title: Winning and losing: differences in reward and punishment sensitivity between smokers and nonsmokers.
abstract: BACKGROUND
  Smokers show increased brain activation in reward processing regions in response to smoking-related cues, yet few studies have examined secondary rewards not associated with smoking (i.e., money). Inconsistencies exist in the studies that do examine secondary rewards with some studies showing increased brain activation in reward processing brain regions, while others show decreased activation or no difference in activation between smokers and nonsmokers.
  
  
  OBJECTIVE
  The goal of the current study is to see if smokers process the evaluation and delivery of equally salient real world rewards similarly or differently than nonsmokers.
  
  
  METHODS
  The current study employed functional magnetic resonance imaging (fMRI) to examine brain responses in smokers and nonsmokers during the evaluation and delivery of monetary gains and losses.
  
  
  RESULTS
  In comparison to nonsmokers, smokers showed increased activation in the ventromedial prefrontal cortex to the evaluation of anticipated monetary losses and the brain response. Moreover, smokers compared to nonsmokers showed decreased activation in the inferior frontal gyrus to the delivery of expected monetary gains. Brain activations to both the evaluation of anticipated monetary losses and the delivery of expected monetary gains correlated with increased self-reported smoking craving to relieve negative withdrawal symptoms and craving related to positive aspects of smoking, respectively.
  
  
  CONCLUSIONS
  Together these results indicate that smokers are hyperresponsive to the evaluation of anticipated punishment and hyporesponsive to the delivery of expected rewards. Although further research is needed, this hypersensitivity to punishments coupled with increased craving may negatively impact quit attempts as smokers anticipate the negative withdrawal symptoms associated with quitting.
authors.affiliation: Hoglund Brain Imaging Center, University of Kansas Medical Center Kansas City, Kansas ; Department of Preventive Medicine and Public Health, University of Kansas Medical Center Kansas City, Kansas.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Martin
authors.affiliation: Department of Preventive Medicine and Public Health, University of Kansas Medical Center Kansas City, Kansas.
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Cox
authors.affiliation: Hoglund Brain Imaging Center, University of Kansas Medical Center Kansas City, Kansas ; Department of Neurology, University of Kansas Medical Center Kansas City, Kansas.
authors.forename: William M
authors.initials: WM
authors.lastname: Brooks
authors.affiliation: Center for Health Behavior Neuroscience, University of Kansas Medical Center Kansas City, Kansas ; Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center Kansas City, Kansas.
authors.forename: Cary R
authors.initials: CR
authors.lastname: Savage
mesh_terms: D000328:Adult; D059031:Anticipation, Psychological / Q000502:physiology*; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D066249:Craving / Q000502:physiology; D003463:Cues; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011678:Punishment; D012201:Reward; D057566:Self Report; D012907:Smoking / Q000503:physiopathology* / Q000523:psychology*
keywords: fMRI; punishment sensitivity; reward sensitivity; smoking