A significant percentage of individuals attempting smoking cessation lapse to smoking within a matter of days, and very few are able to recover to achieve abstinence from smoking. Current models of relapse devote insufficient attention to this phenomenon of early lapse. Studies attempting to relate severity of nicotine withdrawal symptoms to short-term smoking cessation outcomes have yielded equivocal results. We believe that how one reacts to the discomfort of nicotine withdrawal and quitting smoking is a more promising avenue of investigation and may have important treatment implications. Early smoking lapsers (i.e., smokers who have never been able quit smoking for more than 72 hours) represent a particular high-risk group who would benefit from specialized smoking cessation treatment to address their unique needs. In the present application, we propose to develop and obtain preliminary data on the efficacy of a distress tolerance treatment (DT) for early lapsers. In the first phase of this project (Stage Ia), we will develop a specialized treatment protocol for early smoking lapsers that utilizes behavioral exposure to nicotine withdrawal and training in skills based in Acceptance and Commitment Therapy (ACT) to facilitate tolerance of distress associated with quitting smoking. During this phase, 20 early smoking lapsers will complete the protocol, which will be modified and refined based upon feedback from participants and clinicians. In the second phase (Stage lb), we will conduct a preliminary, randomized clinical trial, examining its efficacy of the DT treatment in comparison to standard smoking cessation treatment (ST). All subjects will receive 8 weeks of transdermal nicotine patch. Participants will be followed over 6 months, and self-reported abstinence will be verified by carbon monoxide and saliva cotinine. We will also examine the hypothesis that changes in task persistence and emotional avoidance prior to quit date will mediate the effect of DT treatment. We expect that this study will result in the development of a well-specified and novel behavioral distress tolerance treatment for early smoking lapsers that will then be readied for a large-scale clinical trial. From a longer term perspective, we expect that this program of research will result in the development of a specialized, efficacious treatment for early smoking lapsers, a significant subpopulation of smokers at greatest risk for difficulties quitting, and will therefore have important clinical and public health significance in decreasing the overall prevalence of cigarette smoking.
