Noninvasive Neuromodulation for Addiction (2025-2026)

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 homicide 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 constituted 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, but those with PTSD have the lowest rates of successful cessation.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that can modulate neural activity in targeted regions. This technique has shown potential for inducing 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. Further study is needed to reduce health disparities and support addiction recovery.

Project Description

Building on the work of previous teams, 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. Participants recruited from the Durham VA will undergo a baseline MRI scan, receive five 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.

While the study population of the trial remains the same (veterans with PTSD), students will have the opportunity to explore TMS for smoking cessation in other clinical populations via literature review and potential pilot work. Students will also contribute to the development of WIKISTIM.org, an online platform that serves as a searchable database of clinical studies that employ neuromodulation methodologies, using machine learning and artificial intelligence technologies to build out the non-invasive section of the website.

Anticipated Outputs

Longitudinal data on the use of rTMS for smoking cessation in veterans with PTSD; scholarly publications; podium and/or poster presentations; media engagement

Student Opportunities

Ideally, this project team will include 2-3 graduate students and 6-8 undergraduate students. Applicants should have a strong interest in improving treatment pathways for mental illness, including addiction and trauma. Undergraduates might come from such disciplines as psychology, neuroscience, mathematics, biostatistics, computer science, biomedical engineering and premedical studies. Graduate students may come from professional health science programs (e.g., medicine, nursing), as well as neuroscience, neurobiology, computer science. Students with related research and/or clinical training in other disciplines are also welcome to apply.

The project team will include two subteams: one focused on the clinical trial, and another focused on building out the AI infrastructure for WIKISTIM.org. However, all subgroups will have the opportunity to participate in the ongoing clinical trial and contribute to study data collection activities at Duke. All students will participate in group training didactics and journal club and will have the opportunity to contribute to publications. Graduate and professional students will have the opportunity to independently administer study procedures (such as MRI-guided TMS) and serve in leadership roles on the team.

This project includes optional summer components in 2025 (primarily for students on the 2024-2025 team) and 2026. Summer students who stay on campus may be eligible for paid employment at approximately 10 hours of work per week over the summer, continuing to assist with clinical trial study procedures. For students who are off campus over the summer, opportunities will also be available to continue assisting with WIKISTIM development and writing projects.

Timing

Summer 2025 – Summer 2026

• Summer 2025 (optional): Continuing team members assist with clinical trials, WIKISTIM development and writing projects; new students complete CITI training, begin foundational learning and identify personal goals
• Fall 2025: Complete reading assignments and discussions; finalize goals; participate in clinical trial procedures and WIKISTIM development
• Spring 2026: Receive formal TMS training; continue participating in study procedures and WIKISTIM development; finalize writing projects
• Summer 2026 (optional): Continue participating in study procedures and writing projects

Crediting

Academic credit available for fall and spring semesters; summer funding available

See earlier related team, Noninvasive Neuromodulation for Addiction (2024-2025).