Modeling Initial Smoking Abstinence and Relapse Risk

描述：(申请人提供)美国每年有数百万吸烟者试图戒烟，但在最初的几天或几周内都失败了。在戒烟努力的最初几周内保持禁欲与复发风险的急剧下降有关。事实上，关于吸烟和其他药物滥用的文献中有大量证据支持既往禁欲持续时间与复发风险之间的强烈关联。缺少的是严格的实验研究，这也是这一竞争延续的重点，该研究旨在研究早期禁欲如何防止复发风险。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。 我们提出了四个实验，涉及三种不同的吸烟实验模型，以系统地分析初始戒烟和复发风险之间的关系。这些模型中最主要的是一种应急管理安排，允许对最初实现的戒烟数量进行实验控制。研究对象将是日常吸烟者，目前并未试图戒烟，但作为研究的一部分，他们愿意戒烟。受试者将通过持续禁欲来赚取报酬，这一点通过每天3次的一氧化碳监测得到证实。每天将评估尼古丁戒断、渴求、戒烟自我效能、情绪和相关指标。在研究1和研究2中，受试者将随机接受1-14天的戒烟，然后接受3小时的复发风险挑战课程，评估对吸烟相对强化效应的敏感性。在研究1中，挑战环节将涉及一个离散试验选择模型，在该模型中，受试者在吸烟和金钱强化之间做出选择。在研究2中，挑战环节将涉及一个累进比率(PR)模型，在该模型中，获得吸烟机会所需的可操作性反应的数量在整个过程中逐渐增加，以估计受试者为吸烟而招致的最大代价。在研究3中，我们将使用相同的模型来实验分析临床上重要的和相关的问题，即短暂的重新吸烟如何改变戒烟和相关的自我报告措施以及吸烟的相对强化效应。最后，在研究4中，我们将使用这些相同的模型来实验分析经皮尼古丁如何改变最初戒烟、戒烟和相关措施之间的关系，以及吸烟的相对强化效果。 总体而言，拟议的研究有可能有效和有效地提供新的、详细的信息，说明最初的禁欲如何降低复发风险。这些信息对于制定更有针对性和更有效的戒烟干预措施至关重要。

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.