Where there's smoke, there's fire: the brain reactivity of chronic smokers when exposed to the negative value of smoking.

RATIONAL: The addictive nature of smoking is characterized by responses to cigarette stimuli that significantly impede smoking cessation efforts. Studies have shown that smokers are roused by appetitive smoking-related stimuli, and their consumption tends to be unaffected by the negative value of smoking.

PURPOSE: Using functional magnetic resonance imaging, the goal of this study was two-fold: to examine the brain reactivity of chronic smokers when processing the negative value of smoking using aversive smoking-related cues; to further characterize this response by comparing the latter to the processing of aversive nonsmoking-related and appetitive smoking-related cues.

METHOD: Thirty chronic smokers passively viewed aversive smoking-related, aversive nonsmoking-related, appetitive smoking-related and neutral images presented in a block design while being scanned.

RESULTS: Aversive smoking-related stimuli elicited significantly greater activation in the medial prefrontal cortex, amygdala, inferior frontal gyrus and lateral orbitofrontal cortex than neutral stimuli. Aversive smoking-related stimuli elicited lower activation in the parahippocampal gyrus, insula and inferior frontal gyrus compared to the aversive nonsmoking-related condition, as well as lower activation in the posterior cingulate, precuneus and medial prefrontal cortices compared to appetitive smoking-related cues.

CONCLUSION: The brain activation pattern observed suggests that chronic smokers experience an aversive response when processing aversive smoking-related stimuli, however we argue that the latter triggers a weaker negative emotional and driving response than the aversive non-smoking-related and appetitive smoking-related cues respectively. These fMRI results highlight potentially important processes underlying the insensitivity to the negative value of smoking, an important characteristic of addiction.