Towards treatment stratification for successful smoking cessation: Harnessing predictive neurocognitive models

Smoking is the single biggest preventable cause of death in Ireland. There are many reasons why someone might remain addicted to nicotine and many factors affecting each individual's response to withdrawal. For example, socioeconomic status, gender or life stress can all play a role. Ultimately, nicotine has its effects by altering brain chemistry, particularly in three crucial brain systems: the reward processing system, the cognitive control system and the stress system. Nicotine's effects on the brain render it highly addictive - more addictive than crystal methamphetamine (crystal meth), cannabis or methadone. Indeed, even though a majority of smokers attempt to quit, most (approximately 80%) do so unaided and this method results in a success rate of just 4%. The best smoking-cessation therapies are relatively successful, yet still have low success rates in absolute terms (about 15-20%).
A key problem is that we do not yet understand why some people respond to therapy and why some do not, nor can we tell in advance if particular individuals are suited to particular therapies. This study will compare two of the most promising therapies currently available: Contingency Management and a smartphone application of Acceptance and Commitment therapy. Importantly, these therapies target different aspects of addiction. The former provides money for remaining abstinent, whereas the latter is a type of 'talking therapy'. We will assign individuals each to either type of therapy or to a 'treatment-as-usual' group and measure the brain responses before and during treatment. It is then possible - using a sophisticated method called "machine learning" to make a prediction about who will respond successfully to a particular treatment and who will not, based on pre-existing differences and responses to treatment.
This research will inform future attempts to assign individuals to the type of treatment that is most suitable for them.

Award Date
23 October 2015
Award Value
Principal Investigator
Dr Robert Whelan
Host Institution
University College Dublin
Health Research Awards