Alcohol and Substance Abuse Disorders
Posted October 23, 2018
Steven L. Batki, M.D. University of California, San Francisco School of Medicine, Department of Psychiatry; San Francisco VA Medical Center; and Northern California Institute for Research and Education
Traumatic brain injury (TBI) is a major health problem for military personnel and is associated with elevated rates of alcohol use disorder (AUD). AUD and TBI are known to impair cognition, especially in executive functioning, contributing to poor decision-making, impulsivity, and suicidal behaviors. Medications that can improve cognition and reduce alcohol use could offer major benefits to military personnel and Veterans who suffer from co-occurring TBI and AUD. Dr. Batki, at the UCSF School of Medicine and the San Francisco VA Health Care System was funded by the Alcohol and Substance Abuse Disorder Research Program in 2016, as part of the Institute for Translational Neuroscience (ITN) Consortium to conduct an investigation of N-acetylcysteine (NAC) treatment to reduce alcohol use and TBI symptom severity in Veterans with mild-to-moderate TBI and AUD. NAC is a safe and commonly used over-the-counter nutraceutical and is also prescribed for various FDA-approved indications.
Supported by the ITN Consortium, Dr. Batki and his team, recently completed a pilot study of NAC treatment to improve the care of Veterans with both TBI and AUD. To investigate NAC’s efficacy, 30 Veterans with TBI and AUD were randomly assigned to 8 weeks of treatment with either NAC (3600 mg/day) or placebo, combined with weekly counseling. Preliminary results indicate that NAC treatment was associated with significant reductions in alcohol use from baseline compared to placebo, as measured by heavy drinking days. NAC treatment was also associated with significant improvements in cognitive functioning including processing speed, mental flexibility, and cognitive inhibition, and with reductions in posttraumatic stress disorder (PTSD) symptoms. Dr. Batki and his team are also exploring the effects of NAC treatment on impulsivity, decision-making, and alcohol craving.
In this proof-of-principle pilot clinical study, Dr. Batki and his team found evidence that NAC treatment may benefit Service members and Veterans struggling with alcohol use disorder after suffering a TBI. Data collection and analysis for all 30 participants is now near completion. Dr. Batki plans to seek funding for a larger confirmatory clinical trial to confirm these promising preliminary indicators of NAC’s benefits as a treatment for AUD in Veterans with TBI.
Batki S. 2016. N-acetylcysteine treatment of alcohol use disorder in Veterans with TBI: A pilot study. ClinicalTrials.Gov NCT02791945.