Smoking Cessation Potential of Smartphone-Assisted Behavioral Therapy Coupled to Programmable Carbon Nanotube Membrane Nicotine Delivery Device.

Smoking tobacco continues to be a worldwide major cause of premature death. Although combined behavioral and pharmacotherapy interventions can increase the smoking cessation rate to nearly 25%, the combined approach is generally economically unattainable, and the low success rate leaves large populations at risk. Reviewed are treatments following primarily the principles of cognitive behavioral therapy (CBT) and nicotine replacement therapy (NRT), based on an addiction disease model with reduced dopamine receptors. Particular emphasis is placed on technology-assisted (Internet and smartphone applications) behavioral therapy to reduce economic costs. For smartphone apps, the established clinical strategies of the "5 A's of intervention" and the "5 R's of motivation" should be used. Counseling generally identifies self-expansion behaviors to stimulate dopamine cascades in reward pathways, but success rates are generally low because these patients have fewer dopamine receptors. Timing pharmacological therapy to induce dopamine cascades during self-expansion therapy offers an important increase in CBT success rates. An ideal platform would be a smartphone app, using best CBT practices along with a carbon nanotube-based programmable nicotine delivery device. These devices release variable doses of nicotine to provide relief from sustained withdrawal symptoms and relapse events, and reinforcement of self-expansion behaviors.