The inhibition of cocaine cue reactivity is consistent with existing preclinical data and supports the use of N-acetylcysteine as a treatment for cocaine dependence.

A double-blind placebo-controlled crossover Phase I trial was conducted to assess the safety and tolerability of N-Acetylcysteine (NAC) in healthy, cocaine-dependent humans. Thirteen participants attended a three-day hospitalization in which they received placebo or NAC. Subjects were crossed over to receive the opposite medication condition during a second three-day hospitalization, which occurred the following week. Across placebo and NAC conditions, only mild side effects were noted, and the number of subjects reporting side effects did not differ. There were trends for a greater reduction in withdrawal symptoms and craving within the NAC condition. These preliminary results suggest that NAC is well tolerated in healthy, cocaine-dependent individuals and may reduce cocainerelated withdrawal symptoms and craving. (Am J Addict 2006;15:105-110) Although overall rates of cocaine use and the number of individuals seeking treatment for cocaine dependence has declined over the last decade, cocaine continues to be the most frequently mentioned illicit drug in drug-related emergency department reports. 1 Cocaine use has been associated with numerous adverse health consequences. 2-4 Crack cocaine use has also been associated with multiple high-risk sexual practices 5 as well as criminal activity. 6 At the present time, there is no effective FDA-approved treatment for cocaine dependence, despite over two decades of intense research. A pharmacological treatment that could serve as an effective adjunct to psychosocial treatment for cocaine dependence would constitute a major public health advancement.Preclinical investigations have suggested that cocaine-seeking behavior is mediated by levels of glutamate within the nucleus accumbens. 7 Specifically, studies have shown that cocaine addiction results in a neuroadaptation characterized by lower basal levels of glutamate in the accumbens. 8 The lower basal level of glutamatergic tone results in an exaggerated release of glutamate within the nucleus accumbens during acute cocaine challenge, which in turn

The cold pressor test (CPT) and Trier Social Stress Test (TSST) have been shown to reliably increase HPA activity; however, little research has compared responses to these stressors. In this study, biological (plasma cortisol and ACTH levels) and subjective (e.g., stress and mood) responses were compared in 31 subjects administered both the CPT and TSST. Subjects were diagnosed with alcohol dependence and post-traumatic stress disorder (PTSD) (n = 11), alcohol dependence without PTSD (n = 10), PTSD without alcohol use disorder (n = 4), and neither PTSD nor alcohol use disorder (n = 6). All subjects completed both the CPT and TSST. In all groups, the TSST elicited higher levels of ACTH and cortisol than the CPT, and the response time course differed between tasks. The TSST also produced lower mood ratings than the CPT. A comparison of all diagnosed groups with normal controls revealed group differences in ACTH responding for the CPT but not the TSST. The results suggest that the TSST results in a greater HPA response than the CPT; however, the CPT may have utility in diagnostically heterogeneous patients.

No abstract

These preliminary findings demonstrate significant differences between the alcohol-only and the alcohol/PTSD group in predictors of relapse. For the alcohol-only group, reactivity to an acute laboratory stressor may be predictive of subsequent alcohol use. This was not true for the alcohol/PTSD group. Although preliminary, the findings may help shed light on the mechanistic relationship between stress reactivity and increased risk for alcohol relapse and dependence in individuals with and without other Axis I comorbidity.