Project Quit helps smokers kick the habit

The prevalence of smoking has decreased over the last decade, but roughly 40 million adults in the U.S. still smoke cigarettes, despite 50 years of warnings by surgeons general, explicit labels on cigarette packs, research that points conclusively to the many diseases connected to smoking, even an intolerant society.

And every day nearly 3,300 kids try their first cigarette — many of whom make it a lifelong habit.

“The smoking epidemic is going strong,” said MUSC researcher Kevin Gray, M.D.,director of the Division of Child and Adolescent Psychiatry and a professor in the Department of Psychiatry and Behavioral Sciences, who works with South Carolinians struggling to quit.

According to the New England Journal of Medicine, smoking–related illnesses cost the U.S. a staggering $170 billion annually; that doesn’t include the $156 billion in lost productivity.

And the human toll is even worse: Every year 600,000 Americans will die from smoking.

So why do so many — 15 percent of Americans — still light up, especially considering that smokers today face societal shaming more than any time in history? Anti–smoking campaigns not only point out the serious health risks associated with smoking but also the unattractive cosmetic issues smokers deal with like stained teeth, bad breath, hair that smells of stale smoke and a persistent, junky cough, as well as the hazards of second–hand smoke exposure for those around them. While factually accurate, this also has empowered some people to make their disapproval known when a smoker practices what they consider a “nasty habit.”

Gray and fellow addiction experts see beyond those biases and frame it more scientifically, characterizing smoking as an addiction — a physical, psychological and social dependence on tobacco and nicotine — one that requires intervention. Some research studies have indicated that nicotine is more addictive than even alcohol, cocaine or heroin.

“There is no judgment here,” Gray said. “We see tobacco use as a significant public health issue that is still relatively unaddressed,” he explained, “not as a moral issue or a judgment type of issue. We are very interested, through our treatment and non–treatment research studies, to better understand tobacco use and to be able to better intervene with those who want to quit.”

Gray, along with colleagues Michael Saladin, Ph.D., a professor in the Department of Health Science and Research, Matthew Carpenter, Ph.D., a professor in the Addiction Sciences Division, Erin McClure, Ph.D., an assistant professor in the Addiction Sciences Division, and Rachel Tomko, Ph.D., a postdoctoral fellow also in the Addiction Sciences Division, are part of Project Quit, a team leading several ongoing National Institutes of Health sponsored research studies at MUSC that enroll smokers from ages 14 through 65. The team is dedicated to understanding the innermost mechanics of this addiction and working with smokers who are struggling with it.

This team of addiction specialists works tirelessly to improve treatments and can offer the majority of tobacco smokers options for help. Not only do they have a half–dozen research studies currently underway, it’s a continual process — as one study is ending, another is starting.

“This is a sustained tobacco program,” he explained. “We have a variety of studies, and generally speaking, we have studies that accommodate most smokers, and if we don’t, we have clinical programs we can refer them to. It’s a good fit for most, and we are here to offer hope and possibilities through our studies.”

Deadly consequences

Today, fortunately, more people have the desire to quit than in the past. The Centers for Disease Control and Prevention reports that in 2015, 68 percent of all current U.S. adult cigarette smokers said that they wanted to quit smoking completely. Yet, just over half of all smokers make a quit attempt each year.

Having the desire doesn’t necessarily make it easy by any means. And the tobacco industry doesn’t help — in fact, it makes sure that it’s nearly impossible to quit. Gray explained that the last thing tobacco executives want to lose are lifelong customers.

Gray said that most people, even with the best of evidence–based treatments, are unable to successfully quit. But the team believes there are many reasons to try — especially here in the South, where smoking remains prevalent and nearly 22 percent of South Carolinians smoke, which is far above the national average, added Carpenter.

In addition to smoking being the single leading cause of preventable disease, tobacco use is the No. 1 cause of both death and disability in the United States and can lead to more than a dozen types of cancers, diabetes, heart disease, stroke, tuberculosis, kidney failure and a long list of other serious ailments.

Quitting is well worth it. When smokers quit, Gray said, their heart rates drop down to normal levels within 20 minutes. Within two hours, heart rate and blood pressure will have returned to almost completely normal levels. After only 12 hours, blood oxygen levels rise to near normal levels. Since the risk of having a heart attack is 70 percent higher than for those who do not smoke, after 24 hours, the risk of heart attack begins to decrease and drops sharply after just one year. After two to five years, the risk of having a stroke falls to that of a non–smoker. After five years, the risks for developing certain cancers are cut in half, and the risk of dying from lung cancer drops by half after 10 years. The payoffs are big.

For smokers who quit before they reach the age of 35, they can reduce their risk of suffering premature death to almost the same level as non–smokers. “Still,” Tomko said, adding an important message, “don’t wait to quit. The addiction progresses and quitting becomes that much more difficult.”

Project Quit

While Project Quit was originally a smoking cessation study aimed at adolescents, it has expanded to include other active research, both treatment–based — like medications, behavioral interventions, and clinical therapies — as well as observational — looking at people’s habits and noting the statistical correlations between their behavior and health, in an effort to better understand tobacco use disorder.

Carpenter pointed out how the collaborative efforts that take place on campus have strengthened Project Quit, leading to numerous successes.

“The people involved in Project Quit are a part of a larger whole,” he said. “Tobacco research at MUSC has expanded significantly in the past 15 to 20 years, inclusive of the people involved in this project and these studies. But there are many people on this campus who do tobacco research. Tobacco research at MUSC is actually one of our stronger research programs, arguably in the country, and that’s because of our collective presence on campus and the research successes that we’ve had.”

Saladin agreed. “We have an extremely robust tobacco research program at MUSC, and we work collaboratively with researchers and teams all over campus.”

Carpenter explained that the successes Project Quit has experienced are attributable to the novel therapeutic approaches the team has taken.

“For instance, taking existing medications like varenicline and applying it to novel populations like adolescents is brilliant,” he said, referring to Gray’s study, “as is the marriage of technology to addiction treatment. Dr. Tomko’s study will feature a special lighter that tracks where, when, and how much a person smokes. And Dr. McClure’s video capture of smoking behavior and her study involving NAC and tobacco dependence put MUSC at the very heart of exciting new research.”

McClure explained that addictions are complex and associated with a series of neurocircuits and brain regions, and habits like smoking are partially controlled by the actions of brain chemicals. One particular brain chemical of interest to addiction researchers is called glutamate. When the brain's glutamatergic system
malfunctions, she said, addiction can result, and people trying to quit may be more likely to fail.

Much of the groundbreaking preclinical work revealing glutamate’s role in addiction has been conducted in the lab of Peter Kalivas, Ph.D., professor and chair of the Department of Neuroscience, and the Project Quit team is interested in translating these findings into clinical care. McClure’s study investigates if treatment with N–acetylcysteine (NAC) can, via restoring normal glutamate function in the brain, help with smoking cessation. Another study, led by Gray and Brett Froeliger, Ph.D., assistant professor in the Department of Neuroscience, is investigating the effects of combining NAC and varenicline on brain responses and smoking behavior in daily smokers interested in quitting.

“At the end of the day,” Carpenter said, “we’re pushing the envelope in terms of how we can access and treat tobacco dependence outside our lab.”

Active Project Quit studies

These studies are open to new participants. In addition to smoking cessation studies, there are studies available for smokers who aren’t ready to quit just yet. To inquire about participating in one of these trials or for more information, contact the Project Quit team at 792-4097 or smokingstudy@musc.edu. Please visit the website at muscsmokingstudy.com. You can also text SMOKE to 44332.

Adolescent Cessation Study (original Project Quit Study)
PI: Dr. Kevin Gray
Recruitment summary: This is a research study to determine if varenicline (commonly known as Chantix) helps young cigarette smokers quit. Smokers aged 14 to 21 who participate in the study receive medication or a placebo and help with quitting during 12 weekly sessions. Smokers under 18 must have parental consent. There is no cost to participate and compensation is available to those who qualify.

Translational Neuropsychopharmacology Research of Nicotine Addiction
PIs:  Drs. Brett Froeliger and Kevin Gray
Recruitment summary: This study is investigating the effects of combining two medications, varenicline (commonly known as Chantix) and N–acetylcysteine (NAC), on brain responses and smoking behavior in daily cigarette smokers who are interested in quitting smoking. The study consists of 10 visits over six weeks. Compensation is available for those who qualify. Smokers must be between the ages of 18 and 55.

Evaluating N-acetylcysteine as a Pharmacotherapy for Tobacco Use Disorder
PI:  Dr. Erin McClure
Recruitment summary:  The purpose of this study is to assess the effects of N–acetylcysteine (NAC), an over–the–counter antioxidant, to assist adult cigarette smokers with quitting and preventing relapse to smoking. This medication may help people quit smoking by reducing withdrawal symptoms, craving and preventing relapse, but it is not known if NAC helps smokers early in their quit attempt or after they have already quit.

The Gender–Sex Hormone Interface with Craving and Stress–Related Changes in Smoking
PIs:  Drs. Michael Saladin and Kevin Gray
Recruitment summary: This is a non-treatment study for cigarette smokers ages 18 to 45, examining gender and reproductive hormone influences on smoking behavior. There is no requirement that participants be interested in quitting smoking. The study involves four clinic visits and compensation is provided for those who qualify.

Evaluating Smoking and Relapse in Adolescents and Emerging Adults Using Remote Monitoring Technology
PI:  Dr. Erin McClure
Recruitment summary: This is a research study that will test a new remote monitoring technology to assess smoking in the natural environment among adolescents and young adults ages 15-25. After assessment and inclusion in the study, participants will be asked to report on their smoking by answering questions on a mobile phone for 35 days. Participants will also be asked to make a brief quit attempt lasting for approximately 48 hours. There is no cost to participate and compensation is available to those who qualify.

Gender Differences in Latency to Smoke Following Exposure to Stressful and Smoking Cues in Daily Life
PIs:  Dr. Rachel Tomko (Mentor: Dr. Kevin Gray)
Recruitment summary: This is a non-treatment study for smokers, ages 18 to 45, who are being recruited for research at MUSC to help better understand patterns of cigarette smoking among male and female regular smokers. Specifically, participants will track their cigarette use using an electronic lighter and will complete surveys on a mobile device for two weeks.