Neural basis of smoking relapse

 描述（由申请人提供）：吸烟是最大的可预防的死亡原因和重大的经济负担。即使有最好的治疗方法，大多数吸烟者在尝试戒烟后几天或几周内复发。为了显著提高戒烟率，我们需要更精确地了解为什么这么多试图戒烟的吸烟者会很快复吸。拟议的功能性磁共振成像（fMRI）研究整合了认知神经科学和行为科学领域的概念和工具，以确定早期戒烟的大脑状态如何影响寻求治疗的吸烟者的临床结果。这项假设驱动的研究的主要目的是：（1）确定增加吸烟复吸脆弱性的大脑机制，以及（2）测试吸烟复吸的综合大脑行为模型。使用我们验证的基于fMRI的戒烟挑战范例，200名寻求治疗的吸烟者将完成两次1小时的治疗前fMRI扫描：吸烟饱腹感后和确认戒烟24小时后。我们将研究在验证任务的执行过程中的神经和行为反应，探测工作记忆，线索反应，压力反应以及静息状态功能连接。参与者将 然后设定目标戒烟日期，接受戒烟咨询，并使用经验证的吸烟复吸方案监测6个月以评估复吸时间（天）。主要结果是复发时间。次要结局包括30天时的戒烟症状和吸烟状况。出于人类受试者的原因，研究完成后，将为复吸者提供免费接受8周尼古丁贴片治疗和咨询的机会。虽然神经影像学不太可能在不久的将来成为标准的戒烟前评估，但这项研究将阐明病理性神经行为过程和特定的神经认知领域，这些领域可以在新的治疗方法中成为目标，以帮助戒烟。

 DESCRIPTION (provided by applicant): Smoking is the greatest preventable cause of mortality and a significant economic burden. Even with the best available treatments, most smokers relapse within days or weeks after a quit attempt. To improve quit rates significantly, we need a more refined mechanistic understanding of why so many smokers who attempt to quit will relapse quickly. The proposed functional magnetic resonance imaging (fMRI) study integrates concepts and tools from the fields of cognitive neuroscience and behavioral science to determine how brain states in early abstinence influence clinical outcomes among treatment-seeking smokers. The primary aims of this hypothesis-driven study are: (1) to identify brain mechanisms that increase vulnerability to smoking relapse, and (2) to test an integrated brain-behavior model of smoking relapse. Using our validated fMRI-based abstinence challenge paradigm, 200 treatment-seeking smokers will complete two 1-hour pre- treatment fMRI scans: after smoking satiety and after 24 hours of confirmed abstinence. We will examine neural and behavioral responses during performance of validated tasks probing working memory, cue reactivity, and stress response as well as resting state functional connectivity. Participants will then set a target quit date, receive smoking cessation counseling, and be monitored for 6-months to assess time (days) to relapse, using a validated smoking relapse protocol. The primary outcome is time to relapse. Secondary outcomes include abstinence symptoms and smoking status at 30 days. For human subjects reasons, relapsing smokers will be offered an opportunity to receive 8 weeks of nicotine patch treatment and counseling free of charge following study completion. Although neuroimaging is not likely to become a standard pre- cessation assessment the near future, this study will elucidate pathological neurobehavioral processes and specific neurocognitive domains that can be targeted in new treatments to aid smoking cessation.