Brain Reactivity to Smoking Cues Prior to Smoking Cessation Predicts Ability to Maintain Tobacco Abstinence
Open accessAbstract
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 > or = 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.
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In smokers, decreased functional connectivity between the insula, dACC, and dlPFC was found in those who relapsed.
“In smokers, researchers found a decreased functional connectivity between the insula and the primary sensorimotor cortices (Addicott et al., 2015), as well as the insula, dACC, and dlPFC (Janes et al., 2010), in those who relapsed.”
From The Insula: A Brain Stimulation Target for the Treatment of Addiction (2019) · cites this paper as Janes et al., 2010
Insula reactivity has been suggested as a biomarker to predict relapse.
“Accordingly, the reactivity of the insula has been suggested as a biomarker to help predict relapse (96).”
From The Addictive Dimensionality of Obesity (2013) · cites this paper as [96]
The reactivity of the insula has been suggested to serve as a biomarker to help predict relapse.
“Accordingly, the reactivity of this brain region has been suggested to serve as a biomarker to help predict relapse (Janes et al 2010).”
From Food and Drug Reward: Overlapping Circuits in Human Obesity and Addiction (2011) · cites this paper as Janes et al 2010
Behavioral indices of greater attentional bias and incentive salience attributed to drug cues have neural correlates that also predict relapse.
“More recently, these behavioral indices of greater attentional bias and incentive salience attributed to drug cues have also been shown to possess several neural correlates that also predict relapse (Janes et al., 2010; Marhe, Luijten, van de Wetering, Smits, & Franken, 2013).”
From Cued for Risk: Evidence for an Incentive Sensitization Framework to Explain the Interplay between Stress and Anxiety, Substance Abuse, and Reward Uncertainty in Disordered Gambling Behavior (2019) · cites this paper as Janes et al., 2010
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“^ More recently, these behavioral indices of greater attentional bias and incentive salience attributed to drug cues have also been shown to possess several neural correlates that also predict relapse (Janes et al., 2010; Marhe, Luijten, van de Wetering, Smits, & Franken, 2013).”
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Kutlu, M. G., Burke, D., Slade, S., Hall, B. J., Rose, J. E., & Levin, E. D. (2013) · Behavioural Brain Research · doi:10.1016/j.bbr.2013.08.005 · Cited by 41 · see citing works
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- Authors
- Janes, A. C., Pizzagalli, D. A., Richardt, S., Frederick, B. D., Chuzi, S., Pachas, G., Culhane, M. A., Holmes, A. J., Fava, M., Evins, A. E., & Kaufman, M. J.
- Affiliations
- Harvard University (US)
- Corresponding author
- Janes, Amy C.
- ORCID
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2010-04
- Volume
- 67
- Issue
- 8
- Pages
- 722-729
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC2954596
- OpenAlex
- W2031548929
- Cited by
- 416
- References
- 65
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 9 · 2023: 15 · 2022: 16 · 2021: 23 · 2020: 19 · 2019: 33 · 2018: 25 · 2017: 34 · 2016: 32 · 2015: 43 · 2014: 36 · 2013: 47 · 2012: 37
- FWCI
- 24.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (K02DA017324, R01DA014674, R01DA022276, R01DA09448, T32DA015036, U01DA019378)
- GlaxoSmithKline
- Office of National Drug Control Policy (BK39-03-C-0075)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Nicotinic Acetylcholine Receptors Study
- Keywords
- smoking relapse, smoking cues, smoking cessation, smoking abstinence, insula, dorsal anterior cingulate cortex, attentional bias, emotional Stroop task, functional connectivity, cognitive control, nicotine dependence, women smokers, recurrence prediction, personalized treatment
- MeSH terms
- Adult, Brain, Cerebral Cortex, Cues, Emotions, Female, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Middle Aged, Neural Pathways, Neuropsychological Tests, Psychiatric Status Rating Scales, Smoking, Smoking Cessation, Treatment Outcome, Principal Component Analysis
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