Smoking Abstinence and Impulsive Behavior: A Multi-Process Model

描述(申请人提供)：尽管吸烟对健康造成严重后果，但它仍然是世界上可预防的死亡的主要原因。戒烟后的复发率仍然很高，这意味着需要制定更有效的治疗策略。因此，探讨导致复发的因素势在必行。当代的烟草使用理论提出了一种自我用药模式，在这种模式下，与禁欲相关的缺陷可能会导致冲动行为。然而，冲动是一个定义广泛的概念，因此很难确定哪些维度在复发中最重要。具体地说，吸烟者在戒烟时可能会经历抑制控制的减少和与延迟相关的冲动的增加。通过试图缓解这些赤字，意想不到的后果可能会复发。禁欲导致的这些缺陷的程度可能与先前存在的症状有关。以抑制缺陷为特征的疾病，如注意力缺陷/多动障碍(ADHD)，报告吸烟率较高，戒烟率较低。为了扩大对这些过程之间的联系的理解，这项拟议的研究将检查戒烟对抑制控制和冲动的多个方面的影响，样本是根据ADHD症状的高水平和低水平选择的成年吸烟者。在受试者内部设计中，吸烟者将完成一次被剥夺12小时的时间和一次不被剥夺的时间。这项研究的具体目的是：1)检验戒断对反应抑制(例如，停止信号范式)、干扰控制(例如，惊吓的注意改变)和延迟相关冲动(例如，延迟折扣)的影响，2)检验这些措施之间的关系，3)检验与先前存在缺陷相关的症状(即ADHD症状)是否缓和了目标1和2中的影响。综合多种冲动措施将阐明它们之间的相互关系，以及它们是否反映了与吸烟行为相关的核心过程。将撰写一篇综述，综合现有关于吸烟和ADHD之间遗传关联的文献，以检验冲动是否意味着尼古丁依赖的内表型。进一步了解戒烟和冲动行为之间的关系将有助于深入了解导致吸烟行为持续和复发的因素。针对这些区域的ADHD治疗(即抑制控制、冲动)可能在戒烟或预防复发方面有效。这些治疗对高危人群(例如，有ADHD症状或其他冲动控制问题的个人)可能特别有用。

DESCRIPTION (provided by applicant): Despite the severe health consequences associated with cigarette smoking, it remains the leading cause of preventable death in the world. Relapse rates following cessation remain high, imparting the need for the development of more effective treatment strategies. Therefore, it is imperative to explore the factors leading to relapse. Contemporary theories of tobacco use have proposed a self-medication model in which abstinence-related deficits may potentially lead to impulsive behavior. However, impulsivity is a broadly defined construct making it difficult to determine which dimensions are most important in relapse. Specifically, a smoker may experience a decrement in inhibitory control and an increase in delay-related impulsivity while abstinent. By attempting to alleviate these deficits, the unintended consequence may be relapse. The degree to which these abstinence-induced deficits are experienced may be associated with pre-existing symptoms. Individuals with disorders characterized by inhibitory deficits, such as Attention- Deficit/Hyperactivity Disorder (ADHD), report higher prevalence rates of smoking and lower cessation rates. To broaden understanding of the association among these processes, the proposed research will examine the effects of smoking abstinence on multiple aspects of inhibitory control and impulsivity in a sample of adult smokers selected for high and low levels of ADHD symptoms. In a within-subjects design, smokers will complete one session 12 hours deprived and one session non-deprived. The specific aims of the proposed study are: 1) examine abstinence effects on response inhibition (e.g., Stop-signal paradigm), interference control (e.g., attentional modification of startle), and delay-related impulsivity (e.g., delay discounting), 2) examine the relationships among these measures, 3) examine whether symptoms associated with preexisting deficits (i.e., ADHD symptoms) moderate the effects in Aims 1 and 2. Incorporating multiple measures of impulsivity will elucidate their interrelationships and whether they reflect core processes related to smoking behavior. A review synthesizing existing literature on genetic associations between smoking and ADHD will be written to examine whether impulsivity signifies an endophenotype of nicotine dependence. Further knowledge of the relationship between smoking withdrawal and impulsive behavior will provide insight into factors leading to the maintenance and relapse of smoking behavior. Treatments for ADHD that target these areas (i.e., inhibitory control, impulsivity) may be effective for smoking cessation or relapse prevention. These treatments may be particularly useful for at-risk populations (e.g., individuals who endorse ADHD symptoms or other impulse control problems).