Although women may be particularly susceptible to the damaging effects of chronic cigarette smoking, evidence indicates that they may have more difficulty in maintaining smoking cessation than men. Given women's reduced response to nicotine replacement and other traditional treatments, habitual cigarette smoking, more targeted pharmacotherapy and intervention strategies may be necessary to improve their quit rates. Preliminary data by our group and others indicate that the opioid antagonist naltrexone may be an effective pharmacotherapy approach for female smokers. The purpose of the proposed study is to conduct a randomized clinical trial to compare adjunct treatment with 50 mg oral naltrexone vs. placebo in conjunction with standard smoking cessation treatment with nicotine patch and counseling. Participants (N=324) will be randomized to receive either naltrexone or placebo starting one week prior to the quit date (25 mg for three days; 50 mg thereafter) and continue for 12 weeks after the quit date. The effects of naltrexone will be evaluated during the pre-quit date period, initial smoking cessation, relapse prevention, and at one-year follow-up. It is hypothesized that sex will moderate the effects of naltrexone on outcome, with naltrexone improving prolonged abstinence quit rates in women but not in men. The secondary goal will be to elucidate the mechanisms underlying women's treatment response to naltrexone. Weight (relative weight gain and weight concerns) and smoking-related variables (reduced cigarette pleasure, taste, craving and relief of negative withdrawal affect) may be important factors by which naltrexone improves quit rates in women. Medication compliance, psychosocial stress and levels of naltrexone's metabolite, 6-|3-naltrexol, will also be examined. In sum, the proposed clinical trial will provide a comprehensive study of sex differences in response to adjunct treatment with naltrexone for smoking cessation. Given the public health concerns and significant health consequences of women's continued high rates of smoking, the proposed study may provide important information on a novel treatment strategy targeting the endogenous opioid system to selectively aid in women's smoking cessation.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA016834-03
Application #
7232733
Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Hoffman, Allison
Project Start
2005-09-01
Project End
2010-05-31
Budget Start
2007-06-01
Budget End
2008-05-31
Support Year
3
Fiscal Year
2007
Total Cost
$627,496
Indirect Cost
Name
University of Chicago
Department
Psychiatry
Type
Schools of Medicine
DUNS #
005421136
City
Chicago
State
IL
Country
United States
Zip Code
60637
Roche, Daniel J O; Ray, Lara A; Yardley, Megan M et al. (2016) Current insights into the mechanisms and development of treatments for heavy drinking cigarette smokers. Curr Addict Rep 3:125-137
Fucito, Lisa M; Toll, Benjamin A; Roos, Corey R et al. (2016) Smokers' Treatment Expectancies Predict Smoking Cessation Success. J Smok Cessat 11:143-149
Bress, Adam; Kittles, Rick; Wing, Coady et al. (2015) Genetic ancestry as an effect modifier of naltrexone in smoking cessation among African Americans: an analysis of a randomized controlled trial. Pharmacogenet Genomics 25:305-12
Roche, Daniel J O; King, Andrea C (2015) Sex differences in acute hormonal and subjective response to naltrexone: The impact of menstrual cycle phase. Psychoneuroendocrinology 52:59-71
Fridberg, Daniel J; Cao, Dingcai; Grant, Jon E et al. (2014) Naltrexone improves quit rates, attenuates smoking urge, and reduces alcohol use in heavy drinking smokers attempting to quit smoking. Alcohol Clin Exp Res 38:2622-9
King, Andrea; Cao, Dingcai; Zhang, Lingjiao et al. (2013) Effects of the opioid receptor antagonist naltrexone on smoking and related behaviors in smokers preparing to quit: a randomized controlled trial. Addiction 108:1836-44
King, Andrea C; Cao, Dingcai; Zhang, Lingjiao et al. (2013) Naltrexone reduction of long-term smoking cessation weight gain in women but not men: a randomized controlled trial. Biol Psychiatry 73:924-30
King, Andrea C; Cao, Dingcai; O'Malley, Stephanie S et al. (2012) Effects of naltrexone on smoking cessation outcomes and weight gain in nicotine-dependent men and women. J Clin Psychopharmacol 32:630-6
King, Andrea C; Cao, Dingcai; Southard, Catherine C et al. (2011) Racial differences in eligibility and enrollment in a smoking cessation clinical trial. Health Psychol 30:40-8
Sánchez-Johnsen, Lisa A P; Carpentier, Michelle R; King, Andrea C (2011) Race and sex associations to weight concerns among urban African American and Caucasian smokers. Addict Behav 36:14-7

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