Withdrawal Trajectory Predictors of Smoking Relapse

通过分析四项已完成的NIDA资助研究的结果，本修订版R 03提案的主要目标 评估长期吸烟复发是否可以通过积极情感（PA）的减少来预测， 认知功能（CF）和缓慢恢复的PA和CF在第一天和第一个月的吸烟 保持禁欲至少31天的人。第二个研究目标是复制发现 (Zuo例如，2017年），在禁欲的第一天，消极情绪（NA）的缓慢消散预示着 短期和长期复吸。研究的第三个目标是利用四项研究的数据， 生成临床上有用的复发风险量表（简短认知-情感复发风险量表[SCARRS]） 基于研究中最具预测性的戒断症状项目。虽然NA被评估为 在Zuo等人的研究中，收集了PA和CF作为复发的预测因子，但未将其作为潜在预测因子进行评估 在四项研究中的任何一项中，每项研究都评估了吸烟戒断症状（SWS）的轨迹， 至少31天的激励性、经生化验证的戒烟和收集的复吸 第3、6、9和12个月时的信息。在研究中评估这些关系的一个优点是， 在最初的31天以上保持禁欲的动机是， 复发并因此未被包括在评估样本中的患者保持戒断状态， 避免那些最严重的SWS复发的人的问题， 研究人群。排除这些个体通常会导致低估SWS的严重程度和持续时间 并且最小化了评估那些维持初始禁欲的人中SWS与复发的关系的能力。 此外，相当一部分吸烟者在31天以上后复发。如果NA消散缓慢和/或恢复缓慢 发现早期戒断期间PA和/或CF的增加可预测后期复发的持续风险，这些变量 可能是有效的目标干预措施，以增加长期停止与难治性SWS的个人。到 为了促进临床适应，我们将根据统计数据生成一个简短的SWS复发风险预测因子， 从所用SWS的标准更精确的测量中识别最有效预测复发的项目 在四项研究中。为了探索个体化干预的最早时间窗，我们将评估 戒断第3天至第31天SWS的消散率可作为 复发的显著性;具体而言，SWS从基线至治疗第3天的增加是否更大 禁欲，从禁欲的第3天到第6天以及到第12天和第31天，这些SWS的消退较慢， 预测复发，即使在控制了渴望之后。数据的增长曲线和逻辑回归分析 将这些研究结合起来，用于评估个体SWS轨迹参数的相关性 戒烟后3个月和1年的戒断结果。一个发现是，非常短暂的（例如， 12-20项）SCARRS可以识别复发的高风险个体，可能导致其广泛的临床应用。

By analyzing the results from four completed NIDA-funded studies, the major goal of this revised R03 proposal is to assess whether long-term smoking relapse is predicted by decreases in positive affect (PA) and cognitive functioning (CF) and by slow recovery of PA and CF during the first days and month of smoking abstinence in those who maintain abstinence for at least 31 days. A second study goal is to replicate findings (Zuo et al., 2017) that slow dissipation of negative affect (NA) during the first days of abstinence predicts both short- and long-term relapse to smoking. The third goal of the study is to use data from the four studies to generate a clinically useful risk-for-relapse scale (Short Cognitive-Affective Relapse Risk Scale [SCARRS]) based on the most predictive withdrawal-symptom items from the studies. While NA was assessed as a predictor of relapse in the Zuo et al. study, PA and CF were collected but not assessed as potential predictors in any of the four studies, each of which assessed smoking withdrawal symptom (SWS) trajectories for a minimum of 31 days of incentivized, biochemically verified smoking abstinence, and collected relapse information at 3, 6, 9, and 12 months. An advantage of assessing these relationships in studies that provided incentives for maintaining abstinence during the first 31+ days is that individuals who normally would have relapsed and therefore not have been included in the assessed sample are maintained in the abstinent state, something that avoids the problem of those with the most severe SWSs relapsing and not being included in the study population. Exclusion of such individuals typically results in underestimates of SWS severity and duration and minimizes the ability to assess the relationship of SWS to relapse in those who maintain initial abstinence. In addition, a sizable portion of smokers relapse after 31+ days. If slow dissipation of NA and/or slow recovery of PA and/or CF during early abstinence are found to predict a persistent risk for later relapse, these variables may be valid targets for interventions to increase long-term cessation in individuals with refractory SWSs. To facilitate clinical adaptation, we will generate a brief SWS predictor of risks for relapse based on the statistical identification of items that most effectively predict relapse from the standard lengthier measures of SWSs used in the four studies. To probe the earliest time window for individualized intervention, we will assess whether the rate of dissipation of SWSs across days 3 through 31 of abstinence can be established as markers of significance for relapse; and specifically, whether greater increases in SWSs from baseline to the third day of abstinence, slower resolution of these SWSs from day 3 to day 6 and to day 12 and 31 of abstinence are each predictive of relapse, even after controlling for craving. Growth curve and logistic regression analyses for data combined across the studies will be used to assess associations of an individual’s SWS trajectory parameters and craving with the abstinence outcomes at 3-month and 1-year postquit. A finding that the very brief (e.g., 12-20 item) SCARRS can identify individuals at high risk for relapse could lead to its widespread clinical use.