One of the largest smoking cessation operations in the United States, Duke University’s Quit at Duke program is achieving results using “adaptive pharmacotherapy,” which starts with a sequence of prescriptions designed to reduce cravings prior to quitting.

Dr. James Davis, who started Quit at Duke at the Duke Cancer Institute and has shepherded its growth into a team of a dozen professionals handling 6,000 patients a year from North Carolina, South Carolina, and Virginia.

Quit at Duke begins with assessment and personalized plans. It helps to be able to tell nervous quitters that they don’t have to give up all their cigarettes at once. The medical team “creates highly personalized plans, which often combine two or more medications with intensive behavioral treatment,” Dr. Davis told science writer Angela Spivey for a profile on the School of Medicine’s website. Spivery continues:

[The Quit at Duke] team uses “adaptive pharmacotherapy,” in which the patient is started on an individualized medication regimen, then a few weeks later the team changes the treatment based on the patient’s response. Only after the patient shows a reduction in smoking are they asked to try to gradually quit.

The adaptive method was tested against the standard method in a randomized, controlled trial conducted at the Duke University Health System involving 188 smoking cessation patients. Twelve weeks after the target quit date, Duke biochemically verified whether patients had achieved 30 days of continuous nonsmoking. The adaptive method was significantly more effective than the standard method.

Patients were started on either varenicline or a nicotine patch, the patient’s choice. Medication was started four weeks before the target quit date. Bupropion was added two weeks after the start of the trial and two weeks before the quit date for those who failed to reduce smoking by 50% in the first two weeks. “All participants received brief behavioral support” consisting of “20 minutes of evidence-based smoking cessation counseling by a tobacco treatment specialist.”

It’s not exactly clear what’s included in the behavioral support provided to all participants in this study. Based on Dr. Davis’ interview, it includes mindfulness training. Specifically, patients are taught about cues and triggers, and how to develop strategies for dealing with stressful situations without smoking. Patients are encouraged to break established patterns they associate with smoking by disrupting their standard routines.

How much better is the adaptive pharmacotherapy method? According to the researchers at Duke, “In this trial, the abstinence rate was 24% for adaptive treatment and 9% for standard treatment, with an absolute difference of 15.6 percentage points and a 2.8-fold increase in efficacy.” That is certainly something to crow about!

Written by Steve O’Keefe. First published July 15, 2024.

Sources:

“Duke Team Helps Thousands of Smokers Beat Their Addiction,” Duke University School of Medicine, July 10, 2024.

“Adaptive Smoking Cessation Using Precessation Varenicline or Nicotine Patch, A Randomized Clinical Trial,” JAMA Network Open, September 8, 2023.

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