Strengthening Instrumental Extinction to Prevent Smoking Relapse

Duke University, Durham NC

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): Smoking very low nicotine content cigarettes (VLNCs) has been shown to reduce nicotine dependence, decrease smoking behavior, and decrease brain reactivity to smoking cues. In clinical trials, smoking VLNCs with or without concomitant nicotine patch has shown some promise in improving cessation outcomes. However, despite this promise, very little research has sought to directly enhance or strengthen the effects of smoking VLNCs on relevant smoking outcomes. It has been posited that the effects of smoking VLNCs are due in measure to instrumental extinction associated with engaging in a behavior (e.g. smoking a cigarette) in the absence of reinforcement by the major psychoactive substance in cigarette smoke-nicotine. Presumably, instrumental extinction occurs even when nicotine is administered via a patch since nicotine administration is non-contingent on smoking behavior. Like Pavlovian extinction, recent research and theory suggest instrumental extinction is highly context specific; i.e. does not generalize to contexts outside those in which extinction training occurs. This is a potential advantage for VLNC-based smoking cessation treatments so long as extinction trials (smoking without nicotine reinforcement) occur in all of the places and situations in which a smoker smokes. However, while the context specificity of VLNC-based treatments may prevent relapse in contexts where extinction trials occur, modern learning theory predicts susceptibility to renewal of smoking (i.e. lapse) in infrequently encountered or novel contexts. The proposed project will investigate whether smoking cessation outcomes can be improved by adding extinction trials during exposure to smoking- related contexts that are: a) personally familiar thus strengthening extinction and b) novel or unfamiliar to the smoker (e.g. an unfamiliar bus stop) thus increasing generalization. The overarching hypothesis of the proposed project is that incorporating these smoking-related context stimuli into extinction (i.e. multiple context extinction; MCE) will strengthen the effectsof smoking VLNCs on clinically relevant outcomes (i.e. nicotine dependence and smoking cessation).