Extinction Updating in Reconsolidation
Condition: Nicotine Addiction; Smoking Cessation
MeSH terms: Tobacco Use Disorder; Behavior, Addictive
Study type: Interventional

Summary: 
      Smoking occurs in approximately 21% of the US population, is responsible for an annual
      mortality rate of approximately 438,000 citizens, and has an associated healthcare economic
      burden of $167 billion. Although pharmacotherapies have improved cessation outcome, the vast
      majority of individuals making quit attempts relapse within 5-10 days of cessation. The
      hypotheses to be examined in this study may have potentially important implications for
      smoking cessation treatment and will, therefore, target the single greatest addiction-related
      cause of morbidity and mortality.This study will investigate a novel behavioral strategy for
      altering important memory processes that underlie human smoking-related nicotine addiction.
      This strategy used in this study employs established cue exposure procedures to putatively
      update smoking-related memory with information that will suppress responding to smoking cues.
      The goal here is to alter existing nicotine-related memory directly rather than rely
      exclusively on the establishment of an inhibitory extinction process, via traditional cue
      exposure therapy, which is known to be vulnerable to spontaneous recovery, renewal and
      reinstatement. Positive findings would represent a significant advance in exposure-based
      therapy for addiction and could lead to a treatment that uniquely targets the problem of
      cue-elicited craving and reactivity, thereby addressing a major obstacle to successful
      smoking cessation.
    

Detailed description: 
      We propose to examine the effects of two sessions of retrieval-extinction (R-E) training in
      smokers who are making a quit attempt. Retrieval will be initiated by a brief (5-min.) video
      with smoking-related content and the extinction will consist of protracted (1 hr.) exposure
      to smoking cues. A control group receiving the same treatment except that the retrieval video
      will have nonsmoking/neutral content will serve to demonstrate that retrieval is a key
      feature of R-E training. Effects of training on smoking craving and cue reactivity will be
      assessed 1-day, 2-weeks and 4-weeks post-training, whereas training effects on indices of
      smoking behavior/cessation will be preliminarily assessed 2-weeks and 4-weeks post-training.
      It is expected that the R-E training will result in significant and enduring reductions in
      craving and reactivity to both novel and familiar smoking cues and have a favorable impact on
      smoking. Positive findings from this study could lead to a safe and effective behavioral
      intervention that will help smokers overcome the threat to cessation posed by cue-elicited
      craving and reactivity, and thereby reduce the burden levied against society by this most
      costly addiction. Additionally, this intervention could be modified to treat addiction to
      other substances.
    

Intervention name(s): Retrieval-Extinction; Non-Retrieval Extinction
Intervention type(s): Behavioral; Behavioral
Intervention description(s): A relatively brief exposure to cues prior to conducting more protracted cue exposure. This is referred to as retrieval-extinction training.; Neutral cue exposure.
Other intervention name(s): R-E; NR-E
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Smoking; Nicotine; Addiction; Cessation