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Kunas SL, Stuke H, Heinz A, Ströhle A, Bermpohl F. Evidence for a hijacked brain reward system but no desensitized threat system in quitting-motivated smokers: An fMRI study. Addiction 2022; 117:701-712. [PMID: 34312937 DOI: 10.1111/add.15651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/14/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Several aspects of how quitting-motivated tobacco use disorder (TUD) subjects and never-smokers differ in terms of reward and threat processing remain unresolved. We aimed to examine aberrant reward and threat processes in TUD and the association with smoking characteristics. DESIGN A between- and within-subjects functional magnetic resonance imaging (fMRI) experiment with a 2 (groups) × 4 (stimulus type) factorial design. The experimental paradigm had four conditions: pictures of (1) cigarettes served as drug-related-positive cues, (2) food as alternative reward cues, (3) long-term consequences of smoking as drug-related-negative cues and (4) neutral pictures as control. SETTING/PARTICIPANTS Adult participants (n = 38 TUD subjects and n = 42 never-smokers) were recruited in Berlin, Germany. MEASUREMENTS As contrasts of primary interest, the interactions of group × stimulus-type were assessed. Significance threshold correction for multiple testing was carried out with the family-wise error method. Correlation analyses were used to test the association with smoking characteristics. FINDINGS The 2 × 2 interaction of smoking status and stimulus type revealed activations in the brain reward system to drug-related-positive cues in TUD subjects (between-subjects effect: P-values ≤ 0.036). As a response to drug-related-negative cues, TUD subjects showed no reduced activation of the aversive brain network. Within the TUD group, a significant negative association was found between response of the aversive brain system to drug-related-negative cues (within-subjects effect: P-values ≤ 0.021) and the number of cigarettes smoked per day (right insula r = -0.386, P = 0.024; left insula r = -0.351, P = 0.042; right ACC r = -0.359, P = 0.037). CONCLUSIONS Moderate smokers with tobacco use disorder appear to have altered brain reward processing of drug-related-positive (but not negative) cues compared with never smokers.
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Affiliation(s)
- Stefanie L Kunas
- Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Heiner Stuke
- Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Heinz
- Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Ströhle
- Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Bermpohl
- Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Kunas SL, Bermpohl F, Plank IS, Ströhle A, Stuke H. Aversive drug cues reduce cigarette craving and increase prefrontal cortex activation during processing of cigarette cues in quitting motivated smokers. Addict Biol 2022; 27:e13091. [PMID: 34427358 DOI: 10.1111/adb.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/30/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
Aversive drug cues can be used to support smoking cessation and create awareness of negative health consequences of smoking. Better understanding of the effects of aversive drug cues on craving and the processing of appetitive drug cues in abstinence motivated smokers is important to further improve their use in cessation therapy and smoking-related public health measures. In this study, 38 quitting motivated smokers underwent functional magnetic resonance imaging (fMRI) scanning while performing a novel extended cue-reactivity paradigm. Pictures of cigarettes served as appetitive drug cues, which were preceded by either aversive drug cues (e.g., smokers' leg) or other cues (neutral or alternative reward cues). Participants were instructed to rate their craving for cigarettes after presentation of drug cues. When aversive drug cues preceded the presentation of appetitive drug cues, behavioural craving was reduced and activations in prefrontal (dorsolateral prefrontal cortex) and paralimbic (dorsal anterior cingulate cortex [dACC] and anterior insulae) areas were enhanced. A positive association between behavioural craving reduction and neurofunctional activation changes was shown for the right dACC. Our results suggest that aversive drug cues have an impact on the processing of appetitive drug cues, both on a neurofunctional and a behavioural level. A proposed model states that aversive drug-related cues activate control-associated brain areas (e.g., dACC), leading to increased inhibitory control on reward-associated brain areas (e.g., putamen) and a reduction in subjective cravings.
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Affiliation(s)
- Stefanie L. Kunas
- Department of Psychiatry and Neuroscience Campus Charité Mitte, Charité‐Universitätsmedizin Berlin Berlin Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neuroscience Campus Charité Mitte, Charité‐Universitätsmedizin Berlin Berlin Germany
| | - Irene S. Plank
- Department of Psychiatry and Neuroscience Campus Charité Mitte, Charité‐Universitätsmedizin Berlin Berlin Germany
- Einstein Center for Neurosciences Charité Campus Mitte, Universitätsmedizin Berlin Berlin Germany
- Berlin School of Mind and Brain, Institute of Psychology Humboldt‐Universität zu Berlin Berlin Germany
| | - Andreas Ströhle
- Department of Psychiatry and Neuroscience Campus Charité Mitte, Charité‐Universitätsmedizin Berlin Berlin Germany
| | - Heiner Stuke
- Department of Psychiatry and Neuroscience Campus Charité Mitte, Charité‐Universitätsmedizin Berlin Berlin Germany
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Signs of Warning: Do Health Warning Messages on Sweets Affect the Neural Prefrontal Cortex Activity? Nutrients 2020; 12:nu12123903. [PMID: 33371197 PMCID: PMC7765959 DOI: 10.3390/nu12123903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/13/2020] [Accepted: 12/18/2020] [Indexed: 12/01/2022] Open
Abstract
In the global attempt to combat rising obesity rates, the introduction of health warning messages on food products is discussed as one possible approach. However, the perception of graphical health warning messages in the food context and the possible impact that they may have, in particular at the neuronal level, have hardly been studied. Therefore, the aim of this explorative study was to examine consumers’ reactions (measured as neuronal activity and subjective reporting) of two different types of graphical health warning messages on sweets compared to sweets without warning messages. One type used the red road traffic stop sign as graphical information (“Stop”), while the other one used shocking pictures (“Shock”), an approach similar to the images on cigarette packages. The neural response of 78 participants was examined with the neuroimaging technique functional near-infrared spectroscopy (fNIRS). Different hemodynamic responses in the orbitofrontal cortex (OFC), the frontopolar cortex (FOC), and the dorsolateral prefrontal cortex (dlPFC) were observed, regions which are associated with reward evaluation, social behavior consequences, and self-control. Further, the health warning messages were actively and emotionally remembered by the participants. These findings point to an interesting health information strategy, which should be explored and discussed further.
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Kim BS, Lim YH, Shin JH, Kim SH, Roh S, Choi YW, Shin J, Park JK, Kim KS. The Impact of Aversive Advice During Percutaneous Coronary Intervention on Smoking Cessation in Patients With Acute Coronary Syndrome. Glob Heart 2019; 14:253-257. [PMID: 31103401 DOI: 10.1016/j.gheart.2019.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Smoking cessation is important to prevent recurrence of acute coronary syndrome (ACS), but even in patients with ACS, smoking is hard to quit. OBJECTIVES This study hypothesized that aversive advice during the percutaneous coronary intervention (PCI) procedure works effectively to promote smoking cessation in patients with ACS. METHODS This study was conducted as a prospective, single-blinded, randomized controlled trial. A total of 66 patients were randomly assigned to an aversive advice group or a control group and instructed to visit the outpatient clinic 1, 4, and 24 weeks after discharge. In the aversive advice group, a physician who did not participate in the patient follow-up said the following 3 sentences to the patients during the PCI procedure: "Smoking caused your chest pain"; "If you do not stop smoking right now, this pain will come again"; and "The next time you feel this pain you will probably die." All patients received usual advice on the importance of quitting smoking. RESULTS At 24 weeks after discharge, the smoking cessation rate was higher in the aversive advice group than in the control group. In a multivariable logistic regression analysis, after adjustment for age, smoking quantity, alcohol consumption, and disease severity, the result was maintained (odds ratio = 4.47, 95% confidence interval: 1.50 to 13.34). CONCLUSIONS Aversive advice during a PCI procedure is effective at smoking cessation in patients with ACS. A physician's attention and involvement during the PCI procedure improves the rate of smoking cessation in patients with ACS.
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Affiliation(s)
- Byung Sik Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jeong Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri City, Republic of Korea
| | - Seok Hyeon Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Sungwon Roh
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Yeon Woo Choi
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jin-Kyu Park
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Kyung-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea.
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Whelan ME, Morgan PS, Sherar LB, Kingsnorth AP, Magistro D, Esliger DW. Brain Activation in Response to Personalized Behavioral and Physiological Feedback From Self-Monitoring Technology: Pilot Study. J Med Internet Res 2017; 19:e384. [PMID: 29117928 PMCID: PMC5700408 DOI: 10.2196/jmir.8890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 11/13/2022] Open
Abstract
Background The recent surge in commercially available wearable technology has allowed real-time self-monitoring of behavior (eg, physical activity) and physiology (eg, glucose levels). However, there is limited neuroimaging work (ie, functional magnetic resonance imaging [fMRI]) to identify how people’s brains respond to receiving this personalized health feedback and how this impacts subsequent behavior. Objective Identify regions of the brain activated and examine associations between activation and behavior. Methods This was a pilot study to assess physical activity, sedentary time, and glucose levels over 14 days in 33 adults (aged 30 to 60 years). Extracted accelerometry, inclinometry, and interstitial glucose data informed the construction of personalized feedback messages (eg, average number of steps per day). These messages were subsequently presented visually to participants during fMRI. Participant physical activity levels and sedentary time were assessed again for 8 days following exposure to this personalized feedback. Results Independent tests identified significant activations within the prefrontal cortex in response to glucose feedback compared with behavioral feedback (P<.001). Reductions in mean sedentary time (589.0 vs 560.0 minutes per day, P=.014) were observed. Activation in the subgyral area had a moderate correlation with minutes of moderate-to-vigorous physical activity (r=0.392, P=.043). Conclusion Presenting personalized glucose feedback resulted in significantly more brain activation when compared with behavior. Participants reduced time spent sedentary at follow-up. Research on deploying behavioral and physiological feedback warrants further investigation.
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Affiliation(s)
- Maxine E Whelan
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
| | - Paul S Morgan
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom.,Medical Physics and Clinical Engineering, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Lauren B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom.,National Institute of Health Research Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Andrew P Kingsnorth
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
| | - Daniele Magistro
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom
| | - Dale W Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom.,National Institute of Health Research Leicester Biomedical Research Centre, Leicester, United Kingdom
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Huang P, Shen Z, Wang C, Qian W, Zhang H, Yang Y, Zhang M. Altered White Matter Integrity in Smokers Is Associated with Smoking Cessation Outcomes. Front Hum Neurosci 2017; 11:438. [PMID: 28912702 PMCID: PMC5582085 DOI: 10.3389/fnhum.2017.00438] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/16/2017] [Indexed: 01/03/2023] Open
Abstract
Smoking is a significant cause of preventable mortality worldwide. Understanding the neural mechanisms of nicotine addiction and smoking cessation may provide effective targets for developing treatment strategies. In the present study, we explored whether smokers have white matter alterations and whether these alterations are related to cessation outcomes and smoking behaviors. Sixty-six smokers and thirty-seven healthy non-smokers were enrolled. The participants underwent magnetic resonance imaging scans and smoking-related behavioral assessments. After a 12-week treatment with varenicline, 28 smokers succeeded in quitting smoking and 38 failed. Diffusion parameter maps were compared among the non-smokers, future quitters, and relapsers to identify white matter differences. We found that the future relapsers had significantly lower fractional anisotropy (FA) in the orbitofrontal area than non-smokers, and higher FA in the cerebellum than non-smokers and future quitters. The future quitters had significantly lower FA in the postcentral gyrus compared to non-smokers and future relapsers. Compared to non-smokers, pooled smokers had lower FA in bilateral orbitofrontal gyrus and left superior frontal gyrus. In addition, regression analysis showed that the left orbitofrontal FA was correlated with smoking-relevant behaviors. These results suggest that white matter alterations in smokers may contribute to the formation of aberrant brain circuits underlying smoking behaviors and are associated with future smoking cessation outcomes.
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Affiliation(s)
- Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
| | - Zhujing Shen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
| | - Chao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
| | - Wei Qian
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
| | - Huan Zhang
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang UniversityHangzhou, China
| | - Yihong Yang
- Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health, BaltimoreMD, United States
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of MedicineHangzhou, China
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7
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Whelan ME, Morgan PS, Sherar LB, Orme MW, Esliger DW. Can functional magnetic resonance imaging studies help with the optimization of health messaging for lifestyle behavior change? A systematic review. Prev Med 2017; 99:185-196. [PMID: 28214544 DOI: 10.1016/j.ypmed.2017.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/04/2017] [Accepted: 02/08/2017] [Indexed: 11/17/2022]
Abstract
Unhealthy behaviors, including smoking, poor nutrition, excessive alcohol consumption, physical inactivity and sedentary lifestyles, are global risk factors for non-communicable diseases and premature death. Functional magnetic resonance imaging (fMRI) offers a unique approach to optimize health messages by examining how the brain responds to information relating to health. Our aim was to systematically review fMRI studies that have investigated variations in brain activation in response to health messages relating to (i) smoking; (ii) alcohol consumption; (iii) physical activity; (iv) diet; and (v) sedentary behavior. The electronic databases used were Medline/PubMed, Web of Science (Core Collection), PsychINFO, SPORTDiscuss, Cochrane Library and Open Grey. Studies were included if they investigated subjects aged ≥10years and were published before January 2017. Of the 13,836 studies identified in the database search, 18 studies (smoking k=15; diet k=2; physical activity/sedentary behavior k=1) were included in the review. The prefrontal cortex was activated in seven (47%) of the smoking-related studies and the physical activity study. Results suggest that activation of the ventromedial, dorsolateral and medial prefrontal cortex regions were predictive of subsequent behavior change following exposure to aversive anti-smoking stimuli. Studies investigating the neurological responses to anti-smoking material were most abundant. Of note, the prefrontal cortex and amygdala were most commonly activated in response to health messages across lifestyle behaviors. The review highlights an important disparity between research focusing on different lifestyle behaviors. Insights from smoking literature suggest fMRI may help to optimize health messaging in relation to other lifestyle behaviors.
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Affiliation(s)
- Maxine E Whelan
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom.
| | - Paul S Morgan
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom; Medical Physics & Clinical Engineering, Nottingham University Hospitals, Nottingham, United Kingdom.
| | - Lauren B Sherar
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom; Leicester-Loughborough Diet, Lifestyle and Physical Activity, Biomedical Research Unit, United Kingdom.
| | - Mark W Orme
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom.
| | - Dale W Esliger
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom; Leicester-Loughborough Diet, Lifestyle and Physical Activity, Biomedical Research Unit, United Kingdom.
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Neural correlates of cigarette health warning avoidance among smokers. Drug Alcohol Depend 2016; 161:155-62. [PMID: 26874916 PMCID: PMC4803020 DOI: 10.1016/j.drugalcdep.2016.01.025] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/11/2016] [Accepted: 01/26/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Eye-tracking technology has indicated that daily smokers actively avoid pictorial cigarette package health warnings. Avoidance may be due to a pre-cognitive perceptual bias or a higher order cognitive bias, such as reduced emotional processing. Using electroencephalography (EEG), this study aimed to identify the temporal point at which smokers' responses to health warnings begin to differ. METHOD Non-smokers (n=20) and daily smokers (n=20) viewed pictorial cigarette package health warnings and neutral control stimuli. These elicited Event Related Potentials reflecting early perceptual processing (visual P1), pre-attentive change detection (visual Mismatch Negativity), selective attentional orientation (P3) and a measure of emotional processing, the Late Positive Potential (LPP). RESULTS There was no evidence for a difference in P1 responses between smokers and non-smokers. There was no difference in vMMN and P3 amplitude but some evidence for a delay in vMMN latency amongst smokers. There was strong evidence for delayed and reduced LPP to health warning stimuli amongst smokers compared to non-smokers. CONCLUSION We find no evidence for an early perceptual bias in smokers' visual perception of health warnings but strong evidence that smokers are less sensitive to the emotional content of cigarette health warnings. Future health warning development should focus on increasing the emotional salience of pictorial health warning content amongst smokers.
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Ekhtiari H, Faghiri A, Oghabian MA, Paulus MP. Functional neuroimaging for addiction medicine: From mechanisms to practical considerations. PROGRESS IN BRAIN RESEARCH 2015; 224:129-53. [PMID: 26822357 DOI: 10.1016/bs.pbr.2015.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
During last 20 years, neuroimaging with functional magnetic resonance imaging (fMRI) in people with drug addictions has introduced a wide range of quantitative biomarkers from brain's regional or network level activities during different cognitive functions. These quantitative biomarkers could be potentially used for assessment, planning, prediction, and monitoring for "addiction medicine" during screening, acute intoxication, admission to a program, completion of an acute program, admission to a long-term program, and postgraduation follow-up. In this chapter, we have briefly reviewed main neurocognitive targets for fMRI studies associated with addictive behaviors, main study types using fMRI among drug dependents, and potential applications for fMRI in addiction medicine. Main challenges and limitations for extending fMRI studies and evidences aiming at clinical applications in addiction medicine are also discussed. There is still a significant gap between available evidences from group-based fMRI studies and personalized decisions during daily practices in addiction medicine. It will be important to fill this gap with large-scale clinical trials and longitudinal studies using fMRI measures with a well-defined strategic plan for the future.
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Affiliation(s)
- Hamed Ekhtiari
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran; Neurocognitive Laboratory, Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran; Translational Neuroscience Program, Institute for Cognitive Sciences Studies (ICSS), Tehran, Iran
| | - Ashkan Faghiri
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran; Department of Electrical Engineering, Sharif University of Technology, Tehran, Iran
| | - Mohammad-Ali Oghabian
- Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran; Advanced Diagnostic and Interventional Radiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Martin P Paulus
- Laureate Institute for Brain Research, Tulsa, OK, USA; Department of Psychiatry, University of California at San Diego, San Diego, CA, USA.
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Potvin S, Tikàsz A, Dinh-Williams LLA, Bourque J, Mendrek A. Cigarette Cravings, Impulsivity, and the Brain. Front Psychiatry 2015; 6:125. [PMID: 26441686 PMCID: PMC4562259 DOI: 10.3389/fpsyt.2015.00125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 08/26/2015] [Indexed: 12/28/2022] Open
Abstract
Craving is a core feature of tobacco use disorder as well as a significant predictor of smoking relapse. Studies have shown that appetitive smoking-related stimuli (e.g., someone smoking) trigger significant cravings in smokers impede their self-control capacities and promote drug seeking behavior. In this review, we begin by an overview of functional magnetic resonance imaging (fMRI) studies investigating the neural correlates of smokers to appetitive smoking cues. The literature reveals a complex and vastly distributed neuronal network underlying smokers' craving response that recruits regions involved in self-referential processing, planning/regulatory processes, emotional responding, attentional biases, and automatic conducts. We then selectively review important factors contributing to the heterogeneity of results that significantly limit the implications of these findings, namely between- (abstinence, smoking expectancies, and self-regulation) and within-studies factors (severity of smoking dependence, sex-differences, motivation to quit, and genetic factors). Remarkably, we found that little to no attention has been devoted to examine the influence of personality traits on the neural correlates of cigarette cravings in fMRI studies. Impulsivity has been linked with craving and relapse in substance and tobacco use, which prompted our research team to examine the influence of impulsivity on cigarette cravings in an fMRI study. We found that the influence of impulsivity on cigarette cravings was mediated by fronto-cingulate mechanisms. Given the high prevalence of cigarette smoking in several psychiatric disorders that are characterized by significant levels of impulsivity, we conclude by identifying psychiatric patients as a target population whose tobacco-smoking habits deserve further behavioral and neuro-imaging investigation.
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Affiliation(s)
- Stéphane Potvin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal , Montreal, QC , Canada ; Department of Psychiatry, Faculty of Medicine, University of Montreal , Montreal, QC , Canada
| | - Andràs Tikàsz
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal , Montreal, QC , Canada ; Department of Psychiatry, Faculty of Medicine, University of Montreal , Montreal, QC , Canada
| | | | - Josiane Bourque
- Department of Psychiatry, Faculty of Medicine, University of Montreal , Montreal, QC , Canada ; Centre de Recherche de l'Hôpital Sainte-Justine , Montreal, QC , Canada
| | - Adrianna Mendrek
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal , Montreal, QC , Canada ; Department of Psychology, Bishop's University , Lennoxville, QC , Canada
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Dinh-Williams L, Mendrek A, Dumais A, Bourque J, Potvin S. Executive-affective connectivity in smokers viewing anti-smoking images: an fMRI study. Psychiatry Res 2014; 224:262-8. [PMID: 25453167 DOI: 10.1016/j.pscychresns.2014.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 08/28/2014] [Accepted: 10/24/2014] [Indexed: 11/30/2022]
Abstract
Despite knowledge of the harmful consequences of smoking on health, tobacco users continue to smoke. Neuroimaging studies have begun to provide insight into the mechanisms underlying this response. Regions involved in executive control and affective processing/persuasion are activated when viewing the negative value of smoking, but these systems can interact in ways that promote or hinder its impact on behavior. The goal of this functional magnetic resonance imaging (fMRI) study was to examine the dynamics between these systems during the processing of images designed to elicit a negative emotional response regarding tobacco smoking in a group of current smokers. Thirty chronic smokers passively viewed aversive smoking-related, aversive nonsmoking-related and neutral images presented in a block design while being scanned. Functional connectivity analyses showed that the left inferior frontal gyrus (IFG) is negatively associated to activity in medial frontal, cingulate, limbic, subcortical and parietal regions in chronic smokers during the processing of aversive smoking-related material, a pattern that was significantly greater when stimuli were drug-related compared with when they were nondrug-related. Our results suggest that individuals with tobacco dependence present different patterns of functional connectivity depending on whether the aversive stimuli are smoking- or nonsmoking-related. Activity in the left inferior frontal gyrus may act to down-regulate corresponding activity in regions key to an affective and persuasive response during the processing of anti-smoking material. This mechanism may reduce the extent to which "feeling bad" brings about a change in behavior.
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Affiliation(s)
- Laurence Dinh-Williams
- Centre de recherche de l׳Institut Universitaire en Santé Mentale de Montréal and Department of Psychiatry, University of Montreal, Montreal, Canada
| | - Adrianna Mendrek
- Centre de recherche de l׳Institut Universitaire en Santé Mentale de Montréal and Department of Psychiatry, University of Montreal, Montreal, Canada; Department of Psychology, Bishop׳s University, Sherbrooke, Canada
| | - Alexandre Dumais
- Centre de recherche de l׳Institut Universitaire en Santé Mentale de Montréal and Department of Psychiatry, University of Montreal, Montreal, Canada; Institut Philippe-Pinel de Montréal, Montreal, Canada
| | - Josiane Bourque
- Centre de recherche de l׳Institut Universitaire en Santé Mentale de Montréal and Department of Psychiatry, University of Montreal, Montreal, Canada
| | - Stéphane Potvin
- Centre de recherche de l׳Institut Universitaire en Santé Mentale de Montréal and Department of Psychiatry, University of Montreal, Montreal, Canada.
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