Smoking Abstinence and Impulsive Behavior: A Multi-Process Model

描述（由申请人提供）：尽管与吸烟相关的严重健康后果，但它仍然是世界上可预防死亡的主要原因。戒烟后的复发率仍然很高，需要制定更有效的治疗策略。因此，探讨导致复吸的因素势在必行。当代烟草使用理论提出了一种自我药物模型，其中与禁欲相关的缺陷可能会导致冲动行为。然而，冲动是一个广泛定义的结构，很难确定哪些维度在复发中最重要。具体来说，吸烟者在戒烟时可能会经历抑制控制的减少和延迟相关冲动的增加。试图减轻这些缺陷，意想不到的后果可能是复发。这些禁欲引起的缺陷的程度可能与预先存在的症状有关。患有以抑制缺陷为特征的疾病（例如注意力缺陷/多动障碍（ADHD））的个体报告吸烟的患病率较高且戒烟率较低。为了扩大对这些过程之间关联的理解，拟议的研究将研究戒烟对抑制控制和冲动的多个方面的影响，这些影响来自于针对高水平和低水平ADHD症状选择的成年吸烟者样本。在受试者内设计中，吸烟者将完成一个剥夺12小时的疗程和一个非剥夺的疗程。拟议研究的具体目标是：1）检查禁欲对反应抑制的影响（例如，停止信号范例）、干扰控制（例如，惊吓的注意力修正），和延迟相关的冲动（例如，延迟折扣），2）检查这些测量之间的关系，3）检查是否与预先存在的缺陷相关的症状（即，注意力缺陷多动障碍（ADHD）症状）缓解目标1和2中的影响。阐述冲动性的多种测量方法将阐明它们之间的相互关系，以及它们是否反映了与吸烟行为相关的核心过程。综述综合现有的文献吸烟和多动症之间的遗传关联将被写入检查是否冲动意味着尼古丁依赖的内表型。进一步了解戒烟和冲动行为之间的关系将有助于深入了解导致吸烟行为维持和复发的因素。针对这些区域的ADHD治疗（即，抑制性控制、冲动性）可能对戒烟或预防复吸有效。这些治疗可能特别适用于高危人群（例如，认可ADHD症状或其他冲动控制问题的人）。

DESCRIPTION (provided by applicant): Despite the severe health consequences associated with cigarette smoking, it remains the leading cause of preventable death in the world. Relapse rates following cessation remain high, imparting the need for the development of more effective treatment strategies. Therefore, it is imperative to explore the factors leading to relapse. Contemporary theories of tobacco use have proposed a self-medication model in which abstinence-related deficits may potentially lead to impulsive behavior. However, impulsivity is a broadly defined construct making it difficult to determine which dimensions are most important in relapse. Specifically, a smoker may experience a decrement in inhibitory control and an increase in delay-related impulsivity while abstinent. By attempting to alleviate these deficits, the unintended consequence may be relapse. The degree to which these abstinence-induced deficits are experienced may be associated with pre-existing symptoms. Individuals with disorders characterized by inhibitory deficits, such as Attention- Deficit/Hyperactivity Disorder (ADHD), report higher prevalence rates of smoking and lower cessation rates. To broaden understanding of the association among these processes, the proposed research will examine the effects of smoking abstinence on multiple aspects of inhibitory control and impulsivity in a sample of adult smokers selected for high and low levels of ADHD symptoms. In a within-subjects design, smokers will complete one session 12 hours deprived and one session non-deprived. The specific aims of the proposed study are: 1) examine abstinence effects on response inhibition (e.g., Stop-signal paradigm), interference control (e.g., attentional modification of startle), and delay-related impulsivity (e.g., delay discounting), 2) examine the relationships among these measures, 3) examine whether symptoms associated with preexisting deficits (i.e., ADHD symptoms) moderate the effects in Aims 1 and 2. Incorporating multiple measures of impulsivity will elucidate their interrelationships and whether they reflect core processes related to smoking behavior. A review synthesizing existing literature on genetic associations between smoking and ADHD will be written to examine whether impulsivity signifies an endophenotype of nicotine dependence. Further knowledge of the relationship between smoking withdrawal and impulsive behavior will provide insight into factors leading to the maintenance and relapse of smoking behavior. Treatments for ADHD that target these areas (i.e., inhibitory control, impulsivity) may be effective for smoking cessation or relapse prevention. These treatments may be particularly useful for at-risk populations (e.g., individuals who endorse ADHD symptoms or other impulse control problems).