Maintaining Abstinence in Chronic Cigarette Smokers

描述(由申请人提供)： 这一系列研究的总体目标是治疗慢性吸烟者，并了解这些吸烟者与吸烟和复发相关的过程。联合使用抗抑郁剂、尼古丁替代疗法(NRT)和心理干预可产生较高的初始戒断率。我们正在进行的工作表明，延长治疗可以保持这些比率，在一年中实现大于或等于60%的戒断率。 将测试一系列关于延长抗抑郁药物治疗和基于经验的行为复发预防干预的有效性的假设。有五个实验条件。慢性吸烟者(N=400)接受为期12周的联合药物治疗(缓释安非他酮+尼古丁贴片)和心理干预，然后按安慰剂对照、双盲设计被随机分配到五种情况之一：(1)安非他酮40周加内科治疗(主动/MM)；(2)40周安慰剂加内科治疗(安慰剂/MM)；(3)40周安非他酮+行为预防复发(主动/RP)；(4)40周安慰剂+行为复发预防(安慰剂/RP)；(5)没有进一步治疗(简短治疗)。创新的行为复发预防干预将集中在五个普遍认为是戒烟后重要的领域。这些是波动的动机、抑郁、戒断/依赖、体重增加和社会支持。参与者将在基线上接受吸烟行为、尼古丁依赖、精神诊断、人口统计学和愤怒、焦虑、抑郁、情绪障碍、社会支持、压力、健康状况、改变动机以及药物和酒精使用的评估。在12周、24周、36周、52周、周和第104周，参与者将接受一氧化碳和Anatabine/anabasine检测证实的吸烟自我报告以及心理测量方面的评估。这项拟议的研究将解决治疗预后不良的吸烟者的重大问题，包括制定保持戒烟的策略，确定扩展药物治疗的有效性，以及确定行为复发预防干预的有效性。

DESCRIPTION (provided by applicant): The overall goals of this line of research are to treat chronic cigarette smokers and to understand the processes related to smoking and relapse in these smokers. Combined treatment with antidepressants, nicotine replacement therapies (NRT), and psychological intervention produces high initial abstinence rates. Our ongoing work suggests that extended treatment can maintain these rates, achieving abstinence rates greater than or equal too 60% at one year. A series of hypotheses about the efficacy of extended antidepressant treatment and an empirically based behavioral relapse prevention intervention will be tested. There are five experimental conditions. Chronic smokers (N=400) receive 12 weeks of combined pharmacological treatment (sustained release bupropion + nicotine patch) and psychological intervention, and then are randomly assigned to one of five conditions in a placebo-controlled, double-blind design: (1) 40 weeks active bupropion with medical management (Active/MM); (2) 40 weeks placebo drag with medical management (Placebo/MM); (3) 40 weeks bupropion + behavioral relapse prevention (Active/RP); (4) 40 weeks placebo + behavioral relapse prevention (Placebo/RP); (5) no farther treatment (Brief Treatment). The innovative behavioral relapse prevention intervention will focus on five areas generally agreed to be important post-cessation. These are fluctuating motivation, depression, withdrawal/dependence, weight gain and social support. Participants will be assessed at baseline on smoking behavior, nicotine dependence, psychiatric diagnosis, demographics and measures of anger, anxiety, depression, mood disturbance, social support, stress, health status, motivation for change, and drug and alcohol use. At weeks 12, 24, 36, 52, 64, and 104, participants will be assessed on self-reports of smoking verified by carbon monoxide and anatabine/anabasine assays, as well as on psychometric measures. The proposed research will address significant issues in the treatment of poor prognosis smokers, including the development of strategies to maintain abstinence, determination of the efficacy of extended pharmacological treatment, and determination of the efficacy of a behavioral relapse prevention intervention.