For many people who smoke, quitting is not just a matter of willpower. It is a tug-of-war in the brain \u2013 between the pull of reward and the ability to resist.<\/p>\n
A new study published in the\u00a0Journal of Psychiatric Research\u00a0suggests that shifting that balance may be possible. Using a noninvasive brain stimulation technique called repetitive transcranial magnetic stimulation, or rTMS, researchers at\u00a0MUSC Hollings Cancer Center\u00a0found that stimulating a specific brain region that regulates self-control significantly reduced how much people smoked.<\/p>\n
A brain-based approach to a stubborn problem<\/p>\n
Cigarette smoking remains one of the leading causes of preventable death, yet quitting is notoriously difficult. Even with medication and counseling, fewer than 1 in 10 smokers achieve long-term success.<\/p>\n
Part of the challenge is that addiction is not just behavioral \u2013 it is also biological.<\/p>\n
“In addiction, brain systems can get out of balance,” explained lead researcher\u00a0Xingbao Li, M.D.,\u00a0an associate professor in the MUSC Department of Psychiatry<\/a> & Behavioral Sciences.\u00a0“One system, tied to reward and craving, becomes overactive. Another, responsible for control and decision-making, becomes weaker.”<\/p>\n In this clinical trial, researchers tested how rTMS \u2013 which uses magnetic pulses to stimulate specific areas of the brain \u2013 could restore that balance.<\/p>\n They compared two approaches, each targeting a distinct brain circuit involved in smoking:<\/p>\n
Participants \u2013 adult smokers motivated to quit \u2013 were randomly assigned to one of these groups or to receive a sham, placebo-like treatment. Each participant received 15 sessions of rTMS over three weeks, with brain imaging used to guide precisely where and how the stimulation was delivered.<\/p>\n “It’s a kind of precision medicine,” Li said. “We’re tailoring the treatment to each person’s brain.”<\/p>\n The approach builds on\u00a0earlier MUSC research, exploring how brain imaging could be used to personalize rTMS for smoking cessation, helping to identify the most effective targets for each person.<\/p>\n Helping the brain to take back control<\/p>\n The difference between the approaches was striking.<\/p>\n Participants who received high-frequency stimulation to the DLPFC \u2013 the brain’s “self-control” region \u2013 reduced their cigarette use by an average of more than 11 cigarettes per day. That was a significantly greater reduction than in the reward-targeting or placebo conditions.<\/p>\n Stimulating the DLPFC also led to lower self-reported cravings and reduced carbon monoxide levels, which are biological markers of smoking. These effects persisted for at least a month after treatment. In contrast, the approach aimed at suppressing reward activity in the mOFC did not produce meaningful improvements in either of these areas.<\/p>\n Brain scans offered insight into why.<\/p>\n After treatment, participants in the DLPFC group showed:<\/p>\n
Importantly, the degree of these brain changes tracked with behavior: The greater the shift in brain activity, the more participants reduced their smoking.<\/p>\n Together, the findings suggest that helping the brain to regain control, as opposed to trying to suppress cravings, may be the more effective strategy for smoking cessation.<\/p>\n “It’s a top-down effect,” Li said. “You enhance the control system, and it naturally regulates the reward system.”<\/p>\n Why this matters for patients<\/p>\n The implications could be meaningful for people who struggle with existing treatments.<\/p>\n Some smokers cannot tolerate medications. Others relapse despite repeated attempts. And among patients with cancer, many continue to smoke even after a diagnosis, when quitting becomes more critical.<\/p>\n At Hollings, patients can already access support through the\u00a0Tobacco Treatment Program, which offers counseling, medications and evidence-based tools for smoking cessation. The program connects patients with specialists who address both the physical addiction to nicotine and the behavioral habits and triggers that make quitting difficult.<\/p>\n rTMS could eventually complement these efforts by offering a brain-based approach \u2013 one that targets the underlying circuitry of addiction.<\/p>\n This study was relatively small, and it was not designed to measure quit rates definitively. Larger trials are already underway to confirm the findings and test longer treatment courses.<\/p>\n But this first phase serves an important purpose by identifying which strategy works best.<\/p>\n “We wanted to compare the approaches and pick a winner,” Li said. “Now we know which direction to take in future studies.”<\/p>\n That direction \u2013 strengthening the brain’s ability to say no to cigarettes \u2013 may offer a new way forward for people trying to quit smoking, especially when other options have fallen short.<\/p>\n Source:<\/p>\n Medical University of South Carolina<\/a><\/p>\n Journal reference:<\/p>\n
\n\tStrengthening self-control by stimulating the dorsolateral prefrontal cortex (DLPFC), a brain region involved in decision-making and restraint.
\n\tDampening reward signals by stimulating the medial orbitofrontal cortex (mOFC), a brain region tied to craving and reward.
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\n\tIncreased activity in the prefrontal cortex, the brain’s control center.
\n\tDecreased activity in reward-related regions, including the orbitofrontal cortex.
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