Neural Responses to Smoking Stimuli Are Influenced by Smokers' Attitudes towards Their Own Smoking Behaviour

Abstract

An important feature of addiction is the high drug craving that may promote the continuation of consumption. Environmental stimuli classically conditioned to drug-intake have a strong motivational power for addicts and can elicit craving. However, addicts differ in the attitudes towards their own consumption behavior: some are content with drug taking (consonant users) whereas others are discontent (dissonant users). Such differences may be important for clinical practice because the experience of dissonance might enhance the likelihood to consider treatment. This fMRI study investigated in smokers whether these different attitudes influence subjective and neural responses to smoking stimuli. Based on self-characterization, smokers were divided into consonant and dissonant smokers. These two groups were presented smoking stimuli and neutral stimuli. Former studies have suggested differences in the impact of smoking stimuli depending on the temporal stage of the smoking ritual they are associated with. Therefore, we used stimuli associated with the beginning (BEGIN-smoking-stimuli) and stimuli associated with the terminal stage (END-smoking-stimuli) of the smoking ritual as distinct stimulus categories. Stimulus ratings did not differ between both groups. Brain data showed that BEGIN-smoking-stimuli led to enhanced mesolimbic responses (amygdala, hippocampus, insula) in dissonant compared to consonant smokers. In response to END-smoking-stimuli, dissonant smokers showed reduced mesocortical responses (orbitofrontal cortex, subcallosal cortex) compared to consonant smokers. These results suggest that smoking stimuli with a high incentive value (BEGIN-smoking-stimuli) are more appetitive for dissonant than consonant smokers at least on the neural level. To the contrary, smoking stimuli with low incentive value (END-smoking-stimuli) seem to be less appetitive for dissonant smokers than consonant smokers. These differences might be one reason why dissonant smokers experience difficulties in translating their attitudes into an actual behavior change.

The Insula: A Brain Stimulation Target for the Treatment of Addiction

“…A meta-analysis of fMRI studies on smoking cue reactivity also concluded that smoking cues, as compared to neutral cues, reliably evoke larger fMRI responses in the insula (Engelmann et al, 2012). The effect of smoking initiation-related cues (e.g., lighter) vs. smoking conclusion-related cues (e.g., cigarette butt in ashtray) on two groups of smokers who were either content or discontent with their behavior further examined temporal relations of smoking cues (Stippekohl et al, 2012), with discontent smokers showed greater insular activation in response to initiation-related cues than content smokers, and aIC activation is observed during intrinsic, but not extrinsic, motivation (Lee and Reeve, 2013).…”

Cigarette Cravings, Impulsivity, and the Brain

“…Some authors have shown that one’s intention to quit can impact prefrontal and limbic activity toward cigarette pictures ( 48 ) Furthermore, it was shown that smokers who are dissatisfied with their smoking behavior, relative to those more accepting of their tobacco use, were more reactive (e.g., orbitofrontal and limbic activations) to appetitive cigarette cues ( 49 ).…”

Fronto-striatal dysregulation in drug addiction and pathological gambling: Consistent inconsistencies?

“…Some of the inconsistencies in the field are likely due to clinical or demographic factors that act as moderators, such as the differences between classes of drug (e.g., stimulants vs. opiates) (McNamara et al, 2010), gender (Potenza et al, 2012), or treatment-seeking status (Stippekohl et al, 2012). Inclusion criteria are obviously important; for example, the target group in the Peters et al's (2011) study were adolescents who reported smoking at least one cigarette in the last 30 days, while Jia et al (2011) included cocaine users seeking treatment for dependence.…”