title: Brain reactivity to smoking cues prior to smoking cessation predicts ability to maintain tobacco abstinence.
abstract: 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.
authors.affiliation: Brain Imaging Center McLean Hospital, Harvard Medical School, Belmont, Massachusetts 02478, USA. ajanes@mclean.harvard.edu
authors.forename: Amy C
authors.initials: AC
authors.lastname: Janes
authors.forename: Diego A
authors.initials: DA
authors.lastname: Pizzagalli
authors.forename: Sarah
authors.initials: S
authors.lastname: Richardt
authors.forename: Blaise
authors.initials: B
authors.lastname: deB Frederick
authors.forename: Sarah
authors.initials: S
authors.lastname: Chuzi
authors.forename: Gladys
authors.initials: G
authors.lastname: Pachas
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Culhane
authors.forename: Avram J
authors.initials: AJ
authors.lastname: Holmes
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: A Eden
authors.initials: AE
authors.lastname: Evins
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Kaufman
mesh_terms: D000328:Adult; D001921:Brain / Q000502:physiology*; D002540:Cerebral Cortex / Q000502:physiology; D003463:Cues; D004644:Emotions / Q000502:physiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009434:Neural Pathways / Q000502:physiology; D009483:Neuropsychological Tests; D025341:Principal Component Analysis; D011569:Psychiatric Status Rating Scales; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*; D016896:Treatment Outcome