Shiffman Saul, Ferguson Stuart G, Gwaltney Chad J
University of Pittsburgh and Pinney Associates, Pittsburgh, PA, USA.
Psychopharmacology (Berl). 2006 Mar;184(3-4):608-18. doi: 10.1007/s00213-005-0175-4. Epub 2005 Nov 11.
Smoking lapses represent an important juncture between smoking cessation and relapse. Nicotine replacement therapy (NRT) has been shown to decrease the risk of progression from lapse to relapse. We hypothesized that this effect might be mediated via decreases in reinforcement from smoking lapses.
We assessed 169 subjects who lapsed during treatment in a double-blind placebo-controlled study of high-dose (35 mg) nicotine patch. Following their first lapse, using an electronic diary, subjects recorded the amount they smoked, and rated the pleasantness and satisfaction ("hedonic rating") and the aversiveness of smoking. Subjects were then followed and assessed for further lapses and relapses.
Subjects who smoked more during the first lapse had greater risk of progression [second lapse: hazard ratio (HR)=1.16, confidence interval (CI)=1.01-1.32; relapse: HR=1.22, CI=0.97-1.54]. Subjects with higher hedonic ratings of the first lapse also had a greater risk of progression to the second lapse (HR=1.08, CI=1.02-1.14) and to relapse (HR=1.26, CI=1.11-1.41). Aversive ratings had no bearing on progression. As expected, active treatment reduced the risk of both a second lapse (HR=0.54, CI=0.39-0.78) and a relapse (HR=0.22, CI=0.11-0.45). Importantly, however, NRT had no effect on hedonic ratings, amount smoked during the first lapse, or aversive ratings.
Hedonic response to an initial lapse predicted progression to relapse, but this did not mediate the effect of NRT on progression.
吸烟失误是戒烟与复吸之间的一个重要转折点。尼古丁替代疗法（NRT）已被证明可降低从失误发展为复吸的风险。我们推测这种效应可能是通过减少吸烟失误带来的强化作用来介导的。
在一项关于高剂量（35毫克）尼古丁贴片的双盲安慰剂对照研究中，我们评估了169名在治疗期间出现吸烟失误的受试者。在首次失误后，受试者使用电子日记记录吸烟量，并对吸烟的愉悦感和满意度（“享乐评分”）以及厌恶感进行评分。然后对受试者进行随访，评估是否有进一步的失误和复吸情况。
首次失误时吸烟量较多的受试者发展的风险更大[第二次失误：风险比（HR）=1.16，置信区间（CI）=1.01 - 1.32；复吸：HR = 1.22，CI = 0.97 - 1.54]。对首次失误享乐评分较高的受试者发展为第二次失误（HR = 1.08，CI = 1.02 - 1.14）和复吸（HR = 1.26，CI = 1.11 - 1.41）的风险也更大。厌恶评分与发展情况无关。正如预期的那样，积极治疗降低了第二次失误（HR = 0.54，CI = 0.39 - 0.78）和复吸（HR = 0.22，CI = 0.11 - 0.45）的风险。然而，重要的是，NRT对享乐评分、首次失误时的吸烟量或厌恶评分没有影响。
对初次失误的享乐反应可预测发展为复吸的情况，但这并未介导NRT对发展情况的影响。
