How Nicotine Withdrawal Contributes to Smoking Relapse

Researchers may have found a neurological explanation for the high rate of relapse among smokers, according to a new study in JAMA Psychiatry. They suggest that nicotine withdrawal reduces the brain’s ability to switch from “default mode” to “executive mode,” which would help smokers to exert more self-restraint over cravings and focus on quitting goals.  

“Weakened brain connectivity resulting from stopping smoking contributes to cravings and other symptoms that promote smoking relapse,” says lead author Caryn Lerman, PhD, of the Center for Interdisciplinary Research on Nicotine Addiction at the University of Pennsylvania in Philadelphia.
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Lerman and colleagues took functional magnetic resonance imaging (fMRI) brain scans of 37 healthy patients, ages 19 to 61, who smoked 10 or more cigarettes daily. To capture the abstinence state, they took one set of scans 24 hours after the patients had not had a cigarette. They also took another set after the patients were smoking as usual.

“We were able to provide scientific evidence for brain changes that may explain, in part, why smokers report having difficulty concentrating when they quit,” Lerman says. “In a way, this could validate smokers’ concerns.”

During the abstinence state, the brain scans showed significantly weaker connections between the salience network and the default mode network, compared to those taken after the patients were smoking as usual. The researchers also found that weakened connectivity during nicotine withdrawal was linked with increases in withdrawal symptoms, smoking urges, and negative moods.

They say this is the first study to compare resting brain connectivity during an abstinent state with a satiated state, and to link those differences to symptoms.

“Studies are underway to test whether interventions, such as cognitive exercises (brain games) or noninvasive brain stimulation can help increase connectivity between these large-scale brain networks,” Lerman says.

—Colleen Mullarkey

Reference

Lerman C, Gu H, Loughead J, Ruparel K, Yang Y, Stein EA. Large-scale brain network coupling predicts acute nicotine abstinence effects on craving and cognitive function. JAMA Psychiatry. 2014 Mar 12. [Epub ahead of print.]