Modeling Initial Smoking Abstinence and Relapse Risk

描述：（由申请人提供）在美国，每年都有数百万吸烟者试图戒烟，但在最初的几天或几周内就失败了。在戒烟的最初几周内保持戒断与复发风险的急剧下降有关。事实上，在吸烟和其他药物滥用的文献中有大量证据支持先前戒烟的持续时间和复发风险之间的强烈联系。缺少的是，这一竞争性延续的重点是严格的实验研究，研究早期禁欲时期如何防止复发风险。这些信息有可能促进更有针对性和更有效的行为和药物治疗的发展。

DESCRIPTION: (provided by applicant)Each year millions of cigarette smokers in the U.S. try to quit, only to fail within the initial days or weeks of the effort. Sustaining abstinence through the initial weeks of a cessation effort is associated with a precipitous decline in relapse risk. Indeed, there is substantial evidence in the literature on smoking and other drug abuse supporting strong associations between the duration of prior abstinence and relapse risk. What is missing and is the focus of this competing continuation are rigorous experimental studies examining how a period of early abstinence might protect against relapse risk. Such information has the potential to facilitate development of more focused and effective behavioral and pharmacological treatments. We are proposing 4 experiments involving three different experimental models of cigarette smoking to systematically analyze the relationship between initial abstinence and relapse risk. Primary among the models is a contingency-management arrangement that allows for experimental control over the amount of initial smoking abstinence achieved. Subjects will be daily cigarette smokers not currently trying to quit, but willing to abstain as part of a study. Subjects will earn payment by sustaining abstinence that is verified via 3 x/day CO monitoring. Nicotine withdrawal, craving, abstinence self-efficacy, mood, and related measures will be assessed daily. In Studies 1 and 2, subjects will be randomized to achieve 1-14 days of abstinence prior to undergoing a 3-hr relapse-risk challenge session assessing sensitivity to the relative reinforcing effects of smoking. In Study 1, the challenge session will involve a discrete-trial choice model in which subjects choose between cigarette smoking vs. monetary reinforcement. In Study 2, the challenge session will involve a progressive ratio (PR) model in which the number of operant responses necessary to earn smoking opportunities increases progressively throughout the session to estimate the maximal price that subjects will incur in order to smoke. In Study 3, we will use these same models to experimentally analyze the clinically important and related question of how brief "lapses" back to smoking alter the profile of withdrawal and related self-report measures as well as the relative reinforcing effects of smoking. Finally, in Study 4 we will use these same models to experimentally analyze how transdermal nicotine alters the relationships between initial abstinence, withdrawal and related measures, and the relative reinforcing effects of smoking. Overall, the proposed studies have the potential to efficiently and effectively contribute new, detailed information on how initial abstinence decreases relapse risk. Such information is essential to the development of more focused and effective smoking-cessation interventions.