Study 1: The primary aim of this association study is to characterize the neuropsychological, emotional, and personality functioning in depression vulnerable smokers. Participants are smokers and never smokers with and without a history of chronic depression. The protocol involves a comprehensive assessment battery of clinical interviews, paper and pencil questionnaires, and computerized performance measures of neuropsychological and emotional functioning, smoking-related cognition and behavior, and personality qualities. Findings will have implications for refining the phenotype of depression vulnerable smokers who are at risk for chronic tobacco dependence (and possibly, chronic depression). The factors that distinguish smokers with chronic depression from those with only one of these disorders (nicotine dependence or depression) or neither disorder serve as secondary targets in Study 2 (below).

Study 2: The primary aim of this counter-balanced, placebo-controlled experiment is to examine the neurobiological mechanisms associated with cue-provoked cigarette craving and smoking behavior in chronic depression. Specifically, it will compare the effects of acute tryptophan depletion (reduces availability of serotonin), acute tyrosine-phenylalanine depletion (reduces availability of dopamine), and placebo challenge on hypothesized sub-types of cue-elicited cravings and associated cigarette smoking topography among smokers with and without chronic depression. Little is known about the multidimensional nature of cue-cigarette craving and the mediating neurotransmitter mechanisms. Findings will have implications for tailoring smoking pharmacotherapies to cue-induced craving profiles in depressed smokers.

An Effectiveness Trial of Maintenance Therapy for Nicotine Dependence

Funded by the National Institute on Drug Abuse (Subcontract R01 DA025078, Lead PI: Robert Schnoll PhD)

Tobacco dependence is a chronic disease similar to asthma or diabetes that requires ongoing monitoring and treatment.
This randomized effectiveness trial will evaluate the benefits of maintenance therapy with transdermal nicotine patches (21mg/day) for smoking cessation. Six hundred daily smokers will receive brief counseling and will be randomized to standard (8-weeks), extended (24-weeks), or maintenance (52-weeks) transdermal nicotine therapy. Treatment will be carried out at Northwestern University and the University of Pennsylvania Tobacco Use Research Center. Half of the 600 subjects will treated at each site. The primary outcome will be biochemically verified 7-day point prevalence abstinence at week 52. Additional aims include assessing:

1) treatment side effects;

2) longitudinal patterns of relapse and recovery;

3) mediators (e.g., nicotine withdrawal) and moderators (e.g., degree of nicotine dependence) of treatment effects; and

4) cost-effectiveness.

The study findings will provide critical data for future Public Health Service reviews of maintenance transdermal nicotine for subsequent treatment guideline updates; for third-party payer assessments of maintenance transdermal nicotine as a covered benefit; and for individual smokers’ decisions to use maintenance transdermal nicotine through over-the-counter access.