Leveraging smartphones to facilitate smoking cessation

How long has it been since you last looked at your phone? Chances are, if you’re not already on your phone reading this story, you’ve probably picked your phone up more recently than you’d like to admit.

Over the last decade, smartphones have drastically transformed our way of life; in some instances, these changes have been beneficial, while in others, they have presented challenges. Yet despite increasing awareness of the pernicious negative consequences that come from being more connected than ever before, this relatively young technology may provide solutions to some of today’s most pressing issues including substance use disorder.

Substance use disorders are a category of disorders characterized by the inability to control intake of a given substance, despite any negative effects they may have on one’s life. Though people typically recognize problematic use of alcohol and opiates as a substance use disorder, nicotine use can also be considered a substance use disorder when individuals are unable to quit despite wanting to and recognizing the long-term negative impacts nicotine use has on their health. 

"Smartphones are a relatively young technology and may provide solutions to some of today’s most pressing issues including substance use disorder."

-- Michael Martino

One of the biggest challenges for nicotine users who want to quit is resisting the temptation of smoking cues, such as seeing someone else smoke or holding a cigarette. These cues can trigger strong cravings, driving a return to use despite the best of intentions.

But what if it was possible to “train” the brain to somehow respond less to those cues, reducing the cravings they bring on and making it easier to kick the habit for good?

A study published in Neuropsychopharmacology suggests that app-based mindfulness training may be the answer for a subset of individuals. Amy Jane, Ph.D., lead author of this study, and her colleagues found that nicotine users who received mindfulness training through a smartphone app during a 1-month nicotine cessation program showed decreases in neural responses to smoking cues in a brain region called the posterior cingulate cortex (PCC). This brain region plays a key role in reflecting on oneself and how we react to things around us, including how we respond to habits or cues that can trigger desires or cravings. In women, the degree of PCC activity reduction over the course of the study predicted reductions in cigarette smoking at the individual level, though this wasn’t the case in men.

The study is the first to demonstrate a specific brain mechanism underlying the effectiveness of mindfulness for smoking cessation, and to identify potential biotype markers that can guide personalized treatment, adding to a growing list of smartphone-based apps that have proven effective for the treatment of mental health conditions.

Mental health conditions, including substance use disorder, affect between 20-25% of the US adult population, according to the National Institute of Mental Health. Despite massive investments in biomedical research and drug discovery, pharmacological interventions for psychiatric disorders suffer from low treatment effectiveness, high burden of side effects and inequitable accessibility. 

"Through carefully designed studies, we can begin to leverage mobile technologies to design innovative treatments for mental health conditions."

-- Michael Martino

That isn’t to say that psychiatric medications aren’t useful – for many, these drugs dramatically improve quality of life and in some cases save lives. Yet these medications are not effective for everyone, leaving many patients untreated. Smartphone-based apps offer an innovative approach to boosting mental health, providing an alternative or adjunctive therapy.

While this study aimed to reduce nicotine use in individuals ready to quit, other studies have used apps to collect specific types of data passively, then correlate collected information with patient outcomes. The information obtained from this type of study can further refine our understanding of mental health conditions, identifying information predictive of future mental health or behaviors.

While such insight should not be viewed lightly, these apps have the potential to save lives when medication may not be available. For instance, another study found that a combination of passive data collection and self-report questionnaire answers through an app were able to predict the risk of patients with schizophrenia returning to use drugs of abuse with a 70% probability. Although the study had a small sample size and predictions occurred retrospectively, the authors demonstrated the potential to train predictive algorithms using relatively small data sets to determine the most important factors predicting a return to use.

In the future, apps could potentially track the most important factors predicting return to use in real time and intervene in the hopes of maintaining abstinence. With deaths attributable to opioid overdose continuing to rise, such an intervention could save millions of lives.

Despite increasing awareness of the potential harm caused by excessive smartphone use, it’s unlikely they’re going away anytime soon. Through carefully designed studies by investigators like Dr. Janes, we can begin to leverage mobile technologies to design innovative treatments for mental health conditions. Who knows, maybe one day our phones will be surprised to find how much they’re checking in on us.