This treatment development project will provide valuable information about a novel approach to smoking cessation that intervenes aggressively with poor prognosis smokers who have had a smoking lapse during the first two post-cessation weeks. The model is based on previous observations that early smoking lapse is a powerful predictor of failure in smoking cessation attempts. It utilizes the most potent available empirically tested behavioral techniques, rapid smoking and counseling, combined with bupropion pharmacotherapy, to test a new lapse-contingent model of intervention. Rapid smoking with counseling is expected to counteract some of the adverse cognitive and physiological effects of self-initiated early smoking lapses through counter-conditioning. During the 3-year treatment development project we will 1) write a manual describing the new lapse-contingent rapid smoking plus counseling intervention, 2) train an appropriate staff member to administer the therapy, 3) implement therapist adherence and competency assessments, 4) conduct an open pilot study (n=12) of the new therapy, 5) make interim protocol and manual alterations as needed, and 6) evaluate the new treatment in a small sample (n=63) pilot study in which lapsers are randomly assigned to the full intervention, to intensive counseling only or to a control condition with no special intervention following their first post-cessation smoking lapse. Our hypothesis is that those receiving the full intervention with rapid smoking will have significantly better outcomes than either of the control groups at all follow-up time points (1, 3 and 6 months post-cessation). The novel concept here is to obtain more reliable initiation and early post-cessation abstinence, without which long-term success appears unlikely, by proactively intervening with those who do have an early smoking lapse in an attempt to improve their prognosis. Therapeutic procedures that reduce or reverse the detrimental effects of early lapse could be a significant breakthrough in improving smoking cessation rates.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA013125-03
Application #
6523112
Study Section
Special Emphasis Panel (ZDA1-SXC-O (04))
Program Officer
Grossman, Debra
Project Start
2000-09-05
Project End
2003-09-29
Budget Start
2002-09-01
Budget End
2003-09-29
Support Year
3
Fiscal Year
2002
Total Cost
$327,000
Indirect Cost
Name
Johns Hopkins University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
045911138
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Juliano, Laura M; Donny, Eric C; Houtsmuller, Elisabeth J et al. (2006) Experimental evidence for a causal relationship between smoking lapse and relapse. J Abnorm Psychol 115:166-73
Juliano, Laura M; Houtsmuller, Elisabeth J; Stitzer, Maxine L (2006) A preliminary investigation of rapid smoking as a lapse-responsive treatment for tobacco dependence. Exp Clin Psychopharmacol 14:429-38