Clinical Research Directory

Inclusion Criteria: * Is a US Veteran * Meets DSM-5 criteria for tobacco use disorder * Is between the ages of 18 and 75 * Smokes an average of 10 cigarettes per day for the past 6 months, with carbon monoxide (CO) level \> 6 ppm * Is willing to attempt smoking cessation * Meets DSM-5 criteria for current PTSD diagnosis * Speaks, reads and writes English * Is willing to sign a Duke consent for those portions of the study that occur at Duke * Has been stable on psychotropic medications for at least three months Exclusion Criteria: * Has had a substance use disorder other than tobacco in the preceding 3 months * Has a history of myocardial infarction in the past 6 months or has another contraindication to NRT * Has a contraindication to TMS or MRI * Personal or family history of a seizures or epilepsy * History of neurological condition that increases the risk of seizures including stroke or transient ischemic attack, cerebral aneurysm, or severe traumatic brain injury from a penetrating head injury, loss of consciousness \> 20 minutes at time of traumatic injury, requiring an anticonvulsant medication for seizures, and/or found to have encephalomalacia on baseline MRI * Structural brain lesion, or prior brain surgery * Ferromagnetic metal in head (including shrapnel) * Implanted devices that may be affected by MRI or TMS (pacemaker, medication pump, cochlear implant, implanted deep brain stimulator) * Is pregnant (to be determined at Duke) * Is unable to complete study procedures * Is currently prescribed bupropion and/or varenicline * Uses other forms of nicotine such as cigars, pipes, chewing tobacco, or vaping * Is unable to provide informed consent due to a major neurocognitive disorder or other reason * Meets criteria for a primary psychotic disorder or current manic episode * Is currently imprisoned or psychiatrically hospitalized * Has previously received rTMS