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Cannabis use disorder is particularly prevalent and impairing among young people, and evidence-based treatments are limited. Prior trials of N-acetylcysteine, added to contingency management as a platform behavioral intervention, yielded positive findings in youth but not in adults. This trial sought to rigorously evaluate whether N-acetylcysteine is efficacious in youth when not paired with a robust behavioral treatment platform.
The primary efficacy outcome was the proportion of negative urine cannabinoid tests during treatment, compared between groups. An array of self-report and urine testing measures were examined secondarily to assess cannabis use reduction and cessation outcomes. The mean percentage of cannabis use days and grams of cannabis used per using day decreased over time during treatment but did not differ between groups. Findings indicate that N-acetylcysteine is not efficacious for youth cannabis use disorder when not paired with contingency management, highlighting the potentially crucial role of a robust behavioral treatment platform in facilitating prior positive efficacy findings with N-acetylcysteine.
While cannabis use is increasingly prevalent across age groups, adolescents and young adults represent an age range of particular concern regarding cannabis-related adverse outcomes [ 1 ]. Adolescent-onset cannabis use is more than twice as likely as adult-onset use to progress to an impairing pattern of use defined as cannabis use disorder [ 2 ].
Moreover, youth who use cannabis regularly are particularly prone to adverse educational, occupational, and mental health outcomes associated with cannabis use [ 3 , 4 ]. The current evidence base for addressing cannabis use disorder in youth includes psychosocial, behavioral, and family-based interventions [ 5 , 6 ].
