial conducted by researchers at the Medical University of South Carolina (MUSC) and the Ralph H. Johnson VA Medical Center.

This trial is the first to use NAC as a pharmacotherapy for PTSD and a broad range of SUDs. The results were published online ahead of print on October 11, 2016 by the Journal of Clinical Psychiatry.

Veterans in the NAC-treated group showed a 46% reduction in PTSD symptoms, compared with a 25% reduction in the placebo group on the Clinical-Administered PTSD Scale (CAPS), which assesses trauma history and symptom severity. The threshold CAPS score for diagnosis of PTSD is 50.

Craving and depression were also reduced in the NAC-treated group. The amount of craving was reduced by 81% and the frequency of craving by 71% in the NAC group, compared with 32% and 29% in the placebo group. "Craving is a key component of substance use in relapse," said Back. "If you have a medication that can really reduce craving, that will go a long way to helping people stay clean and sober." Depression, gauged using the Beck Depression Inventory, was reduced 48% in the NAC group vs. 15% in the placebo group.

NAC is available over the counter and does not cause side effects at the doses used in the study, but it degrades quickly when stored, is contraindicated in patients with asthma, and can cause nausea at higher doses and so should always be obtained and administered under a physician's supervision.