A Randomized Controlled Trial of N-acetylcysteine for Adolescent and Young Adult Alcohol Use Disorder.

In 30 seconds

This double-blind, randomized, placebo-controlled trial evaluated N-acetylcysteine in 126 treatment-seeking people aged 15 to 25 years with alcohol use disorder (AUD). Participants received N-acetylcysteine 2,400 mg/day or placebo for 8 weeks, alongside weekly alcohol intervention sessions, and were followed for 6 months. Overall, N-acetylcysteine did not significantly improve alcohol-use outcomes; the primary endpoint was 37.9 versus 42.6 standard drinks in the final 4 treatment weeks (risk ratio = 1.19, 95% CI = 0.89, 1.61, p = .24). Exploratory analyses found lower consumption with N-acetylcysteine among participants with moderate to severe AUD.

Key findings

• Overall, the primary endpoint was 37.9 versus 42.6 standard drinks in the final 4 treatment weeks; risk ratio = 1.19, 95% CI = 0.89, 1.61, p = .24.
• Among participants with moderate to severe AUD, consumption was 31.7 versus 44.4 standard drinks over the final 4 treatment weeks (p = .01).
• N-acetylcysteine did not reduce drinking frequency, and it did not significantly reduce alcohol use among participants with mild AUD.
• Video-confirmed medication adherence was 82.7% overall, and adverse-event rates did not differ between groups.

Why it matters

The overall null result cautions against assuming benefit across all young people with AUD. The exploratory severity-stratified finding suggests that treatment effects may differ by baseline AUD severity, while the absence of an effect on drinking frequency indicates that consumption and frequency may need to be considered separately when evaluating outcomes. These results also inform the design of future youth AUD treatment trials.

What to keep in mind

The benefit in moderate to severe AUD arose from exploratory subgroup analyses, while the overall primary and secondary outcomes showed no group differences.