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，并了解这些吸烟者吸烟和复吸的相关过程。抗抑郁药、尼古丁替代疗法（NRT）和心理干预的联合治疗可提高初始戒烟率。我们正在进行的工作表明，延长治疗可以维持这些比率，在一年内实现禁欲率大于或等于60%。 一系列关于扩展抗抑郁治疗和基于经验的行为复发预防干预的有效性的假设将被检验。有五个实验条件。慢性吸烟者（N=400）接受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，然后在安慰剂对照的双盲设计中随机分配到五种条件之一：（1）40周的活性安非他酮与药物管理（活性药物/MM）;（2）40周安慰剂药物联合药物管理（安慰剂/MM）;（3）40周安非他酮+行为复发预防（活性/RP）;（4）40周安慰剂+行为复发预防（安慰剂/RP）;（5）无进一步治疗（短期治疗）。创新的行为复发预防干预将集中在五个领域，普遍认为是重要的戒烟后。这些是波动的动机，抑郁，退缩/依赖，体重增加和社会支持。参与者将在基线时评估吸烟行为，尼古丁依赖，精神病诊断，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测量。在第12周、第24周、第36周、第52周、第64周和第104周，将对参与者进行评估，评估通过一氧化碳和新烟草碱/毒木贼碱检测验证的吸烟自我报告以及心理测量。拟议的研究将解决预后不良吸烟者治疗中的重大问题，包括制定维持戒烟的策略，确定延长药物治疗的疗效，以及确定行为复发预防干预的疗效。

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.