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Brain Damage Sheds Light on Urge to Smoke

Posted: Fri Jan 26, 2007 11:24 am
by Xar
Science Magazine wrote:Cigarette smokers who suffer damage to a particular brain region often lose the urge to smoke, according to a new study. Although brain damage is hardly a recommended treatment for smokers who want to quit, researchers say the findings provide important insight into the biological basis of addictive behaviors.

Previous research on addiction has implicated the insula, a brain region tucked into a deep fold in the cerebral cortex. In brain scans of cocaine addicts, for example, the insula lights up in response to images of drug paraphernalia. Those kinds of images also tend to give addicts an urge to take more drugs. Similarly, videos of people smoking stimulate the insula in smokers' brains. Such work suggests that the insula helps generate addicts' drug-related urges. So what would happen if the insula suddenly went offline?

Antoine Bechara, a neuroscientist at the University Southern California in Los Angeles, and colleagues investigated this question in 19 cigarette smokers who had suffered insula damage as a result of a stroke or other neurological problem. Twelve of these people stopped smoking immediately after their brain injury and reported feeling no urges to smoke and no relapses since they quit. "My body forgot the urge to smoke," one man told the researchers. Before his stroke he was smoking 40 unfiltered cigarettes a day and had no intention of quitting. Among a group of 50 smokers with brain damage that did not include the insula, only four quit the habit with comparable ease, the researchers report in tomorrow's issue of Science.

"This really helps us understand how the brain works in addictive disorders," says Edythe London, a neuropharmacologist at the University of California, Los Angeles. London says the new study bolsters the idea that the insula mediates emotional responses that contribute to addiction. "Gut feelings that are associated with cravings are probably only experienced after the information is processed in the insula," she says.

The findings could have implications for how to beat addiction, Bechara says. Based on the experiences related by the insula-damaged patients, he suspects that the insula is needed create the feeling that smoking is a bodily need. Bechara notes that other research has suggested that the bodily effects of smoking--particularly the effects on the airways--are a crucial part of the satisfaction smokers get from puffing away. If so, he speculates, smoking cessation therapies such as denicotinized cigarettes may ultimately prove more effective than nicotine patches because they provide physical sensations that stimulate the insula and satisfy the smoker.

Posted: Fri Jan 26, 2007 11:34 am
by Avatar
That is fascinating.

I know that heroin addiction, which thickens the bundle of nerves low in the spine can be "cured" by breaking the spine just above those nerves.

Hopefully one day this research will come up with a way to simply circumvent those nerves or brain areas.

--A

Posted: Fri Jan 26, 2007 12:05 pm
by stonemaybe
Bah! My insula is completely intact and I have not had the urge to smoke for 24 days, 4 hours, 5 minutes and 45 seconds ...NOW!

Actually that's a lie, cravings are coming thicker and faster every day, despite the 15mg patch, the 4mg gum, and the inhalator almost continually in my mouth!!!! It doesn't help when you dream of lovely lovely lovely cigarettes too!

Still, I've been off them longer now than at any period in the last 17 years (over half my life). :biggrin:

Posted: Fri Jan 26, 2007 12:10 pm
by Avatar
Congrats. :D

My date to quit is coming up fast, and I've been smoking for 15 years.

--A

Posted: Fri Jan 26, 2007 12:57 pm
by Loredoctor
Avatar wrote:That is fascinating.

I know that heroin addiction, which thickens the bundle of nerves low in the spine can be "cured" by breaking the spine just above those nerves.

Hopefully one day this research will come up with a way to simply circumvent those nerves or brain areas.

--A
It's a bit more complex than that. I also read studies on dopaminergic (dopamine) pathways in the CNS, and had a meeting with one of the leader researchers. They've found that addiction correlates strongly with these pathways.

Posted: Mon Jan 29, 2007 9:15 am
by Avatar
Do you mean it alters the pathways of the nervous system?

--A

Posted: Mon Jan 29, 2007 10:53 am
by Xar
Avatar wrote:Do you mean it alters the pathways of the nervous system?

--A
The brain is a plastic structure... not only do you constantly build or destroy synapses when creating memories, but your actions can strengthen or weaken synapses, thus strengthening or weakening whole pathways. Certain substances can significantly affect this process or simulate it in vivo; so it wouldn't be far-fetched to imagine such a thing.

Posted: Mon Jan 29, 2007 10:59 am
by Avatar
So by strengthening the "reward" response, those "habits" are reinforced in the brain?

--A

Posted: Mon Jan 29, 2007 11:33 am
by Loredoctor
Avatar wrote:So by strengthening the "reward" response, those "habits" are reinforced in the brain?

--A
Yep. Or pathways that are more active tend to be strengthened by more synaptic connections forming and greater frequency of chemical pores in the neural membranes. Activity can alter a neuron, which in turn affects neural responses and neural connections.

Posted: Mon Jan 29, 2007 11:47 am
by Avatar
But do strengthened pathways, or higher levels of connection, encourage the brain to use them more often?

(Hmmm, I'm not sure if I'm saying what I mean here...

...Does the fact that they're "stronger" make them more likely to "attract traffic" as it were? )

--A

Posted: Mon Jan 29, 2007 12:07 pm
by Loredoctor
Avatar wrote:But do strengthened pathways, or higher levels of connection, encourage the brain to use them more often?

(Hmmm, I'm not sure if I'm saying what I mean here...

...Does the fact that they're "stronger" make them more likely to "attract traffic" as it were? )

--A
It means they are more efficient. But if there are an increased number of pores, it also means the neuron is likely to be more active. If we use the theory that addiction is related to chemicals in the brain (or the number of pores), then the individual will desire stimulation of the 'heightened' pathway. For instance, the dopaminergic system is said to be the 'pleasure pathway', and some people possess more dopamine pores (hence, the name), making it likely there will be more of an effect (feeling) to a stimulus. Greater feedback from a stimulus means that the individual will want to experience that stimulus again.

Posted: Mon Jan 29, 2007 12:16 pm
by Avatar
Sure, but say now, for example, that pathway is "turned off" as it were. Say, blocked from taking up dopamine...then it's "enlargement" or whatever wouldn't make a difference would it?

--A

Posted: Mon Jan 29, 2007 12:18 pm
by Loredoctor
Avatar wrote:Sure, but say now, for example, that pathway is "turned off" as it were. Say, blocked from taking up dopamine...then it's "enlargement" or whatever wouldn't make a difference would it?

--A
Yeah, but that's how most antagonists (block pores) work - how most drugs work fighting mental disorders.

Posted: Mon Jan 29, 2007 12:38 pm
by Avatar
So if you can block those pores, (which I assume prevents any pleasure being experienced), then you can interrupt the "reward" response, making it pointless to do the drug?

--A

Posted: Mon Jan 29, 2007 12:41 pm
by Loredoctor
Avatar wrote:So if you can block those pores, (which I assume prevents any pleasure being experienced), then you can interrupt the "reward" response, making it pointless to do the drug?

--A
Absolutely. But, the complicating factor here is what the body has done to counter the drug. That is, the learned response to a chemical. If you block the effects of say, opioids (heroin and opium) you don't affect the mechanisms of combatting the drugs. That's why it's hard to break drug addiction; the body's responses kick in despite the absence of the drug. So dealing with the pores is a limited option.

Posted: Mon Jan 29, 2007 12:50 pm
by Avatar
Right, I see what you're saying. Withdrawal still happens because of the learned response.

--A

Posted: Mon Jan 29, 2007 12:52 pm
by Loredoctor
Avatar wrote:Right, I see what you're saying. Withdrawal still happens because of the learned response.

--A
Spot on. Interesting fact: most overdoses occur outside of the usual locations where drug users take their drugs. The body picks up environmental cues (light level, smells, etc) and prepares itself for the flood of chemicals. When it lacks these cues its response is either delayed or lessened.

Posted: Sat Mar 10, 2007 7:31 am
by Wyldewode
Interesting. :)

One of my clients was a smoker (around 10 a day), who had to undergo hernia surgery. She had to stop smoking for a day before the surgery, and was not to be allowed to smoke in the hospital following the surgery. Normally the hospital will provide nicotine patches if it becomes unbearable for the person. But a strange thing happened. Even though my client was desperately craving a smoke before surgery, she awoke from the general anesthetic without any desire to smoke! She remained smoke-free for over 5 months, until her first husband died and her best friend moved away all in the same week. But even now she "forgets" to smoke, and I think it is more habit than anything for her.