Impulsivity and Relapse Prevention in Smoking

说明(申请人提供)：吸烟是发达国家发病率和死亡率的最大可预防风险因素。越来越多的基于问卷的研究表明，吸烟者比不吸烟者更冲动，这表明冲动可能是吸烟习得、维持和复发的一种机制。然而，影响吸烟者冲动的条件几乎是未知的，基于问卷和基于行为的冲动测量之间的关系也仍然不清楚。在拟议的项目中，吸烟者将在实验室环境中选择立即增强剂和延迟增强剂。这个实验室模型很好地捕捉到了复发的一个核心特征：当选择立即烟雾增强剂而不是延迟的替代增强剂时，戒烟者会复发。该项目将采用强大的基于问卷和行为的实验室准备，并检查一个与治疗相关的问题：什么条件影响冲动的选择？正在进行的研究表明，剥夺尼古丁会增加吸烟的冲动选择和总体上的冲动。这项拟议的研究将检验药物干预对冲动的影响。这是一种尼古丁贴片，预计将使冲动的选择恢复到非剥夺水平。该实验室模型对于预防复发的药理学和行为学干预措施的初步测试可能非常有用。例如，利用动物模型开发的减少冲动选择的方法可以在吸烟者身上进行评估，并可能导致新的治疗策略。更广泛地说，该模型可以加深我们对关键变量(例如，线索暴露、上下文因素、尼古丁剥夺、滥用药物、药物治疗、压力等)是否以及如何影响导致或防止复发的冲动选择的理解。

DESCRIPTION (provided by applicant): Cigarette smoking is the largest preventable risk factor for morbidity and mortality in developed countries. There is growing evidence from questionnaire-based research that smokers are more impulsive than nonsmokers, suggesting that impulsivity could be one mechanism operating in the acquisition, maintenance, and relapse of cigarette smoking. However, the conditions that affect impulsivity in smokers are virtually unknown, and the relationship between questionnaire- and behavior-based measures of impulsivity remains unclear. In the proposed project, smokers will choose between immediate reinforcers and delayed reinforcers in a laboratory setting. This laboratory model nicely captures a central characteristic of relapse: An abstaining smoker relapses when an immediate smoke reinforcer is chosen over a delayed alternative reinforcer. The project will adapt powerful questionnaire- and behavior-based laboratory preparations and examine a treatment-relevant question: What conditions influence impulsive choice? Ongoing studies are showing that nicotine deprivation increases impulsive choices to smoke and impulsivity in general. The proposed study will examine the effects of a pharmacological intervention on impulsivity. The intervention, a nicotine patch, is expected to return impulsive choice to non-deprivation levels. The laboratory model may be enormously useful for initial testing of both pharmacological and behavioral interventions designed for relapse prevention. For instance, methods to decrease impulsive choice developed using animal models can be assessed in smokers and could lead to novel treatment strategies. More generally, the model could further our understanding about whether and how critical variables (e.g., cue exposure, contextual factors, nicotine deprivation, drugs of abuse, pharmacotherapies, stress, etc) affect the impulsive choices that lead to or prevent relapse.