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The Potential of N-acetyl Cysteine in Behavioral Addictions and Related Compulsive and Impulsive Behaviors and Disorders: a Scoping Review

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Abstract

Purpose of Review

Behavioral addictions (also termed disorders due to addictive behaviors) contain impulsive and compulsive features and have been shown to involve glutamate dysregulation. N-acetylcysteine (NAC), a well-tolerated cysteine pro-drug and antioxidant, may reduce addictive behaviors by restoring glutamate homeostasis. The current review details and discusses the use of NAC in behavioral addictions and related impulsive and compulsive behaviors, including gambling disorder, problematic use of the internet, problematic video gaming, compulsive sexual behavior, problematic shopping/buying, problematic stealing, repetitive self-injurious behavior, and binge eating disorder.

Recent Findings

Preliminary results have indicated the usefulness of NAC in gambling disorder, self-injurious behaviors, and compulsive sexual behaviors. Preclinical studies indicate that NAC is effective in improving binge eating behavior, but clinical trials are limited to a small open-label trial and case report. Studies are lacking on the efficacy of NAC in problematic use of the internet, problematic video gaming, problematic stealing, and problematic shopping/buying.

Summary

NAC demonstrates potential for use in behavioral addictions and compulsive behaviors, particularly in gambling disorder and self-injury. However, more studies are needed to assess the effectiveness of NAC in other behavioral addictions and the mechanisms by which NAC improves these conditions.

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Funding

This work was funded by the National Institute on Drug Abuse (NIDA) R21 DA043055 (GAA, MNP), National Center for Complementary and Integrative Health (NCCIH) R01 AT010508 (GAA, MNP) and National Institute on Diabetes and Diseases of the Kidney (NIDDK) R01 DK121551 (MNP). The content is solely the authors’ responsibility and does not necessarily represent the official views of the NIDA or NIDDK. The work described in this article was funded in part by the State of Connecticut, Department of Mental Health and Addiction Services, but this publication does not express the views of the Department of Mental Health and Addiction Services or the State of Connecticut. The views and opinions expressed are those of the authors.

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Authors and Affiliations

  1. Department of Psychiatry, Weill Cornell Medicine, 418 E 71st Street, New York, NY, USA

    Norman R. Greenberg

  2. Department of Psychiatry, University of Washington School of Medicine, Seattle, WA, USA

    Farzaneh Farhadi

  3. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Benjamin Kazer, Marc N. Potenza & Gustavo A. Angarita

  4. Connecticut Mental Health Center, New Haven, CT, USA

    Marc N. Potenza & Gustavo A. Angarita

  5. Connecticut Council On Problem Gambling, Wethersfield, CT, USA

    Marc N. Potenza

  6. Child Study Center, Yale School of Medicine, New Haven, CT, USA

    Marc N. Potenza

  7. Department of Neuroscience, Yale University, New Haven, CT, USA

    Marc N. Potenza

  8. Wu Tsai Institute, Yale University, New Haven, CT, USA

    Marc N. Potenza

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  1. Norman R. Greenberg
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GAA and MNP conceived the project. NRG, FF, and BK conducted the literature search. NRG, FF, and BK drafted the original manuscript with GAA and MNP critically revising. All authors read and approved the final manuscript.

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Correspondence to Norman R. Greenberg.

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Conflict of Interest

The authors declare no conflicts of interest with the content of this manuscript. Dr. Potenza has consulted for Opiant Therapeutics, Game Day Data, Baria-Tek, the Addiction Policy Forum, AXA and Idorsia Pharmaceuticals; has been involved in a patent application with Yale University and Novartis; has received research support from Mohegan Sun Casino and the National Center for Responsible Gaming; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse-control disorders or other health topics; has consulted for and/or advised gambling and legal entities on issues related to impulse-control/addictive disorders; has provided clinical care in a problem gambling services program; has performed grant reviews for research-funding agencies; has edited journals and journal sections; has given academic lectures in grand rounds, CME events, and other clinical or scientific venues; and has generated books or book chapters for publishers of mental health texts. The other authors do not report disclosures.

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Greenberg, N.R., Farhadi, F., Kazer, B. et al. The Potential of N-acetyl Cysteine in Behavioral Addictions and Related Compulsive and Impulsive Behaviors and Disorders: a Scoping Review. Curr Addict Rep 9, 660–670 (2022). https://doi.org/10.1007/s40429-022-00446-3

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