Early Abstinence's Effect on Later Abstinence in Smokers

描述（由申请人提供）：美国每年有数百万吸烟者试图戒烟，但绝大多数人在戒烟后的头几天或几周内复发。在戒烟努力的最初几周，特别是前两周，保持禁欲与复发风险的急剧下降有关。事实上，在关于吸烟和其他药物滥用的文献中，有大量相关证据支持先前戒烟时间与复发风险之间的强相关性。 我们的研究小组进行了一系列实验室和准实验室研究，旨在严格和实验性地检查吸烟者早期和晚期戒烟之间的关系。在我们的模型中，应急管理（CM）程序提供了实验控制的吸烟者不试图戒烟，但愿意放弃作为研究的一部分，实现早期戒烟的数量。总的来说，这些研究的结果支持早期和晚期禁欲之间的直接因果关系。在吸烟者中开发关于这一主题的实验文献的下一步是进入寻求治疗的人群。在拟议的研究中，我们将使用CM程序来实验性地操纵寻求治疗者在戒烟尝试的最初两周内实现的戒断量。在14天戒烟监测期内，受试者将被随机分配以获得金钱支付，这取决于通过1x/天CO监测验证的戒烟情况（条件）或独立于戒烟情况（对照条件）。每天还将评估尼古丁戒断、吸烟的相对强化效应和相关措施。将在治疗入组后1个月和3个月进行随访评估，以评估吸烟状态。主要假设是，通过在偶然条件下通过CM增加早期禁欲，长期禁欲也将相对于对照条件增加。此外，我们还将研究尼古丁戒断的动态变化、吸烟的相对强化效应以及早期戒烟期间的相关措施如何与复发风险相关。 总的来说，拟议的研究有可能有效地提供新的信息，在戒烟治疗寻求者的早期和后期戒烟之间的直接关系。这些信息对于开发这一领域的实验文献至关重要，并可能最终导致更有针对性和更有效的干预措施，以针对我们国家的主要公共卫生问题之一。

DESCRIPTION (provided by applicant): Each year millions of cigarette smokers in the U.S. try to quit smoking, but the vast majority relapse within the first few days or weeks of the cessation effort. Sustaining abstinence through the initial weeks of a cessation effort, particularly the first two weeks, is associated with a precipitous decline in relapse risk. Indeed, there is substantial correlational evidence in the literature on smoking and other drug abuse supporting strong associations between the duration of prior abstinence and relapse risk. Our group has conducted a series of laboratory and quasi-laboratory studies designed to rigorously and experimentally examine the relationship between early and later abstinence in cigarette smokers. In our model, a contingency-management (CM) procedure provides experimental control over the amount of early smoking abstinence achieved by smokers who are not trying to quit, but are willing to abstain as part of a study. Collectively, the results of these studies support a direct, causal relationship between early and later abstinence. The next step in developing an experimental literature on this topic in smokers is to move into a treatment-seeking population. In the proposed study, we will use a CM procedure to experimentally manipulate the amount of abstinence achieved during the initial two weeks of a quit attempt by treatment seekers. Participants will be randomized to earn monetary payments contingent on smoking abstinence verified by 1x/day CO monitoring (contingent condition) or independent of smoking abstinence (control condition) during a 14-day abstinence-monitoring period. Nicotine withdrawal, the relative reinforcing effects of smoking, and related measures will also be assessed daily. Follow-up assessments will be conducted 1 and 3 months after treatment entry to assess smoking status. The primary hypothesis is that by increasing early abstinence via CM in the contingent condition, longer-term abstinence will also increase relative to the control condition. In addition, we will examine how dynamic changes in nicotine withdrawal, the relative reinforcing effects of smoking, and related measures during early abstinence may relate to relapse risk. Overall, the proposed study has the potential to effectively contribute new information on the direct relationship between early and later abstinence in smoking-cessation treatment seekers. Such information is essential for the development of an experimental literature in this area and may ultimately lead to more focused and effective interventions to target one of our nation s major public health problems.