FRONT-LOADED COUNSELING TO TREAT TOBACCO ADDICTION

描述(由申请人提供)： 对于大多数试图戒烟的吸烟者来说，戒烟后不久就会复发。即使对那些接受药物治疗的人来说，吸烟也会迅速恢复。大约25%的人在戒烟后1天内吸烟，50%的人在戒烟后1周内吸烟，60%-70%的人在戒烟后2周内吸烟。如果可以防止这种早期戒烟，那么一次戒烟的成功率应该会高得多。研究发现，那些能坚持禁欲两周或更长时间的人戒烟成功的可能性明显提高。 我们建议采用两组设计来研究“前置式”治疗程序的疗效。我们计划确定在复发最有可能的时候提供早期咨询是否会提高成功戒烟的可能性。根据临床指南的建议，在我们拟议的研究中，所有400名受试者都将接受药物治疗(通过尼古丁贴片进行尼古丁替代)。我们样本的一半将被随机分配到“标准咨询”组，并将接受每周咨询。第二组200名吸烟者将被随机分配到“前置”咨询条件下，咨询时间安排在戒烟后最有可能复发的几天(戒烟后1-14天)。两个治疗组的咨询内容和次数将完全相同。 据我们所知，这项研究将是第一次通过精心控制的实验设计来检验，在认真尝试戒烟的吸烟者中，“复发敏感”的前置咨询是否会显著提高戒烟率。我们还将研究前置咨询可能调停成功禁欲的潜在机制。我们将这项研究视为测试概念上简单但潜在强大的精细化治疗的有效性的必要的第一步，以提高戒烟后早期和几周的成功率。如果我们关于“前置式”咨询有效性的中心假设得到支持，这一发现似乎会对烟瘾患者的治疗产生直接的临床影响。

DESCRIPTION (provided by applicant): Relapse occurs very soon after a quit-smoking attempt for the majority of smokers who try to quit. Rapid return to smoking occurs even for those given pharmacologic treatments. Approximately 25% smoke within 1 day of their quit attempts, 50% by 1-week post-cessation, and 60-70% by 2 weeks post-quit. If this early return to smoking could be prevented, success rates for a given quit attempt should be much higher. It has been found that those who can maintain abstinence for 2 weeks or more have a markedly-improved likelihood of succeeding in their quit attempts. We are proposing a 2-group design to study the efficacy of a "front-loaded" treatment procedure. We plan to determine if the provision of early counseling, timed to occur when relapse is most likely, will improve the likelihood of successful cessation. Following the recommendations of the Clinical Guidelines, all 400 subjects in our proposed study will be given pharmacologic treatment (nicotine replacement via nicotine patches). One half of our sample will be randomly assigned to a "standard-counseling" group, and will receive weekly counseling. The second set of 200 smokers will be randomly assigned to a "front-loaded" counseling condition, with sessions timed to coincide with the days post-cessation when relapse is most likely (Days 1 - 14 post-quit). The content and number of counseling sessions will be exactly the same for the 2 treatment groups. This study will be the first, to our knowledge, to examine, in a carefully-controlled experimental design, whether "relapse-sensitive" front-loaded counseling will significantly improve cessation rates among smokers making a serious quit-smoking attempt. We will also examine potential mechanisms through which front-loaded counseling may mediate successful abstinence. We see this study as an essential first step for testing the efficacy of a conceptually straightforward, but potentially powerful, treatment-refinement for enhancing success rates in the early days and weeks post-cessation. If our central hypothesis concerning the efficacy of "front-loaded" counseling is supported, this finding would seemingly have immediate clinical implications for the treatment of addicted smokers.