NOVEL LAPSE-RESPONSIVE APPROACH TO SMOKING CESSATION

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DESCRIPTION: (Applicant's Abstract) This treatment development project will provide valuable information about a novel approach to smoking cessation that intervenes aggressively with poor prognosis smokers who have had a smoking lapse during the first two post-cessation weeks. The model is based on previous observations that early smoking lapse is a powerful predictor of failure in smoking cessation attempts. It utilizes the most potent available empirically tested behavioral techniques, rapid smoking and counseling, combined with bupropion pharmacotherapy, to test a new lapse-contingent model of intervention. Rapid smoking with counseling is expected to counteract some of the adverse cognitive and physiological effects of self-initiated early smoking lapses through counter-conditioning. During the 3-year treatment development project we will 1) write a manual describing the new lapse-contingent rapid smoking plus counseling intervention, 2) train an appropriate staff member to administer the therapy, 3) implement therapist adherence and competency assessments, 4) conduct an open pilot study (n=12) of the new therapy, 5) make interim protocol and manual alterations as needed, and 6) evaluate the new treatment in a small sample (n=63) pilot study in which lapsers are randomly assigned to the full intervention, to intensive counseling only or to a control condition with no special intervention following their first post-cessation smoking lapse. Our hypothesis is that those receiving the full intervention with rapid smoking will have significantly better outcomes than either of the control groups at all follow-up time points (1, 3 and 6 months post-cessation). The novel concept here is to obtain more reliable initiation and early post-cessation abstinence, without which long-term success appears unlikely, by proactively intervening with those who do have an early smoking lapse in an attempt to improve their prognosis. Therapeutic procedures that reduce or reverse the detrimental effects of early lapse could be a significant breakthrough in improving smoking cessation rates.