Although cigarette smoking rates have declined below 20% among US adults, smoking remains the most preventable cause of death and disability in the country. Reports show that nearly 7 in 10 adults who smoke cigarettes would like to quit. However, addiction—whether to tobacco, alcohol, or an illicit substance—is a chronic, relapsing disorder, where individuals are often caught in a cycle of use, seeking treatment and quitting, and then returning to use again.
With the goals of better understanding the root causes of relapse and of developing and disseminating new and more effective treatments, in 2015, Duke professor of psychiatry and behavioral sciences F. Joseph McClernon, PhD, founded the Duke Center for Addiction Science and Technology (CfAST).
The center focuses on several research themes related to tobacco addiction. In particular, McClernon says, significant research is devoted to understanding the mechanism that leads some people, including those with mental illness, to be more likely to smoke and to have greater difficulty quitting. CfAST investigators hope to improve the lives of people with tobacco addiction as well as their families and, by conducting tobacco regulatory science, help inform US Food and Drug Administration decision making and policy.
Currently, CfAST is involved in 3 clinical trials related to smoking cessation. In one of these trials, CfAST researchers are working with a technology company to develop and test a smartphone application designed to increase medication adherence during a person’s quit attempt.
“While smoking cessation medications, such as nicotine-replacement therapy, bupropion, and varenicline, all increase the odds of quit success, adherence rates are suboptimal,” McClernon explains. “It’s therefore very important to identify ways we can increase adherence.”
The smartphone application provides reminders to take the medication and uses the phone’s camera to verify dosing. When study participants miss a dose, the application asks questions about barriers to taking the medication—Is the study participant experiencing side effects? Is forgetfulness responsible?—and provides targeted strategies for coping with these barriers. The system includes a dashboard that reports to the researchers how well each study participant is doing with regard to adherence.
Two other smoking cessation trials include studies focused on understanding how places where people can smoke can increase cravings and result in relapse. Depending on the study, participants will receive either first-line pharmacotherapy or an experimental behavioral treatment to improve cessation outcomes.
“We have a lot to offer patients through our clinical trials, including access to first-line smoking cessation interventions and new, experimental treatments,” McClernon remarks.
He hopes to expand his center’s smoking cessation research to other patient groups, including people living with HIV infection. “My philosophy has always been to go where the problems are, and if we find something that works for one problem or one patient population, let’s try applying it, with some modifications, to others.”