Noninvasive Neuromodulation for Addiction (2024-2025)
Background
Nearly 45 million U.S. adults smoke cigarettes, causing death or disability in half of this population. Tobacco use relates to more deaths than AIDS, illicit drugs, alcohol use, auto accidents, suicide and homicides combined.
Those with mental illness are disproportionately affected, dying on average 25 years early, yet smoking rates are increasing in this population. In a U.S. study, smokers with psychiatric disorders were nearly half of the 520,000 annual tobacco-related deaths. Veterans with posttraumatic stress disorder (PTSD) are more likely to smoke, with triple the risk of tobacco use disorder. Most veterans who smoke are interested in quitting, yet those with PTSD have the lowest rates of successful cessation.
Noninvasive brain stimulation, such as repetitive transcranial magnetic stimulation (rTMS), can safely modulate cortical and subcortical functioning. By targeting neurocircuitry implicated in substance use disorders, rTMS can induce long-lasting changes in the brain that ultimately influence behavior.
Unfortunately, there is a lack of research on rTMS for smoking cessation in populations with psychiatric illness, including veterans with PTSD. In a review of current clinical trials, none focus on those with PTSD and most exclude comorbid psychiatric illness, which may contribute to treatment and/or health disparities. Further study is needed to support addiction recovery.
Project Description
Building on the work of the 2023-2024 team, this project team will help conduct a longitudinal intervention study of rTMS for smoking cessation in veterans with PTSD.
The study will involve a two-arm, parallel design comparing active versus “sham” rTMS targeting alongside Cognitive Behavioral Therapy (CBT) for smoking cessation and Nicotine Replacement Therapy (NRT). Participants recruited from the Durham VA will undergo a baseline MRI scan, receive 5 days of twice-daily active or sham rTMS the week before their quit date, and have a post-treatment MRI scan. Concurrently, they will undergo five sessions of CBT for smoking cessation, with the third session marked as the quit date.
Data from the study will be used to evaluate the feasibility and acceptability of the multi-pronged smoking cessation treatment; evaluate the impact of the intervention on smoking outcomes; and demonstrate neural target engagement and evaluate mechanisms of the rTMS intervention.
Team members will also have the flexibility to explore the multimodal rTMS cessation interventions in additional clinical areas in which short-term smoking cessation has a significant impact on health outcomes, such as pregnancy, cancer and multiple sclerosis.
In addition to the clinical interventions, a long-term goal of this work will be to build a searchable database of clinical studies from which to model future treatment development for substance use disorders through the integration of noninvasive neuromodulation, neuroimaging and evidence-based pharmacotherapy and psychotherapy.
Anticipated Outputs
Publications; conference presentations; new clinical treatment pathway/health service delivery model for civilians and veterans; searchable database of clinical studies
Student Opportunities
Ideally, this team will include 2-3 graduate students and 6-8 undergraduate students who are familiar with statistical software (e.g., STATA, R) and/or have experience or interest in learning about survey tools (e.g., Qualtrics, REDCap), traumatic stress responses, neuroimaging and/or brain stimulation. Interested applicants will likely be from disciplines such as psychology, neuroscience, mathematics, biostatistics, computer science and biomedical engineering, as well as professional health sciences. Students with related research and/or clinical training in other disciplines are also welcome.
Team members will gain understanding and skills in rTMS, MRI, cognitive behavioral therapy, STATA and survey development. Learning will occur through hands-on training, lectures and discussions. Undergraduate students will be exposed to an innovative study bridging clinical, technological and academic realms to help inform their future career decisions. Graduate students will have opportunities for leadership and honing review and feedback skills with undergraduate students. All team members will have the opportunity to contribute to an academic publication.
In Fall 2024, this team will meet on Fridays from 9-10 a.m.
Timing
Fall 2024 – Spring 2025
- Fall 2024: Begin team meetings; complete reading assignments and contribute to discussion with submitted reviews/questions; establish sub-team/individual goals; initiate writing projects; participate in clinical trial procedures (MRI, TMS)
- Spring 2025: Receive formal TMS training at BSRC; continue participating in study procedures; submit/finalize writing projects
Crediting
Academic credit available for fall and spring semesters
See earlier related team, Noninvasive Neuromodulation for Addiction (2023-2024).