Evaluation of Learning-Theory-Based Smoking Cessation Strategies

描述（由申请人提供）：拟议的临床试验将评估两种治疗策略激活的疗效和机制，旨在帮助人们实现永久戒烟。关于药物动机和学习的基础研究表明，改变环境事件、药物使用和戒烟前使用的强化后果之间的联系可能会提高戒烟的成功率。在美国，吸烟仍然是导致成年人死亡的主要可预防原因1，而复发仍然是任何戒烟尝试的最有可能的结果2。尽管先进的治疗方法帮助许多人戒烟，但更多的人希望戒烟，但尽管一再尝试，却未能成功。拟议的项目将采用实验设计来评估两种治疗策略的有效性，这两种治疗策略旨在改变吸烟与其前因后果之间明显的学习关联。第一种策略包括通过七个逐渐延长的戒烟期，或“练习戒烟”阶段，逐步暴露在令人厌恶的尼古丁戒断症状中，然后是一个令人厌恶的吸烟控制程序，这将减少每次练习戒烟后重新吸烟的强化效应。第二种策略是在戒烟尝试的前6周抽去尼古丁的香烟，通过联想效应暂时减少戒断，然后停止尼古丁的自我服用仪式。拟议的研究包括3种处理条件。所有受试者将接受标准戒烟治疗（ST），包括6周的透皮尼古丁贴片治疗和个人戒烟咨询。对照条件只接受这种处理。标准治疗加戒断暴露+烟雾保持（ST+WE/SH）条件的受试者也将在戒烟前接受分级戒断暴露和烟雾保持。最终状态（ST+WE/SH+DC）的受试者将接受标准治疗，戒断暴露和烟雾保持，并在戒烟后提供6周的脱硝香烟。我们预测，相对于ST条件，ST+ We /SH会促进禁欲，相对于ST+ We /SH， ST+ We /SH+DC会促进禁欲。我们预测，ST+ We /SH将主要消除吸烟及其前因（例如，戒断痛苦）之间的习得关联，而ST+ We /SH+DC将在戒烟尝试的早期提供条件戒断缓解，并最终消除吸烟与其积极后果之间的关联。我们将使用中介分析来调查这些假设。这项研究的目标是确定新的、基于学习的治疗成分，这些成分可以添加到现有的治疗中，以提高戒烟的成功率。

DESCRIPTION (provided by applicant): The proposed clinical trial will assess the efficacy of and mechanisms of change activated by two treatment strategies designed to help people achieve permanent abstinence from tobacco. Basic research on drug motivation and learning suggests that altering associations among setting events, drug use, and the reinforcing consequences of use prior to a smoking cessation attempt may enhance success in quitting. Smoking remains the leading preventable cause of death among adults in the U.S.1 and relapse remains the most likely outcome of any smoking cessation attempt2. Although treatment advances have helped many people quit smoking, many more wish to quit but fail to do so despite repeated attempts2. The proposed project will use an experimental design to assess the efficacies of two treatment strategies designed to alter distinct learned associations between smoking and its antecedents and consequences. The first strategy involves graded exposure to aversive nicotine withdrawal symptoms through seven progressively longer periods of abstinence, or "practice quitting" sessions, followed by an aversive smoke holding procedure that will reduce the reinforcing effects of returning to smoking after each practice quitting session. The second strategy involves smoking denicotinized cigarettes for the first 6 weeks of a quit attempt in order to temporarily reduce withdrawal through associative effects and then extinguish the nicotine self-administration ritual. The proposed study comprises 3 treatment conditions. All subjects will receive a standard cessation treatment (ST) including a 6-weeks course transdermal nicotine patch therapy and individual smoking cessation counseling. The control condition will receive only this treatment. Subjects in the standard treatment plus Withdrawal Exposure + Smoke Holding (ST+WE/SH) condition will also receive graded withdrawal exposure and smoke holding pre-quit. Subjects in the final condition (ST+WE/SH+DC) will receive standard treatment, withdrawal exposure and smoke holding, and a 6-week supply of denicotinized cigarettes to smoke after quitting use of usual-brand cigarettes. We predict that ST+WE/SH will promote abstinence, relative to the ST condition, and that ST+WE/SH+DC will promote abstinence relative to ST+WE/SH. We predict that ST+WE/SH will primarily extinguish learned associations between smoking and its antecedents (e.g., withdrawal distress) whereas ST+WE/SH+DC will provided conditioned withdrawal relief in the early part of the quit attempt and will ultimately extinguish associations between smoking and its positive consequences. We will investigate these hypotheses using mediation analyses. The goal of this research is to identify new, learning-based treatment components that can be added to existing treatments to increase successful smoking cessation. PUBLIC HEALTH RELEVANCE: The proposed study will test two treatment strategies designed to help smokers quit smoking. The study will tell us whether combining distinct treatments enhances quitting rates and will identify changes that may account for treatment benefits. The project will test the efficacy of behavioral and pharmacological treatments designed to interrupt learned associations among triggers to smoke, smoking behavior, and the positive consequences of smoking.