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，戒烟后很快就会复发。即使是那些接受药物治疗的人也会迅速恢复吸烟。大约25%的人在尝试戒烟后1天内吸烟，50%在戒烟后1周内吸烟，60-70%在戒烟后2周内吸烟。如果可以预防这种早期吸烟的复发，那么戒烟尝试的成功率应该会高得多。已经发现，那些能够保持禁欲2周或更长时间的人在戒烟尝试中成功的可能性显着提高。 我们提出了一个2组设计来研究“前负荷”治疗程序的有效性。我们计划确定提供早期咨询，在最有可能复发的时候进行，是否会提高成功戒烟的可能性。根据临床指南的建议，我们拟定研究中的所有400例受试者都将接受药物治疗（通过尼古丁贴片替代尼古丁）。一半的样本将被随机分配到一个“标准咨询”小组，每周接受一次咨询。第二组200名吸烟者将被随机分配到“前负荷”咨询条件下，会议时间与戒烟后最有可能复发的日子（戒烟后第1 - 14天）一致。两个治疗组的咨询会议内容和次数完全相同。 据我们所知，这项研究将是第一个在精心控制的实验设计中研究“复发敏感”前负荷咨询是否会显着提高认真戒烟尝试的吸烟者的戒烟率。我们还将研究潜在的机制，通过前置辅导可能调解成功的禁欲。我们认为这项研究是测试概念简单但可能强大的治疗效果的重要第一步，可以提高戒烟后早期和数周的成功率。如果我们关于“前负荷”咨询的有效性的中心假设得到支持，这一发现似乎对成瘾吸烟者的治疗有直接的临床意义。

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.