Beta-Adrenergic Modulation of Drug Cue Reactivity

Study Overview
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Brief Summary
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This study is designed to investigate the effects of a beta-adrenergic antagonist (Propranolol; 40 mg IR) and nicotine patch (14 mg) administered alone and in combination on neurobiological and behavioral responses to smoking cues in ongoing cigarette smokers. This is a basic experimental study in humans and participants will not take these medications for an extended period or make a cessation attempt as part of their involvement in this research project.

Detailed Description
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Cigarette use remains a serious public health problem in the United States and worldwide. Effective pharmacological interventions for smoking cessation exist, but these medications primarily target nicotine withdrawal and smoking reinforcement. The cues and contexts associated with smoking also play an important role in driving smoking behavior, but evidence is extremely mixed whether existing interventions can effectively attenuate smoking urges and behavior in response to these cues and contexts. In a previous pilot trial, the investigators demonstrated that propranolol suppressed smoking cue reactivity and brain activation across a constellation of brain regions implicated in nicotine dependence. Here, the investigators seek to extend this work by examining effects when the drug is administered in combination with an established treatment targeting withdrawal and reinforcement (i.e., nicotine patch). Following consent and screening/baseline activities, participants will attend four neuroimaging appointments each lasting approximately 5 hours. Participants will be fitted with a nicotine or placebo patch, fed a standard meal and then administered propranolol or placebo. Participants will complete questionnaires and have their heart rate/blood pressure monitored throughout the visit. During the MRI scan, participants will be asked to complete both resting scans and task-based scans during which participants will view images of smoking and non-smoking objects and scenes.

Official Title
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Beta-Adrenergic Modulation of Drug Cue Reactivity: Neural and Behavioral Mechanisms

Conditions
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Tobacco Use Disorder, Nicotine Dependence, Cigarette Smoking

Intervention / Treatment
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* Drug: Propranolol
* Drug: Nicotine Patch
* Drug: Placebo Propranolol
* Drug: Placebo Patch


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Generally healthy Age 21-60 Right-handed using a three-item scale Daily smoker of ≥ 5 cigarettes/day delivering 0.5 mg nicotine (FTC) Smoking regularly for ≥ 1 year, with stable smoking for the past 6 months Afternoon expired Carbon Monoxide (CO) concentration ≥ 6 ppm and/or morning urinary cotinine >100 ng/ml Must identity at least 4 different smoking locations used in a typical week Able to read and understand English Exclusion Criteria: Inability to attend all required sessions Significant health problems that would preclude active participation Presence of conditions that would make MRI unsafe (e.g. pacemaker) or (e.g. weight and body shape) Current use of psychoactive medications/drugs as indicated by self-report or urine screen Positive breath alcohol concentration Pregnant, breastfeeding, or planning to become pregnant during the course of the study (females) Problems with vision that cannot be corrected with contacts or glasses Current regular use of smokeless tobacco, smoking cessation medications, or other nicotine containing products (e.g. electronic cigarettes) Current use of beta-adrenergic medications (e.g. beta-blockers) or other blood pressure medications Systolic blood pressure < 90 mmHg or diastolic blood pressure < 60 mmHg (sitting or standing) Abnormal EKG Presence of severe anemia Presence of electrolyte imbalance that could impact blood pressure Presence of any other contraindications for propranolol or nicotine patch (e.g. cardiovascular disease, bronchial asthma, prior allergic reactions, diabetes)

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Placebo Patch/Placebo Propranolol<br>Placebo Nicotine Patch Placebo Propranolol | Drug: Placebo Propranolol<br>* Placebo Capsule, no active ingredients<br>Drug: Placebo Patch<br>* Placebo Patch, no active ingredients<br>|
| Experimental: Placebo Patch/Active Propranolol<br>Placebo Nicotine Patch Active Propranolol (40 mg, immediate release) | Drug: Propranolol<br>* Propranolol Capsule; 40 mg IR<br>Drug: Placebo Patch<br>* Placebo Patch, no active ingredients<br>|
| Experimental: Active Patch/Placebo Propranolol<br>Active Nicotine Patch (14 mg) Placebo Propranolol | Drug: Nicotine Patch<br>* Nicotine Patch; 14 mg<br>Drug: Placebo Propranolol<br>* Placebo Capsule, no active ingredients<br>|
| Experimental: Active Patch/Active Propranolol<br>Active Nicotine Patch (14 mg) Active Propranolol (40 mg, immediate release) | Drug: Propranolol<br>* Propranolol Capsule; 40 mg IR<br>Drug: Nicotine Patch<br>* Nicotine Patch; 14 mg<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cue-Provoked Craving Ratings | Self-reported smoking urges in response to smoking and non-smoking cues during magnetic resonance imaging (MRI) scan. Scores range from 0 to 10 with higher values indicating increased craving for cigarettes. | Approximately 4-5 hours | 
| Blood-Oxygen Level Dependent (BOLD) Activation to Smoking Cues | Blood-Oxygen Level Dependent (BOLD) Contrast (Smoking-Neutral) in Anterior Hippocampus, Amygdala, Dorsal Anterior Insula, Medial Prefrontal Cortex, Posterior Cingulate Cortex and Ventral Striatum | Approximately 4-5 hours | 
| Association between Smoking Urge and Brain Activation | Indices of covariation between cue-provoked craving BOLD activation to smoking cues | Approximately 4-5 hours | 
| Hippocampus-Amygdala connectivity to smoking cues | Index of connectivity between these brain regions | Approximately 4-5 hours | 
| Medial Prefrontal Cortex and Posterior Cingulate Cortex connectivity | Index of connectivity between these brain regions | Approximately 4-5 hours | 
| Association between Smoking Urge and Brain Connectivity | Indices of covariation between cue-provoked craving BOLD activation to smoking cues | Approximately 4-5 hours |