Withdrawal Trajectory Predictors of Smoking Relapse

通过分析NIDA资助的四项已完成研究的结果，修订后的R03提案的主要目标是 评估长期吸烟复发是否可以通过减少积极情绪(PA)和 在吸烟的最初几天和一个月中，认知功能(CF)和PA和CF的缓慢恢复 禁欲持续至少31天的人。第二个研究目标是重复研究结果 (Zuo等人，2017)在禁欲的最初几天，负面影响(NA)的缓慢消散预测了两者 短期和长期的吸烟复发。这项研究的第三个目标是使用四项研究的数据来 编制临床有用的复发风险量表(短期认知-情感复发风险量表[SCARRS]) 基于研究中最具预测性的戒断症状项目。而NA被评估为 左氏等人复发的预测因素。研究收集了PA和CF，但没有评估为潜在的预测因素 在四项研究中的任何一项中，每项研究都评估了吸烟戒断症状(SWS)的轨迹 至少31天的受激励的、经过生化验证的戒烟，并收集到复发 在3、6、9和12个月时的信息。在研究中评估这些关系的优势在于提供了 在前31天内保持禁欲的激励措施是，正常情况下 复发并因此未被包括在评估样本中的被维持在禁欲状态， 避免那些患有最严重的SWSS的人复发并不包括在 研究人口。排除这些人通常会导致低估SWS的严重性和持续时间 并最大限度地减少了评估SWS与那些保持初步禁欲的人复发的关系的能力。 此外，相当大一部分吸烟者在31天以上后复发。如果NA消散缓慢和/或恢复缓慢 在早期禁欲期间PA和/或CF的变化被发现预测以后复发的持续风险，这些变量 可能是干预的有效目标，以增加难治性SWSS患者的长期戒断率。至 促进临床适应，我们将根据统计数据生成一个简短的复发风险SWS预测因子 从使用的标准较长的SWSS衡量标准中确定最有效地预测复发的项目 在这四项研究中。为了探讨个体化干预的最早时间窗口，我们将评估 在禁欲的第3天到第31天，SWSS的消失率可以作为 复发的意义；具体地说，从基线到第三天，SWSS是否有更大的增长 戒酒后第3天至第6天以及戒酒第12天和第31天的SWSS消退速度均较慢 预测复发，即使在控制了渴望之后。数据的增长曲线与Logistic回归分析 所有研究的组合将被用来评估个人的SWS轨迹参数的关联性 戒烟后3个月和1年的戒断结果与渴求有关。发现非常简短的(例如， 12-20项)SCARRS可以识别复发的高危个体，可能导致其在临床上的广泛应用。

By analyzing the results from four completed NIDA-funded studies, the major goal of this revised R03 proposal is to assess whether long-term smoking relapse is predicted by decreases in positive affect (PA) and cognitive functioning (CF) and by slow recovery of PA and CF during the first days and month of smoking abstinence in those who maintain abstinence for at least 31 days. A second study goal is to replicate findings (Zuo et al., 2017) that slow dissipation of negative affect (NA) during the first days of abstinence predicts both short- and long-term relapse to smoking. The third goal of the study is to use data from the four studies to generate a clinically useful risk-for-relapse scale (Short Cognitive-Affective Relapse Risk Scale [SCARRS]) based on the most predictive withdrawal-symptom items from the studies. While NA was assessed as a predictor of relapse in the Zuo et al. study, PA and CF were collected but not assessed as potential predictors in any of the four studies, each of which assessed smoking withdrawal symptom (SWS) trajectories for a minimum of 31 days of incentivized, biochemically verified smoking abstinence, and collected relapse information at 3, 6, 9, and 12 months. An advantage of assessing these relationships in studies that provided incentives for maintaining abstinence during the first 31+ days is that individuals who normally would have relapsed and therefore not have been included in the assessed sample are maintained in the abstinent state, something that avoids the problem of those with the most severe SWSs relapsing and not being included in the study population. Exclusion of such individuals typically results in underestimates of SWS severity and duration and minimizes the ability to assess the relationship of SWS to relapse in those who maintain initial abstinence. In addition, a sizable portion of smokers relapse after 31+ days. If slow dissipation of NA and/or slow recovery of PA and/or CF during early abstinence are found to predict a persistent risk for later relapse, these variables may be valid targets for interventions to increase long-term cessation in individuals with refractory SWSs. To facilitate clinical adaptation, we will generate a brief SWS predictor of risks for relapse based on the statistical identification of items that most effectively predict relapse from the standard lengthier measures of SWSs used in the four studies. To probe the earliest time window for individualized intervention, we will assess whether the rate of dissipation of SWSs across days 3 through 31 of abstinence can be established as markers of significance for relapse; and specifically, whether greater increases in SWSs from baseline to the third day of abstinence, slower resolution of these SWSs from day 3 to day 6 and to day 12 and 31 of abstinence are each predictive of relapse, even after controlling for craving. Growth curve and logistic regression analyses for data combined across the studies will be used to assess associations of an individual’s SWS trajectory parameters and craving with the abstinence outcomes at 3-month and 1-year postquit. A finding that the very brief (e.g., 12-20 item) SCARRS can identify individuals at high risk for relapse could lead to its widespread clinical use.