McClernon FJ, Kozink RV, Lutz AM, Rose JE. 24-h smoking abstinence potentiates fMRI-BOLD activation to smoking cues in cerebral cortex and dorsal striatum. Psychopharmacology (Berl) 204: 25-35

Duke University Medical Center Box 2701 Durham NC 27708 USA
Psychopharmacology (Impact Factor: 3.88). 05/2009; 204(1):25-35. DOI: 10.1007/s00213-008-1436-9


RationaleExposure to smoking-related cues can trigger relapse in smokers attempting to maintain abstinence.

ObjectivesIn the present study, we evaluated the effect of 24-h smoking abstinence on brain responses to smoking-related cues using
functional magnetic resonance imaging (fMRI).

Materials and methodsEighteen adult smokers underwent fMRI scanning following smoking as usual (satiated condition) and following 24-h abstinence
(abstinent condition). During scanning, they viewed blocks of photographic smoking and control cues.

ResultsFollowing abstinence, greater activation was found in response to smoking cues compared to control cues in parietal (BA 7/31),
frontal (BA 8/9), occipital (BA 19), and central (BA 4) cortical regions and in dorsal striatum (putamen) and thalamus. In
contrast, no smoking cue greater than control cue activations were observed following smoking as usual. Direct comparisons
between conditions (satiated vs. abstinent) showed greater brain reactivity in response to smoking cues following abstinence.
In addition, positive correlations between pre-scan craving in the abstinent condition and smoking cue activation were observed
in right dorsomedial prefrontal cortex (dmPFC) including superior frontal gyrus (BA 6/10), anterior cingulate gyrus (BA 32),
and supplementary motor area (BA 6).

ConclusionsThe present findings indicate that smoking abstinence significantly potentiates neural responses to smoking-related cues in
brain regions subserving visual sensory processing, attention, and action planning. Moreover, greater abstinence-induced craving
was significantly correlated with increased smoking cue activation in dmPFC areas involved in action planning and decision
making. These findings suggest that drug abstinence can increase the salience of conditioned cues, which is consistent with
incentive-motivation models of addiction.

Download full-text


Available from: Francis Joseph McClernon,
  • Source
    • "increased BOLD signal in nucleus accumbens and medial-prefrontal and orbitofrontal cortices; Kareken et al., 2004; Bragulat et al., 2008) are consistent with the extensive drug cue-reactivity literature that demonstrates the involvement of paralimbic and prefrontal cortical areas underlying drug craving and reward (Grüsser et al., 2004; Myrick. et al., 2004; McClernon et al., 2009; Hartwell et al., 2011; Kuhn and Gallinat, 2011; Vollstädt-Klein et al., 2011; Schacht et al., 2013). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Given that the vast majority of functional magnetic resonance imaging (fMRI) studies of drug cue reactivity use unisensory visual cues, but that multisensory cues may elicit greater craving-related brain responses, the current study sought to compare the fMRI BOLD response to unisensory visual and multisensory, visual plus odor, smoking cues in 17 nicotine-dependent adult cigarette smokers. Brain activation to smoking-related, compared to neutral, pictures was assessed under cigarette smoke and odorless odor conditions. While smoking pictures elicited a pattern of activation consistent with the addiction literature, the multisensory (odor+picture) smoking cues elicited significantly greater and more widespread activation in mainly frontal and temporal regions. BOLD signal elicited by the multisensory, but not unisensory cues, was significantly related to participants' level of control over craving as well. Results demonstrated that the co-presentation of cigarette smoke odor with smoking-related visual cues, compared to the visual cues alone, elicited greater levels of craving-related brain activation in key regions implicated in reward. These preliminary findings support future research aimed at a better understanding of multisensory integration of drug cues and craving.
    10/2015; DOI:10.1016/j.pscychresns.2015.10.008
    • "Despite these limitations, CR studies have yielded findings indicating that smokers (and other drug users) react to smoking/drug cues (Carter and Tiffany, 1999), that such responses are reproducible (LaRowe et al., 2007), that some smokers react more strongly than others (Shiffman et al., 2003), and that these individual differences are sometimes (but not consistently) correlated with other variables of interest (Abrams et al., 1988; Powell et al., 2010; Waters et al., 2004; Watson et al., 2010). This has been seen not only for subjective measures of craving, but also for objective measures such as changes in regional brain activity (Engelmann et al., 2012; Janes et al., 2010; McClernon et al., 2009). This suggests that CR studies are measuring something, even if they are not representing real-world reaction to particular cues. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Laboratory cue reactivity (CR) assessments are used to assess smokers' responses to cues. Likewise, EMA recording is used to characterize real-world response to cues. Understanding the relationship between CR and EMA responses addresses the ecological validity of CR. In 190 daily smokers not currently quitting, craving and smoking responses to cues were assessed in laboratory CR and by real-world EMA recording. Separate CR sessions involved 5 smoking-relevant cues (smoking, alcohol, negative affect, positive affect, smoking prohibitions), and a neutral cue. Subjects used EMA to monitor smoking situations for 3 weeks, completing parallel situational assessments (presence of others smoking, alcohol consumption, negative affect, positive affect, and smoking prohibitions, plus current craving) in smoking and non-smoking occasions (averaging 70 and 60 occasions each). Analyses correlated CR craving and smoking cue responses with EMA craving and smoking correlations with similar cues. Although some cues did not show main effects on average craving or smoking, a wide range of individual differences in response to cues was apparent in both CR and EMA data, providing the necessary context to assess their relationship. Laboratory CR measures of cue response were not correlated with real-world cue responses assessed by EMA. The average correlation was 0.03; none exceeded 0.32. One of 40 correlations examined was significantly greater than 0. Laboratory CR measures do not correlate with EMA-assessed craving or smoking in response to cues, suggesting that CR measures are not accurate predictors of how smokers react to relevant stimuli in the real world. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and alcohol dependence 07/2015; 155. DOI:10.1016/j.drugalcdep.2015.07.673 · 3.42 Impact Factor
  • Source
    • "Heavy smokers significantly inhibited the startle reflex in response to tobacco-related cues compared with light smokers (Cui et al. 2012). Twenty-four hour abstinence periods increased the startle reflex to tobacco-related cues (McClernon et al. 2009), whereas abstinence periods of 12 h or less have shown mixed results (Cinciripini et al. 2006; McBride et al. 2006; McClernon et al. 2005). Few studies have explored the influence of motivation to change on modulation of the startle reflex in smokers with low and high motivation to change (Dempsey et al. 2007; Muñoz et al. 2011); but not in ex-smokers, these results provide a better understanding of the changes in the motivational response through the entire process of change. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Studies that have investigated the effect of motivation to change on the startle reflex have been limited to comparisons among smokers with low and high motivation, but differences in the startle reflex throughout all stages of change have not been studied. Therefore, the aim of the present study was to identify differences in the startle reflex in response to tobacco-related cues in smokers in the initial, intermediate, and final stages of change. The startle reflex was recorded in 67 smokers and ex-smokers while they viewed pleasant, neutral, unpleasant, and tobacco-related pictures. The results showed that the pattern of the startle reflex in response to tobacco-related pictures varied according to the motivation to change. In smokers in the initial stages, the magnitude of the startle reflex was similar between tobacco-related pictures and pleasant pictures. In smokers in intermediate stages, the magnitude of the startle reflex was similar between tobacco-related pictures and unpleasant pictures. In ex-smokers in the final stages, the magnitude of the startle reflex was similar between tobacco-related pictures and neutral pictures. These results suggest that motivational systems that are activated by tobacco-related cues vary according to smokers’ motivation to change.
    Motivation and Emotion 03/2015; 39(2):293-298. DOI:10.1007/s11031-014-9449-7 · 1.55 Impact Factor
Show more