N-Acetylcysteine (NAC), a powerful anti-oxidant has become a well-researched nutritional supplement in today’s literature for its potent effect in treating patients with substance abuse disorders (SUDs).

It has also, become popular and widely purchased to improve therapeutic strategies for COVID-19 treatment (Wong et al., 2021), which at one point, couldn’t be purchased anywhere!

Mind you, though, we’re not here to talk about that.

What we want to talk about in this article is what N-Acetylcysteine actually is, and some of the evidence available on using NAC to assist with various substance use disorders, and manage our withdrawal symptoms.

What is N-acetylcysteine?

N-Acetylcysteine (NAC) is a precursor of the amino acid L-cysteine, and acts as a strong free radical scavenger, making it a potent anti-oxidant.

NAC’s potency comes from its role to influence the production of glutathione, the body’s strongest and most naturally occurring anti-oxidant compound (Mokhtari et al., 2016).

This anti-oxidant potential is important for many things, including improving the function of our immune system, and boosting various detoxification pathways (Dröge & Breitkreutz, 2000), something we may need to boost in alcohol or drug sobriety.

On top of this, glutathione also helps increase oxygen delivery to tissues, boosts the function of our mitochondrial powerhouses found in our cells, and improves blood flow to the liver to further assist in detoxification processes (Ershad et al., 2021).

In terms of clinical treatment, N-Acetylcysteine has been used for over 30 years in situations of paracetamol overdose, and also more recently in the treatment of chronic obstructive pulmonary disease, cystic fibrosis, and contrast-induced nephropathy (Ooi et al., 2018).

 In recent studies, NAC has been applied to conditions of oxidative stress and reduced anti-oxidant status, which is closely tied to psychiatric and psychiatric-related conditions, including substance abuse (Chang et al., 2021).

Is alcohol craving more of a major issue for you? Read this article on crushing alcohol cravings with L-Glutamine.

How does N-Acetylcysteine help with Alcohol Addiction?

NAC has many pathways that have been shown to assist with alcohol addiction, or more particularly, managing the cravings and withdrawal symptoms that come from it.

N-Acetylcysteine Helps to Increase Glutathione Production

Glutathione, a tripeptide with potent antioxidant properties, plays a pivotal role in maintaining balance in the body. It’s particularly noteworthy for its ability to regulate the immune system and restore the balance of antioxidants, which is often disrupted in psychiatric and addictive conditions.

According to Ooi et al. (2018), enhancing glutathione production can significantly impact mental health and addiction recovery. This process involves boosting the body’s natural ability to combat oxidative stress, a common feature in various substance use disorders.

Restore Dopamine Neurotransmitter Dysregulation

We’ve all heard of dopamine at some point. Dopamine is a key neurotransmitter that manages the body’s natural risk and rewards behavioural system. Monti et al. (2016) highlight the importance of correcting dopamine dysregulation in addiction and mental health disorders.

This includes improving dopamine receptor binding and enhancing neuron survival. Restoring this delicate balance can create a substantial aid in the recovery from addictive behaviours, and enhance overall mental well-being.

Glutamate Neurotransmitter Dysregulation in Addiction

Glutamate (and GABA) imbalances are quite common in alcohol addiction, and symptoms often manifest as anxiety, irritation and jitteriness. Interventions that re-balance glutamate levels (such as NAC) can have profound effects on addiction recovery (Gorelick, 2019).

NAC not only helps in regulating glutamate levels but also increases Gamma-Aminobutyric Acid (GABA) – Our primary inhibitory neurotransmitter known for its calming effects. It does this due to the Glutamate and GABA Seesaw effect, learn more here.

N-Acetylcysteine Modulates Inflammatory Pathways

Inflammation is a key factor in the pathology of many disorders, including those related to substance abuse. Elevated levels of cytokines such as interleukin-6, C-reactive protein, and tumor necrosis factor-alpha are common in these conditions.

As suggested by Ooi et al. (2018), reducing these inflammatory pathways can mitigate oxidative stress implications, thereby aiding in the recovery process. This reduction not only alleviates physical symptoms but also contributes to mental and emotional healing.

N-Acetylcysteine Dosages and Use in Treatment

While we are primarily an alcohol addiction-based resource, I feel it’s important here to highlight the wide use of NAC in other specific substance use disorders.

Don’t worry, I’ve listed Alcohol Use Disorder first, and for each application, listed recommended dosages according to research. Don’t take these dosages as gospel though, always do your own research and consult with a health professional if needed.

• NAC and Alcohol Use Disorder Treatment – Doses of between 1,000 – 2,400 mg/day have reported outcomes that NAC may reduce symptoms of withdrawal, prevent alcohol toxicity and reduce oxidative stress that comes from excessive alcohol use (Ooi et al., 2018).
• NAC and Cocaine Use Disorder Treatment – Doses of between 1,200 – 2,400 mg/day have reported outcomes of a reduction and frequency of cocaine cravings (Amen et al., 2010), and were more likely to remain abstinent for longer (LaRowe et al., 2013).
• NAC and Methamphetamine Use Disorder Treatment – Doses of 1,200 mg/day have reported outcomes of a reduction in methamphetamine cravings during a crossover trial of 4 weeks, concluding it as an efficacious method in the treatment of methamphetamine dependency (Schmaal et al., 2011).
• NAC and Cannabis Use Disorder Treatment – Doses of 2,400 mg/day have reported outcomes of a reduction in cravings and the amount of cannabis use and “hits” per day. More research is suggested for further understanding of efficacy (Gray et al., 2010).
• NAC and Tobacco Use Disorder Treatment – Doses of between 1,200 – 3,600 mg/day have reported outcomes of fewer symptoms of nicotine dependence (Grant et al., 2013) and a reduction in cigarette usage, compared with the placebo group (Prado et al., 2015).
• NAC and Other Psychiatric Uses – Due to NAC’s oxidative stress-reducing and anti-inflammatory properties, it also serves as a great use for schizophrenia, bipolar, irritability, depression, and other various mood-related symptoms (Ooi et al., 2018).

What Are Some Recommended N-Acetylcysteine Supplements?

NAC boomed when COVID-19 hit, and to be honest, there either not much on the market, or was out of stock for long periods of time.

Today, NAC is everywhere, and better yet, it’s super affordable. Below is a list of top recommended supplements to search for and use. I do link some brands, and I encourage you to use the links, which helps support Clarity.

• NAC by Thorne Research
• NAC by Healthwise
• NAC by BioActiv

Frequently Asked Questions on NAC and Alcohol Addiction

Is N-Acetylcysteine (NAC) effective in reducing alcohol consumption?

Some research does suggest that NAC can help reduce alcohol consumption. While further studies are still recommended, this study outcomes the potential for promising results in this area.

Does N-Acetylcysteine (NAC) provide benefits for substance cravings?

Yes, N-Acetylcysteine (NAC) has shown to offer noticeable benefits in reducing cravings from addictive substances. It can also help alleviate depressive and withdrawal symptoms associated with substance abuse.

Are there any side effects of using N-Acetylcysteine (NAC) for Alcohol Addiction treatment?

NAC is generally well-tolerated. No significant difference in adverse effects was found between NAC treatment and control groups in the studies. That being said, you should not use NAC alone to stop drinking, it is only a tool.

Are there any studies supporting the use of N-Acetylcysteine (NAC) in alcohol addiction treatment?

Yes, there are several studies, including clinical trials and preclinical studies, that support the use of NAC in the treatment of alcohol addiction​​​​​​. You can find one here, here, and here.

Is N-Acetylcysteine (NAC) suitable for patients with liver disease?

N-Acetylcysteine (NAC) Could be beneficial for patients with alcohol use disorder who also have liver disease. This is due to it’s anti-oxidant properties, which can be protective to the liver.

The Takeaway

N-Acetylcysteine (NAC) is an amazing and nutritional compound when It comes to managing our sobriety, and has been well studied across various substance use disorders.

Not only does it fix some of the neurotransmitters that may come out of balance during alcohol or drug addiction, but it’s also a potent anti-oxidant, and helps lower inflammation that may come from excessive substance use.

Personally, I found it extremely useful in managing alcohol withdrawal, but it has also shown effective in other addiction disorders including cocaine, methamphetamine, cannabis, and tobacco.

There are many good N-Acetylcysteine powders on the market, such as this one, which delivers pure bioavailable and high-quality NAC.

It has been shown effective in various SUDs including cocaine, methamphetamine, cannabis, tobacco, and alcohol; although in some instances more research is required.

Have you used NAC before? What were your experiences with it? Let us know in the comments!

References:

• Amen, S. L., Piacentine, L. B., Ahmad, M. E., Li, S., Mantsch, J. R., Risinger, R. C., & Baker, D. A. (2010). Repeated N-acetyl cysteine reduces cocaine seeking in rodents and craving in cocaine-dependent humans. Neuropsychopharmacology, 36(4), 871-878. https://doi.org/10.1038/npp.2010.226
• Chang, C., Hsieh, P., Lee, H., Lo, C., Tam, K., & Loh, E. (2021). Effectiveness of N-acetylcysteine in treating clinical symptoms of substance abuse and dependence: A meta-analysis of randomized controlled trials. Clinical Psychopharmacology and Neuroscience, 19(2), 282-293. https://doi.org/10.9758/cpn.2021.19.2.282
• Dröge, W., & Breitkreutz, R. (2000). Glutathione and immune function. Proceedings of the Nutrition Society, 59(4), 595-600. https://doi.org/10.1017/s0029665100000847
• Ershad M, Naji A, Vearrier D. N Acetylcysteine. [Updated 2021 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537183/
• Gorelick, D. A. (2019). N-acetylcysteine in treatment of substance use disorders. Biological Psychiatry, 85(11), e59. https://doi.org/10.1016/j.biopsych.2018.11.018
• Grant, J. E., Odlaug, B. L., Chamberlain, S. R., Potenza, M. N., Schreiber, L. R., Donahue, C. B., & Kim, S. W. (2013). A randomized, placebo-controlled trial ofn-acetylcysteine plus imaginal desensitization for nicotine-dependent pathological gamblers. The Journal of Clinical Psychiatry, 75(01), 39-45. https://doi.org/10.4088/jcp.13m08411
• Gray, K. M., Watson, N. L., Carpenter, M. J., & LaRowe, S. D. (2010). N-acetylcysteine (NAC) in young marijuana users: An open-label pilot study. The American Journal on Addictions, 19(2), 187-189. https://doi.org/10.1111/j.1521-0391.2009.00027.x
• LaRowe, S. D., Kalivas, P. W., Nicholas, J. S., Randall, P. K., Mardikian, P. N., & Malcolm, R. J. (2013). A double-blind placebo-controlled trial of N-acetylcysteine in the treatment of cocaine dependence. The American Journal on Addictions, 22(5), 443-452. https://doi.org/10.1111/j.1521-0391.2013.12034.x
• Mokhtari, V., Afsharian, P., Shahhoseini, M., Kalantar, S. M., & Moini, A. (2017). A Review on Various Uses of N-Acetyl Cysteine. Cell journal, 19(1), 11–17. https://doi.org/10.22074/cellj.2016.4872
• Monti, D. A., Zabrecky, G., Kremens, D., Liang, T., Wintering, N. A., Cai, J., Wei, X., Bazzan, A. J., Zhong, L., Bowen, B., Intenzo, C. M., Iacovitti, L., & Newberg, A. B. (2016). N-acetyl cysteine may support dopamine neurons in Parkinson’s disease: Preliminary clinical and cell line data. PLOS ONE, 11(6), e0157602. https://doi.org/10.1371/journal.pone.0157602
• Ooi, S. L., Green, R., & Pak, S. C. (2018). N-acetylcysteine for the treatment of psychiatric disorders: A review of current evidence. BioMed Research International, 2018, 1-8. https://doi.org/10.1155/2018/2469486
• Prado, E., Maes, M., Piccoli, L. G., Baracat, M., Barbosa, D. S., Franco, O., Dodd, S., Berk, M., & Vargas Nunes, S. O. (2015). N-acetylcysteine for therapy-resistant tobacco use disorder: A pilot study. Redox Report, 20(5), 215-222. https://doi.org/10.1179/1351000215y.0000000004
• Schmaal, L., Berk, L., Hulstijn, K. P., Cousijn, J., Wiers, R. W., & Van den Brink, W. (2011). Efficacy of N-acetylcysteine in the treatment of nicotine dependence: A double-blind placebo-controlled pilot study. European Addiction Research, 17(4), 211-216. https://doi.org/10.1159/000327682
• Wong, K. K., Lee, S. W., & Kua, K. P. (2021). N-acetylcysteine as adjuvant therapy for COVID-19 – A perspective on the current state of the evidence. Journal of Inflammation Research, 14, 2993-3013. https://doi.org/10.2147/jir.s306849

Related Articles

Stephen Brumwell

Former drinker, Nutritionist, Biohacking enthusiast, self-experimenter, research fanatic, and self-taught writer, Stephen immerses himself deep into the literature of human optimisation and better understand the nature of addiction. His goal is to help people take control of their addiction, reset their cravings, unscramble their broken brain circuitry and use actionable strategies that work ten times better than anything else.