SRNT’s Jarvik-Russell Early Career Award Winner
Please tell us about your work.
The focus of my research is on helping people to stop smoking. A lot of what we at the University of Wisconsin Center for Tobacco Research and Intervention do is to try to identify the best treatments to help patients quit smoking. There are different groups or types of people that respond better to certain treatments. For example, we have found that women respond better with a combination of nicotine replacement – the nicotine patch and lozenge – than they do with one replacement.
We also focus on how different treatments are working. Why does a combination of two nicotine replacement therapies, such the nicotine patch and nicotine gum, work better than one? We have found that it has to do with craving suppression. A combination of nicotine replacement therapy does a better job of alleviating cravings.
The Center also has a focus on smokers with psychiatric comorbidities. Smoking is becoming more concentrated with this group of people and we are trying to find out what works best for people with anxiety and/or depression.
Additionally, the Center is trying to develop treatments and systems that can be provided to all smokers in primary care clinics. With this approach, we engage smokers directly in the primary care setting and offer them evidence-based treatment to either help them quit smoking, if that’s what they are ready to do, or help them cut down and get ready to quit at a later time. Since about 70% of smokers see a primary care doctor each year, this represents an ideal opportunity to connect people with evidence-based treatment.
You recently received the Jarvik-Russell Early Career Award at SRNT. Tell us about your work that led to this award.
The award is given to people who have made substantial contributions to tobacco science within the first seven years post degree. In addition to the recognition, it’s an opportunity to share research at the conference.
The talk I gave at the conference focused on how new, multidimensional measures of tobacco dependence, new data collection technology and analytic techniques, and modern theories of reward and cognition can be used to better understand why so many smokers relapse.
We know Classical Addiction Theory says the more dependent someone is, the more likely that person will have more trouble quitting. This theory also suggests that dependence causes withdrawal and that’s what triggers relapse. However, we also know that some people with strong withdrawal symptoms don’t relapse and others who report minimal withdrawal go back to smoking.
Clearly, we don’t understand all of the mechanisms via which dependence results in relapse. However, with new, multidimensional measures of dependence, we are able to see that some components of dependence are more closely linked to withdrawal than others, and that some individuals (e.g., those with different psychiatric diagnoses) report different dependence profiles.
In addition, we have gained a broader understanding of withdrawal. Using ecological momentary assessment techniques, we can assess smokers in their real-world environment and understand how smoking deprivation is linked to not only negative affect and craving, but also a reduction in pleasure and an increased reactivity to various smoking cues and temptations.
Further, we have been able to understand how these withdrawal phenomena are linked to exhaustion of cognitive resources so that smokers essentially get worn out by trying to quit.
Taken together, these findings help us understand the cessation process that smokers go through a little better. However, there are still many questions that need to be answered and more treatments need to be developed to target these different cessation processes, so that we can help people quit.
What are some of the challenges you face in your work?
Funding is always a challenge. Translating our findings is sometimes a challenge. We face the challenge of getting medical officials to truly understand how smoking contributes to the symptoms patients present. Providers know it’s important for their patients to quit smoking, but there are competing priorities and limited time. So the Center works to educate medical providers and to develop health systems that make efficient use of resources to provide evidence-based treatment in a way that is feasible within the healthcare system. For example, the Center is integrating tobacco treatment into electronic health records, with eReferrals to the national tobacco quitline at 1-800-QUIT-NOW.
Sometimes we have challenges recruiting participants -– trying to find smokers who are interested, willing to quit, and eligible to participate in a research program.
What are some success stories as a result of your work?
The Food and Drug Administration now supports the safety of combination nicotine replacement therapy. My hope is this, in combination with our findings, will make a difference and change clinical practice.
Also, we developed one of the two multidimensional scales of dependence, the Wisconsin Inventory of Smoking Dependence Motives (WISDM), to help us get a closer look at different components of dependence and understand how it manifests. The WISDM and the Brief WISDM are now being used by researchers who want to understand dependence in a more comprehensive manner than is permitted using the 6-item Fagerström Test of Nicotine Dependence (FTND).
What was the reason you got involved with this type of work?
I have always been interested in behavioral health issues. I actually began my career focusing on alcohol and how drinking becomes problematic for some people. While at the University of Wisconsin for my Ph.D. in clinical psychology, I connected with Tim Baker, who was a professor in the psychology department and the Director of Research at the Center. I switched my focus to understanding tobacco addiction and how to help people stop using the drug that would most likely kill them – tobacco.
Tobacco science is a complex issue. I feel that the thing that has been most helpful is to work with a good team – including collaborators with complementary areas of expertise, whether at the Center or elsewhere. Working as a team across disciplines to help others has been most satisfying.