News & Observer | newsobserver.com | Scientists connect part of brain with urge to smoke

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Published: Jan 26, 2007 12:00 AM
Modified: Jan 26, 2007 03:24 AM

Scientists connect part of brain with urge to smoke

Injury to region can end addiction

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ABOUT THE BRAIN INJURY STUDY

WHO WAS STUDIED: The researchers, from the University of Iowa and the University of Southern California, examined 32 former smokers, all of whom had suffered a brain injury. They had all smoked at least five cigarettes a day for two years or more, and 16 of them said they quit with ease, losing their cravings entirely.

HOW WERE THEY TESTED: The men and women were lucid enough to answer a battery of questions about their habits and to rate how hard it was to quit and how strong their subsequent urges to smoke were. The researchers performed MRI scans on all of the patients' brains to identify the location and extent of each injury.

WHO QUIT? They found that the 16 patients who quit easily were far more likely to have an injury to their insula than to any other area. The researchers found no association between a diminished urge to smoke and injuries to other regions of the brain, including tissue surrounding the insula.

DOES IT AFFECT OTHER ADDICTIONS? The patients' desire to eat, by contrast, was intact. This suggests, the authors wrote, that the insula is critical for behaviors such as smoking cigarettes whose bodily effects become pleasurable because they are learned.

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Scientists studying stroke patients are reporting that an injury to a specific part of the brain, near the ear, can instantly and permanently break a smoking habit, effectively erasing the most stubborn addiction. People with the injury who stopped smoking found that their bodies, as one man put it, "forgot the urge to smoke."

The finding, which is to appear in the journal Science today, is likely to alter the course of addiction research, experts say, pointing researchers toward new ideas for treatment. Though no one is suggesting brain injury as a solution for addiction, the findings suggest that therapies might focus on the insula, a prune-size region under the frontal lobes that is thought to register gut feelings and seems to be a critical part of the network that sustains addictive behavior.

Previous research on addicts focused on regions of the cortex involved in thinking and decision-making. Although those regions are involved in maintaining habits, the new study suggests that they are not as central.

The study did not examine dependence on alcohol, cocaine or other substances. Yet smoking is as at least as hard to quit as any other habit, and it probably involves the same brain circuits, experts said. Most smokers who manage to quit do so only after repeated attempts, and the craving for cigarettes usually lasts for years, if not for life.

"This is the first time we've shown anything like this, that damage to a specific brain area could remove the problem of addiction entirely," said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which financed the study, along with the National Institute of Neurological Disorders and Stroke. "It's absolutely mind-boggling."

Others cautioned that the study was small, and that scientists still knew little about the widely distributed neural networks involved in sustaining habits.

"One has to be careful not to extrapolate too much based on brain injuries to what's going on in all addictive behavior, in healthy brains," said Dr. Martin Paulus, a psychiatric researcher at the University of California in San Diego, and the San Diego VA Medical Center. Still, he added, the study "opens up a whole new way to think about addiction."

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