Cue-induced brain activation and relapse in cigarette smokers during long-term smoking cessation treatment: a prospective fMRI study

Abstract

Background: Studies investigating cue-induced brain activation as markers for cigarette use relapse have yet to be
examined for their relevance in long-term cessation treatment. This feasibility functional magnetic resonance imaging
(fMRI) investigation compared regions of cigarette cue-induced brain activation between cigarette smokers who
relapsed versus those who abstained during a six-month intervention programme.
Methods: Eighteen adult cigarette smokers (>15x/day cigarette use >2 years) with tobacco use disorder completed
a baseline fMRI cue exposure paradigm before undergoing treatment. Whole-brain fMRI contrasts between cue
exposure conditions (cigarette, neutral) were assessed in patients who relapsed (≥1x cigarette use) compared to those
who abstained during treatment. Subjective craving was assessed after each block.
Results: Nine patients relapsed (38.9 ± 6.9 years old; 4F) and nine abstained (40.3 ± 7.4; 6F) from cigarette use.
Relative to abstainers, patients who relapsed exhibited greater activation in parietal, fusiform, cingulate, prefrontal,
orbitofrontal, and supplementary motor area regions. There were no group differences in craving.
Conclusion: Cue-elicited brain activation associated with cigarette use relapse during treatment was observed in
areas involved in value-driven attention. Cue-related neural activation in these areas may be potential vulnerability
markers for cigarette use relapse during long-term interventions. Given the promising results in this small pilot,
further investigations are warranted.