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Having A Hard Time Quitting Cigarettes? It's All In Your Head

Natalie Staats Reiss, Ph.D. Updated: Apr 13th 2007

Everyone knows that smoking is bad for you, and the nicotine is a highly addictive drug. Even so, the Office on Smoking and Health of the National Center for Chronic Disease Prevention and Health Promotion estimates that approximately 20.9% of U.S. adults are current smokers. Among those who smoke every day, 40.5% (14.6 million) are trying to quit. However, only about 5% of smokers who try to quit each year succeed in stopping smoking permanently. New research (Neuropsychopharmacology, Mar 14, 2007) suggests that certain brain structures may play a role in why so many people have such a hard time quitting.

Researchers at Duke University studied the brains of smokers using Positron Emission Tomography (PET scans). PET is a noninvasive (doesn't require surgery) technique that enables neuroscientists to determine which parts of the brain are working during different activities. Prior to the scan, a very small amount of a radioactive substance is attached to glucose, and then injected into the bloodstream of the person being studied. The radioactive molecule travels to the area of interest (in this case, the brain) and is detected by the PET scanner. The resulting 3-D image of the brain is projected on a computer screen. Within the image, different colors or degrees of brightness indicate different levels of tissue or organ function. Areas of high radioactivity "light up", and are associated with increased brain activity.

In the smoking study, PET scans showed that three brain regions demonstrated changes in activity when smokers craved cigarettes. Interestingly, different brain regions were related to specific reasons reported by the subjects for why they smoke.

People who smoked to calm down when they were stressed out showed decreased activity in the area of the brain known as the thalamus. The thalamus is an information relay center in the brain which transmits information to and from our sensory organs (eye, ears, etc.) and our muscles. In addition, (and more relevant to the study findings), the thalamus regulates our levels of arousal (sleep/wakefulness), awareness and activity. People who smoke and have decreased thalamic activity may experience a greater ability to focus thoughts and feel less overwhelmed.

People who smoked to calm down also showed increased activity in their amygdala. The amygdala helps us to form and store memories associated with emotional events. In addition (and again, most relevant to the study), the amygdala is involved in appetitive conditioning, a psychological term meaning that smokers learn to associate and anticipate that smoking a cigarette will cause a positive calming body effect.

People who smoked to gain a sense of pleasurable relaxation showed increased activity in the striatum. The striatum is involved in planning and controlling movement, learning and memory, as well as our level of motivation to continue a behavior (smoking) to obtain a reward (sense of relaxation). In addition, the striatum serves to decrease activity in the thalamus, which (as mentioned above), increases a sense of calm.

People who smoked to reduce a craving for cigarettes showed activity in the anterior cingulate cortex. This brain structure plays a role in enhancing self-regulation and ability to make decisions, empathy (being sensitive to others' feelings), and emotion. Activation of the anterior cingulate cortex is also tied to anticipating a reward. People who smoke and have increased activity in the anterior cingulate cortex may feel more in control of themselves and better able to make decisions.

The study found that brain changes are not permanent, but will change as a person becomes more or less dependent on nicotine. This type of brain research may go a long way in developing specific and successful smoking cessation strategies.

    Reader Comments
    Discuss this issue below or in our forums.

    ariva - jason - Feb 16th 2010

    have you heard of ariva?  its a tobacco lozenge thats has removed the cancer causing TSNA's but kept the nicotine and they are going for FDA approval in a few weeks.

    'Its In Your Head?' - Allan N. Schwartz, PhD - Aug 6th 2009


    I want to congratulate you for beginning the difficult journey of putting an end to cigarette smoking.

    I understand that this is your first day and you are feeling irritable coming off of cigarettes. So, I want to very gently point out to you that you misread and misinterpreted the article. What is meant by "its in your head" is that smoking affects various parts of your brain. Even though the brain is affected, stopping smoking will allow the brain to repair itself. The writer did not mean that its all in your imagination.

    I have a suggestion to help you with this difficult process. Speak to your medical doctor. If he says its OK, you can either try the "patch," because that makes the withdrawal a little easier, or, try the nicotene gum. There is also a medication available but you would need to have your Doctor explain the side effects of that prescription.

    Good luck in the process of recovery and do not give up.

    Dr. Schwartz

    smoking or not?!? - Rachel - Aug 5th 2009

    Hi there, today is day 1... and I'm in a fowl mood

    this women who calls herself a doctor wants to say it's all in my head???

    well I'll tell you!!!

     shove it where the sun dont shine, how much do you pay to have your dark hair turned blonde huh?

    take care now

    Quitting Smoking/Stimulant Replacer - belle - Oct 9th 2008

    I have found that smoking was for me quite the stimulant, beyond other things, and extremely addictive that is... But for the sake of this post, and seeking help if there is any out there to make sense of the following:

    After quitting, I slowly put on weight, not even because I exercised less, but something changed completely in my body as the "smoker" wore off... I could no longer go to the gym and take a class, soaring through it, with probably more energy than anyone.  My threshold to workout and exert high levels of energy had lowered drastically. You would expect it to be the other way around, especially at the gym - if your lungs are clearing out, but in actuality as a smoker, I was able to really exert far more energy to extremes through workout and dance, that i am just no longer able to do - It now takes a lot more for me to even sweat. Quite strange, and really disappointing - I quit over a year ago, and recently picked up a pack of smokes here and there. Interestingly enough, I am able to really soar again through a class at the gym. My bowels too, feel more regulated... Does anyone have anything to promote for smokers who want to quit that would actually healthily act toward the body the way that a cigarette clearly does... No one would need diet pills etc - there must be something out there - that has a similar stimulant effect!?

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