Elsevier

Biological Psychiatry

Volume 67, Issue 8, 15 April 2010, Pages 722-729
Biological Psychiatry

Archival Report
Brain Reactivity to Smoking Cues Prior to Smoking Cessation Predicts Ability to Maintain Tobacco Abstinence

https://doi.org/10.1016/j.biopsych.2009.12.034Get rights and content

Background

Developing the means to identify smokers at high risk for relapse could advance relapse prevention therapy. We hypothesized that functional magnetic resonance imaging (fMRI) reactivity to smoking-related cues, measured before a quit attempt, could identify smokers with heightened relapse vulnerability.

Methods

Before quitting smoking, 21 nicotine-dependent women underwent fMRI during which smoking-related and neutral images were shown. These smokers also were tested for possible attentional biases to smoking-related words using a computerized emotional Stroop (ES) task previously found to predict relapse. Smokers then made a quit attempt and were grouped based on outcomes (abstinence vs. slip: smoking ≥ 1 cigarette after attaining abstinence). Prequit fMRI and ES measurements in these groups were compared.

Results

Slip subjects had heightened fMRI reactivity to smoking-related images in brain regions implicated in emotion, interoceptive awareness, and motor planning and execution. Insula and dorsal anterior cingulate cortex (dACC) reactivity induced by smoking images correlated with an attentional bias to smoking-related words. A discriminant analysis of ES and fMRI data predicted outcomes with 79% accuracy. Additionally, smokers who slipped had decreased fMRI functional connectivity between an insula-containing network and brain regions involved in cognitive control, including the dACC and dorsal lateral prefrontal cortex, possibly reflecting reduced top-down control of cue-induced emotions.

Conclusions

These findings suggest that the insula and dACC are important substrates of smoking relapse vulnerability. The data also suggest that relapse-vulnerable smokers can be identified before quit attempts, which could enable personalized treatment, improve tobacco-dependence treatment outcomes, and reduce smoking-related morbidity and mortality.

Section snippets

Subjects

Twenty-one women underwent neuroimaging at McLean Hospital before participating in a smoking cessation clinical trial at Massachusetts General Hospital (MGH; NCT00218465). Subjects met DSM-IV criteria for current nicotine dependence, reported smoking ≥10 cigarettes per day in the previous 6 months, and had expired air carbon monoxide (CO) >10 ppmv at screening. Smokers with current unstable medical illness, pregnancy, recent drug and alcohol use (QuickTox 11 Panel Drug Test Card, Branan

Results

Of the 21 subjects who completed prequit neuroimaging, nine slipped while on NRT. Slips took place on average 17.4 days (range: 1–49 days) after established abstinence. Slip and abstinence groups differed at a trend level on FTND scores (t19 = 2.0, p < .07; Table 1) and not on any other demographic variable. Of the 19 subjects completing the ES task, eight slipped, and these groups differed on FTND scores (t17 = 2.12, p < .05). In the entire clinical trial cohort (n = 126) from which study

Discussion

Smokers who slipped during the quit attempt exhibited increased prequit brain fMRI reactivity to smoking-related images in the insula, amygdala, and several other brain areas. Insula and amygdala activation might imply that smoking-related images are more emotionally salient and may induce interoceptive awareness to a greater extent than neutral images in smokers vulnerable to relapse. Our insula findings are in line with evidence suggesting that this region is involved in maintaining smoking

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    Authors AEE and MJK contributed equally to this work.

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