Self-Control Improvement Intervention (SCII): Improving Abstinence in Smokers. More than 15 years of our translational research has shown that discounting (i.e., devaluing) future rewards in favor of immediate rewards (which we will refer to as self-control failure) is endemic among individuals addicted to cigarettes and other drugs. Indeed, we propose that individuals who excessively discount future rewards may be "stimulus bound" and more susceptible to drug-related cues and negative consequences. Consistent with this view, treatment success among smokers is inversely correlated with their rates of discounting. Unfortunately, no research translating basic findings on excessive discounting among smokers into clinical treatments has been conducted. This proposed project is a systematic effort to translate basic research on self-control failure into effective interventons to normalize or improve self-control among smokers. In the first phase, a laboratory study will determine if smokers with less self-control are more stimulus bound. Within this phase, we will delineate the target for subsequent intervention, self-control failure (i.e., excessive discounting, and its functional relation to measures that could determine whether smokers are stimulus bound under cigarette available and deprivation conditions. Concurrently, we will examine the quantitative relation between smokers'discounting rates and responsiveness to those measures. In the second phase, we will conduct a proof-of-concept field study testing a novel Self-Control Improvement Intervention (SCII). This intervention is based on our prior work demonstrating that working memory training (hereafter, SCII) improves self-control in stimulant-dependent individuals. We will examine (1) whether SCII decreases the extent to which smokers are stimulus bound, and (2) if this decrease in being stimulus bound is dependent on baseline self- control level. In the third phase, we will seek to improve current smoking cessation treatments (i.e., combination cognitive behavioral therapy and nicotine replacement therapy) that have been shown to be efficacious, but still fail to produce abstinence in the vast majority o participants. This will be accomplished by incorporating SCII into the multi-modal smoking treatment program among those individuals who we demonstrated to be sensitive to the SCII in Phase 2.
Despite smoking being the single largest preventable cause of mortality and morbidity in the U.S., even the most efficacious smoking cessation treatments fail to produce abstinence among the majority of smokers. As self-control failure is a major source of poor treatment outcomes among smokers, a greater understanding of self-control failure and its repair could lead to new and more refined approaches to smoking cessation treatment. We will attempt to improve treatment outcomes in three inter-related Aims: (1) a basic research study to characterize, in detail, self-control failure among smokers and its relationship to measures that suggest smokers are more sensitive to the immediate environment (stimulus bound), (2) a proof-of-concept study to characterize a novel Self-Control Improvement Intervention (SCII) on measures indicative of being stimulus bound among smokers, and (3) a pilot/feasibility study to address the role of our SCII in a multi-modal smoking cessation treatment regimen.
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