Treatment of Smoking Among Individuals with PTSD

创伤后应激障碍 (PTSD) 患者吸烟的治疗

• 批准号: 8074405
• 负责人: EDNA B FOA
• 金额: $ 63.33万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-30 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8074405
• 关键词: Abstinence; Address; Affect; Alcohol dependence; Anger; Anxiety; Applications Grants; Area; Arousal; Behavior; Bupropion; Cessation of life; Chronic; Chronic Post Traumatic Stress Disorder; Cigarette; Cognitive Therapy; Comorbidity; Consumption; Data; Dependence; Development; Disease; Distress; Epidemiology; Fright; Guidelines; Health; Health Policy; Individual; Institute of Medicine (U.S.); International; Lead; Light; Maintenance; Measures; Mental Depression; Mental disorders; Naltrexone; Nicotine; Nicotine Dependence; Outcome Measure; Persons; Pharmaceutical Preparations; Pharmacotherapy; Pilot Projects; Placebos; Population; Post-Traumatic Stress Disorders; Prevalence; Process; Psychological reinforcement; Psychopathology; Psychotherapy; Public Health; Publishing; Randomized; Randomized Controlled Trials; Recommendation; Recording of previous events; Relapse; Research; Research Design; Risk; Risk Factors; Role; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Staging; Study models; Substance Use Disorder; Surveys; Symptoms; Testing; Theoretical model; Time; Tobacco Dependence; Withdrawal; Withdrawal Symptom; Withholding Treatment; base; cigarette smoking; combat; comparative efficacy; cost effectiveness; dependence relapse; drinking; evidence base; experience; follow-up; improved; innovation; model development; multi-site trial; nicotine craving; placebo controlled study; premature; primary outcome; programs; randomized trial; secondary outcome; smoking cessation; smoking prevalence; success; treatment program; varenicline

DESCRIPTION (provided by applicant): This study will evaluate an innovative program for smokers with Post-Traumatic Stress Disorder (PTSD) that integrates the most effective medication for smoking cessation (varenicline) with prolonged exposure (PE), a highly efficacious cognitive behavioral therapy for PTSD. The development of specifically tailored and more efficacious smoking cessation treatments for smokers with psychiatric disorders, whose cigarette smoking is disproportionately high, has been identified as a high priority in public health policy. PTSD is a common mental disorder with a lifetime prevalence of 6.8%. The prevalence of smoking in people with current PTSD is 44.6% -- double the rate of those with no history of a psychological disorder (22.5%). Smokers with PTSD are more likely to be nicotine dependent, smoke heavily, experience more severe withdrawal symptoms, and relapse after a quit attempt. In fact, the quit rate for smokers with PTSD is among the lowest compared to other mental disorders. Factors that may contribute to smokers' progression to nicotine dependence and relapse include negative affect, fear, anxiety sensitivity, increased arousal, irritability, and anger. Therefore, the integration of treatment for smoking cessation with treatment for PTSD that reduces these factors is hypothesized to improve success of smoking cessation about smokers with PTSD. To test this hypothesis, we will randomly assign smokers with PTSD to either the "best practice" pharmacotherapy for smoking cessation (varenicline) alone or to a treatment that integrates varenicline with PE. The primary outcome measure will be biochemically confirmed abstinence rates at the end of treatment and at follow-up 6-months post quit date. Secondary outcome measures will be continuous abstinence, prolonged abstinence, and time to relapse. We will also obtain measures of PTSD and associated psychopathology (e.g. depression and anxiety) and risk factors (e.g. anxiety sensitivity). Collectively, our research group has expertise in the development of efficacious treatments for PTSD, including PE (Foa, Cahill, Hembree), the epidemiology of smoking and psychiatric disorders (Breslau), and smoking cessation (Lerman, O'Brian, Gariti). The proposed research affords a unique opportunity to combine experts from diverse areas with the aim of developing an innovative, integrated approach to the treatment of people who are likely to fail using existing treatments. PUBLIC HEALTH RELEVANCE: Cigarette smoking is the single most preventable cause of premature death in the US; approximately 50% of long-term smokers die of a disease caused by their dependence, shortening lives by an average of 13-14 years. Smokers with Post Traumatic Stress Disorder (PTSD) are more likely to be nicotine dependent, to smoke heavily (25 cigarettes per day or more), experience more severe withdrawal symptoms, and relapse following a quit attempt than smokers without PTSD. In this grant application, we propose to evaluate an innovative treatment program for smokers with PTSD that integrates varenicline, the most effective medication for smoking cessation, with prolonged exposure therapy, a highly effective form of psychotherapy for PTSD.

描述（由申请人提供）：本研究将评估针对创伤后应激障碍（PTSD）吸烟者的创新计划，该计划将最有效的戒烟药物（VAREnicline）与长期暴露（PE）（一种高效的PTSD认知行为治疗）相结合。为患有精神疾病的吸烟者（吸烟的吸烟者的饮用者量不高的吸烟者）的开发被确定为公共卫生政策中的重中之重。 PTSD是一种常见的精神障碍，终生患病率为6.8％。当前PTSD患者吸烟的患病率为44.6％，是没有心理障碍史的人的两倍（22.5％）。患有PTSD的吸烟者更有可能依赖尼古丁，大量吸烟，经历更严重的戒断症状以及戒烟尝试后复发。实际上，与其他精神障碍相比，患有PTSD的吸烟者的戒烟率最低。可能有助于吸烟者向尼古丁依赖和复发进展的因素包括负面影响，恐惧，焦虑敏感性，唤醒，易怒和愤怒。因此，假设将吸烟戒烟与PTSD治疗的治疗相结合，以提高使用PTSD吸烟者的吸烟戒烟的成功。为了检验这一假设，我们将单独将具有PTSD的吸烟者随机分配给“最佳实践”药物疗法（varenicline），或者将吸烟者分配给将Varenicline与PE整合的治疗方法。主要结局措施将在治疗结束时和随访6个月后的生化确认的戒酒率。次要结果度量将是连续的戒酒，延长的戒酒和复发时间。我们还将获得PTSD和相关心理病理学（例如抑郁和焦虑）和危险因素（例如焦虑敏感性）的度量。总的来说，我们的研究小组在开发PTSD的有效治疗方法方面具有专业知识，包括PE（FOA，Cahill，Hembree），吸烟和精神疾病的流行病学（Breslau）（Breslau）和吸烟戒烟（Lerman，O'Brian，Gariti）。拟议的研究为将各个领域的专家相结合，以开发一种创新的，综合的方法来治疗可能无法使用现有治疗方法的人进行治疗。 公共卫生相关性：吸烟是美国过早死亡的最可预防的原因；大约50％的长期吸烟者死于由于其依赖性引起的疾病，平均寿命缩短了13 - 14年。患有创伤后应激障碍（PTSD）的吸烟者更可能是尼古丁依赖性的，大量吸烟（每天25支香烟或更多），经历更严重的戒断症状，​​并在戒烟尝试后复发，而不是没有PTSD的吸烟者。在此赠款应用中，我们建议评估针对患有PTSD吸烟者的创新治疗计划，该治疗方法整合了Varenicline，这是最有效的戒烟药物，以及长期暴露疗法，这是PTSD的高效心理治疗形式。