Cysteine Effect on Smoking Cessation

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Background of the study

The problem of smoking has been thorny to the government and the society for many years now. Continued tobacco use can and in most cases leads to addiction because of the nicotine drug contained in tobacco. Nicotine dependence means that the person will continually use the drug to an extent that his/her body may not function well without it. When a person reaches the addiction stage, it becomes harder for them to quit smoking. Health agencies and medical researchers have tried to develop effective procedures and interventions of helping in the cessation of nicotine. Among those available options for cessation are treatment options. Extensive research findings have shown that pharmacotherapy is a viable option for helping people quit smoking. Different forms of pharmacotherapy have been coined with drug companies seeking to balance the trade-offs between the effectiveness of the drug and the side effects its use. Some of the common forms of pharmacotherapy are noradrenaline and NRT, varenicline. The use of N- Acetylcysteine (NAC), which has been used to reduce or eliminate the good feeling effects of using nicotine, has been on the rise. Thus, this paper seeks to understand the effectiveness of N-Acetylcysteine (NAC) in cessation smoking and get an understanding of how it works. Evidence will be drawn from two cases studies on the subject. 

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Study 1

The objective of this study was to establish the effectiveness of NAC in the prevention of relapse for dependence on nicotine. The study design used in this case is the double-blind randomized controlled trial. In this study design, participants are chosen randomly from the large population. Selection is therefore by chance. Once they are selected, participants are subjected to the clinical interventions one of which is the control intervention. In this study, participants were given either 3 g/day of NAC or placebo in a period of 12 weeks consecutively. As in the double-blind design, information that can influence the performance of the participants was withheld

Twenty-three students were selected from the University of Amsterdam who smoked at least 15 cigarettes in a day. This selection excluded students on medication, pregnant students, students suffering from a medical disease, and those addicted to other substances. Subjects were not supposed to smoke during the experiment and that was confirmed though tests of the levels of carbon (II) oxide of breathe. Study credits were given to those who completed the study as a form of motivation to them. The impact of NAC treatment was checked in the short-term on the basis of self-reported cravings from cigarettes, withdrawal effects and rewarding effects of smoking. The subjects were administered NAC (n=10) or placebo (n=12) dosages every day taking one dose in the morning and another one in the evening. Baseline data was collected on the first day for comparison. The NAC was given in dosages of 1,800 mg in the morning and in the evening for three days and only in the morning on the fourth day. Collected data were analyzed through normal distribution to test the effects (Schmaal, Berk, Hulstijn, Cousijn, Wiers, & van den Brink, 2011).

The effects in the of NAC were checked using Cohen’s d such that 0.2 to 0.4 represented a small effect, 0.5 to 0.7 represented medium effect while scores above that to represent large effects. One of the 23 participants was disqualified for using cannabis leaving 22 subjects. Self-reported side effects were collected at the end of the experiment. Two of the subjects in the intervention condition reported cases of mild stomach ache while five from the control condition reported cases of stomachaches. These were the only side effects observed. An observation was made on the intervention condition group of more alcohol consumption (t = 1.97; df = 13.27; p = 0.07). The NAC group showed fewer withdrawal symptoms than the control group as seen in the p = 0.07; d = 0.80. In rating the first cigarette after the withdrawal from smoking, the NAC participants rated it as less rewarding than the placebo group (p = 0.04; d = 0.85). The withdrawal symptoms were easy to obtain because the subject did not smoke during the experiment period. However, because of the samples size, this was not significant, (p =0.07) (Schmaal, Berk, Hulstijn, Cousijn, Wiers, & van den Brink, 2011).

The critiques to this study stem from the samples size used. Critics argue that the samples size was too small and thus the results could not be used to infer to the whole population. In addition, the duration of the study as been critiqued as it was short and did not give enough time to reach steady levels of the N- Acetylcysteine. The fact that the participating were asked to stop smoking and then asked to smoke again just after three and half days also presented a point for criticisms. 

Study 2

The pilot study followed the design of randomized controlled trial (RCT). In this study design, participants are chosen randomly from the population with every member of the population having an equal chance of being selected for the study. The population of the study was made up of heavy smokers in the University of Amsterdam. Selection is therefore by chance. Once they are selected, participants are subjected to the clinical interventions one of which is the control intervention. In this study, participants were given either NAC or placebo in a period of four days consecutively. This administration is also random and by chance in the case of the randomized controlled trial.  

Study participants included 34 men and women aged between 18 and 65 years. The criteria for selection included subjects with diagnosed tobaccos disorders, subjects who were currently active smokers and subjects who were resistant to other smoking intervention measures such as bupropion and varenicline. The objective was to examine whether N- Acetylcysteine treatment had clinical effectiveness in the treatment of tobacco use disorders. Participants were taken through daily assessment to assess the daily cigarette usage, carbon monoxide exhaled and the rates of quitting smoking as indicated by the COExh 6 ppm or less. The Hamilton Depression Rating Scale was used to measure depression during the experiment. Statistical data analysis was applied to interpret the results (Prado, Maes, Piccoli, Baracat, Barbosa, Franco, & Vargas Nunes, 2015). 

Out of the 34 participants, only 18 completed the study without any violations. These included eleven participants in the NAC group and seven participants in the placebo. Dropouts were witnessed at different stages of the experiment with different reasons from the participants. The administration of NAC reduced daily cigarettes intake more, (mean ± SD = −10.9 ± 7.9) than the placebo effect of −3.2 ± 6.1 deviation from the mean. The measure of exhaled carbon monoxide which was the secondary measure of reduced cigarette use also reduces much in the NAC group (mean± SD = −10.4 ± 8.6 ppm). The placebo group deviation from the mean was −1.5 ± 4.5 ppm, which was lower. Of the participants in the NAC group, 47.1% quit smoking compared to 21.4% in the placebo group. There months after the baseline, the NAC treatments reduced the Hamilton Depression Rating Scale score significantly. Nausea, diarrhea, and respiratory allergy were some of the side effects reported in the case study with p = 0.596, p = 0.389 and p = 1 respectively (Prado, Maes, Piccoli, Baracat, Barbosa, Franco, & Vargas Nunes, 2015). 

Critics argue that the samples size was too small and thus the results could not be used to infer to the whole population. The selection of participants aged between 18 to 65 years only has also been a point of criticism. Furthermore, the study recruited participants who were resistant to tobacco-use treatment interventions. The critics further favored long –term abstinence in a double-blind placebo –controlled study, over the design used.

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Conclusion and Recommendations 

According to the findings of the first study, the administration of NAC was found to be a viable and effective treatment for preventing relapse and reducing dependence on tobacco use. Furthermore, the NAC treatment was found to have fewer withdrawal effects. In the second case, the research concluded that NAC treatment has a clinical efficacy in tobacco use disorders. It reduces the daily intake of cigarettes and also enhances tobacco-use cessation. Therefore, in conclusion, the study question can be answered in the positive. N- Acetylcysteine (NAC) can work effectively for the cessation of smoking. The studies have shown that it does work well. Its clinical efficacy is explained by its effects on craving for nicotine and the feeling of reward after smoking. Furthermore, the recommendation would be a combination of N- Acetylcysteine (NAC) treatment with appropriate psychotherapy to improve the effectiveness of the treatment intervention. 

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  1. Prado, E., Maes, M., Piccoli, L. G., Baracat, M., Barbosa, D. S., Franco, O., … & Vargas Nunes, S. O. (2015). N-acetylcysteine for therapy-resistant tobacco use disorder: a pilot study. Redox Report, 20(5), 215-222. – Study 2
  2. 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. – study 1
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