FRONT-LOADED COUNSELING TO TREAT TOBACCO ADDICTION

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DESCRIPTION (provided by applicant): Relapse occurs very soon after a quit-smoking attempt for the majority of smokers who try to quit. Rapid return to smoking occurs even for those given pharmacologic treatments. Approximately 25% smoke within 1 day of their quit attempts, 50% by 1-week post-cessation, and 60-70% by 2 weeks post-quit. If this early return to smoking could be prevented, success rates for a given quit attempt should be much higher. It has been found that those who can maintain abstinence for 2 weeks or more have a markedly-improved likelihood of succeeding in their quit attempts. We are proposing a 2-group design to study the efficacy of a "front-loaded" treatment procedure. We plan to determine if the provision of early counseling, timed to occur when relapse is most likely, will improve the likelihood of successful cessation. Following the recommendations of the Clinical Guidelines, all 400 subjects in our proposed study will be given pharmacologic treatment (nicotine replacement via nicotine patches). One half of our sample will be randomly assigned to a "standard-counseling" group, and will receive weekly counseling. The second set of 200 smokers will be randomly assigned to a "front-loaded" counseling condition, with sessions timed to coincide with the days post-cessation when relapse is most likely (Days 1 - 14 post-quit). The content and number of counseling sessions will be exactly the same for the 2 treatment groups. This study will be the first, to our knowledge, to examine, in a carefully-controlled experimental design, whether "relapse-sensitive" front-loaded counseling will significantly improve cessation rates among smokers making a serious quit-smoking attempt. We will also examine potential mechanisms through which front-loaded counseling may mediate successful abstinence. We see this study as an essential first step for testing the efficacy of a conceptually straightforward, but potentially powerful, treatment-refinement for enhancing success rates in the early days and weeks post-cessation. If our central hypothesis concerning the efficacy of "front-loaded" counseling is supported, this finding would seemingly have immediate clinical implications for the treatment of addicted smokers.