Lifelong fascination with addiction leads to UW-CTRI

Tim Baker, principal investigator for several studies about tobacco addition and smoking cessation programs, poses with a poster illustrating some of his group’s findings. Baker is a professor of psychology and associate director of the Center for Tobacco Research and Intervention.

Photo: Jeff Miller

Tim Baker’s first encounter with alcohol treatment in the 1970s taught him two things. First, he was surprised that seemingly competent people who have strong reasons and commitment to change their behavior were strikingly unable to do so. And he discovered that the people treating them did not really know how to help.

“Alcohol treatment at that time was based on hunches, folklore and trial and error — not research,” says Baker, now a UW–Madison professor of psychology and associate director of the Center for Tobacco Research and Intervention (UW-CTRI). “People were as well off staying home as they were in treatment,” he adds.

Thus began Baker’s lifelong fascination with addiction. He continued to study alcoholism through his graduate work at the University of Utah, where he completed his Ph.D., but changed to opiate research on animals after coming to UW–Madison in 1978. Now he’s a national expert on tobacco dependence, contributing chapters to various surgeon general reports and publishing seminal articles in journals such as the Journal of the American Medical Association and the Annual Review of Psychology.

Why the change to tobacco?

“I was attracted to the fact that tobacco use is the most common form of addiction, and the most lethal. More people die from tobacco use than all other addictions combined,” says Baker. “It also serves as an analog for other kinds of addiction. Tobacco dependence, tolerance and urges are similar to other addictions.”

Currently, Baker is shepherding an enormous study of tobacco treatment, supported by the National Institute on Drug Abuse. This research, the Wisconsin Smokers’ Health Study, will ultimately involve more than 1,500 smokers in Madison and Milwaukee and will follow both those who quit and those who continue to smoke for up to three years. Participants are randomized to five treatment groups using FDA-approved medications with the goal of determining which medications work with which individuals. This information will be useful to health-care providers in treating tobacco dependence.

The study looks at the smoker as a whole person, using physical and mental assessments as well as questionnaires about diet, exercise, health and social relationships.

“We want to know how quitting smoking or continuing to smoke affects a person’s life. Does he gain weight? Do friends change? What happens to cardiovascular markers such as intima medial thickness and lipoprotein subparticles? What happens when a smoker relapses? These areas have never been studied in depth and over time,” says Baker. “The potential for gaining new knowledge is tremendous.”

This study illustrates one of the trends Baker notes in current tobacco research. The work has become much more transdisciplinary. Researchers involved in the Wisconsin Smokers’ Health Study have expertise in cardiovascular disease, genetics, nutrition, exercise, social psychology, neuroscience and pulmonology.

Another trend in tobacco studies is the increase in methods of measurement and analysis. Tobacco researchers use personal digital assistants and cell phones to gather information about urges, emotions, stresses and temptations. Brain imaging using functional magnetic resonance imaging shows which areas of the brain are affected when someone is administered nicotine. Genetic analysis spotlights genes that are linked to tobacco use and disease risk and progression.

“The last 20 years have seen an explosion in tobacco research,” says Baker. “And we have learned a great deal.”

Some similarities between tobacco and other addictions are becoming more apparent. The same brain regions are involved with opiates and tobacco. The effects of heredity and personality are similar for tobacco use and other addictions. Moreover, the determinants of relapse are quite similar.

“Research in the last 20 years has shown the profound health effects of smoking and that it’s not a habit, but a highly addictive, chronic disease,” says Baker. “We’ve also developed an appreciation of the health threats from secondhand smoke. This has had a profound impact — changing norms around smoking.”

Several areas hold promise for the future, according to Baker. Studies of brain chemistry — how the brain processes nicotine — can lead to more and better treatments. UW-CTRI has been engaged in numerous medication clinical trials. Varenicline, a medication that interacts with nicotine receptors in the brain, has just received FDA approval. Currently under study is a nicotine vaccine that binds to the nicotine molecule to enlarge it and prevent its absorption. More can be expected.

Genetics is another area ripe for further investigation.

“We are working with the University of Utah on genetics research that will, we hope, help us understand why some individuals become highly addicted and others do not,” says Baker. “We have already found that the genetically influenced ability to taste bitterness has an effect on smoking.”

Looking back, what does Baker see as most rewarding? One is the working with graduate students — “training them and having them train me,” he says. Baker has mentored 15 so far and almost all are in faculty and research positions. “These students are conducting research that will make a tremendous difference to those who are suffering the physical and psychological damage from addiction,” he adds.

His research and that of others has resulted in treatments that can significantly increase quit rates. Twenty years ago, going “cold turkey” was the norm. Now an array of effective treatments exist. In fact, now Baker can say that staying home is not equal to getting treatment — and research has made the difference.