Duke researchers gathered at the Durham Convention Center Thursday to discuss treating the most common drug addiction—smoking.

The 18th Annual Duke Nicotine Research Conference focused on decreasing smoking addiction with treatments that are tailored to the individual. Because there is a very limited amount of treatments that smokers can use to quit, the researchers presented new, out-of-the -box approaches that can help more people break the addictive habit.

Jed Rose, co-inventor of the nicotine skin patch and director of the Duke Center for Nicotine and Smoking Cessation Research, stressed individualizing treatment—such as tailoring the dosage of nicotine replacement therapies.

“After tailoring the treatment, the idea is to… very early on assess markers that predict ultimate likelihood of success,” said Rose, who is also a medical research professor of psychiatry. “Then, if the treatment looks like it won’t work, the idea is to revise [it].”

Rose noted that clinical trials typically do not alter a user’s course of treatment even if markers indicate it is not helping the patient quit.

According to the Centers for Disease Control and Prevention, smoking causes more deaths than murders, suicides, HIV, motor vehicle accidents, illegal drug use and alcohol use combined. Research also suggests that smoking may be as addictive as cocaine or heroin.

Despite its addictive qualities, in 2010 52.4 percent of all adult smokers reported that they had stopped smoking for more than one day because they wanted to quit.

Alternative therapies

In a study currently under peer review, Rose put more than 500 volunteer smokers who had not yet quit smoking on nicotine replacement therapies—such as the nicotine patch—and tailored the dosage so that heavier smokers received greater quantities of NRT. After a week, the researchers measured the amount of carbon monoxide in their bodies to see whether NRT had curbed their cigarette cravings.

Those whose carbon monoxide levels decreased by more than 50 percent continued using NRT, whereas those who did not respond adequately to the treatment were randomized into three different courses of treatment. One group continued using NRT, one group stopped using NRT and replaced it with Chantix, and the third group continued NRT augmented with Zyban. Chantix and Zyban are medications designed to help smokers quit.

The findings showed that of the three non-responder subgroups, the smoking abstinence rates significantly increased for those who augmented NRT with Zyban. Their abstinence rates were two to three times higher compared to those who continued with NRT alone.

A follow-up study on a different group of smokers is comparing two potential rescue treatments, Chantix plus Zyban and Chantix alone. This study also looks at the demographics of people who used the different types of treatment and results thus far show saw that womendo did better on Chantix and men do did better on the combination of drugs. Rose noted that one factor that might explain this phenomenon is that men enjoy the respiratory sensations they feel in their throat while smoking more than women do, and the combination treatment reduces the enjoyment of these smoking-related sensations.

Rose added that the study gives greater insight about treating smokers and the importance of following up on the success of different approaches to see if other courses of action are worthwhile. The study showed that if nicotine patches are not working for smokers, a significant number of them will benefit from switching to alternative treatment before their quit date.

“The 500 pound gorilla in the room is that, despite all the work we are doing to get people to abstain from smoking, the current smoking-dependent population may not succeed with the [current] treatments,” he said. “So do we tell those people you can quit smoking or die or provide other treatments that reduce the harms they are exposing themselves to?”

Dr. Anne Evins, an associate professor of psychiatry at Harvard Medical School, focused on behavioral treatments for nicotine dependence.

In one of her studies, non-treatment seeking smokers were shown their neurological activity when they see pictures of smoking or things unrelated to smoking. Tobacco users gained greater confidence in quitting when they saw that their addiction is controlled by their mind.

“They said that... they realized [addiction] has to do with something linked in their brain and maybe they can... control it,” said Evins, who is also director of the Center for Addiction Medicine and the Addiction Research Program at Massachusetts General Hospital.

Using ‘science not rhetoric’

Scott Ballin, former vice president and legislative counsel for the American Heart Association, said science must be used to change the public health discussion on smoking.

“The government often makes sweeping statements such as tobacco accounts for the death of over 400,000 Americans per year—a correct statement, but it is the combustible cigarette that is perpetuating disease and death in our society,” he said. “It would be like saying sex causes STDs—it’s a true statement, but we have to get to the heart of the issue when discussing tobacco and nicotine.”

Ballin recommended providing greater clarity as to what products are the most harmful, so users are aware of the differences between tobacco products. The rhetoric regarding tobacco industries as evil does little to advance discourse, he said, adding that the focus needs to shift from vilifying the manufacturer to looking at the science behind the product itself.

One way to encourage manufacturers to produce safer products is to place greater regulations on those that cause more harm. This would give tobacco industries incentive to produce less harmful products.

“In order to get the industry to change, we need to give them a way to go down a different road,” he said. “Most of them probably won’t do it, but we want to drive the bad players off of the field.”

Correction 10/6/2012: An earlier version of this article incorrectly stated that the three treatment subgroups received either NRT (the control), Chantix only or Chantix and Zyban. The treatments received were in fact NRT, NRT with Zyban and Chantix only. The Chronicle regrets the error.

The earlier version also incorrectly stated that of the three subgroups, the control group that remained on NRT had the best outcome for smoking cessation, when they in fact had the worst of the three. The Chronicle regrets the error.

Clarification 10/7/2012: The story has been clarified to reflect that a followup study still in progress is researching the use of the Chantix plus Zyban and Chantix only as treatment options.