Cue-Induced Brain Activation and Relapse in Cigarette Smokers DuringLong-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.
Method: 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.