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Arthur L. Brody, MD; Mark A. Mandelkern, MD,PhD; Edythe D. London, PhD; Anna Rose Childress, PhD; Grace S. Lee, BS; Robert G. Bota, MD; Matthew L. Ho, BS; Sanjaya Saxena, MD; Lewis R. Baxter, Jr, MD; Damian Madsen, BA; Murray E. Jarvik, MD,PhD

Arch Gen Psychiatry. 2002;59:1162-1172.

Background  In functional brain imaging studies, exposure to cues related to cocaine, opiates, and alcohol in dependent individuals is associated with activation of the anterior cingulate gyrus, amygdala, orbitofrontal cortex, and dorsolateral prefrontal cortex. Craving for these substances positively correlates with activity in the orbitofrontal cortex, dorsolateral prefrontal cortex, and anterior insula. The objective of this study was to determine changes in regional cerebral glucose metabolism and correlations between craving and regional metabolism in heavy cigarette smokers exposed to cigarette-related cues.

Methods  Twenty heavy smokers (who smoked 20 cigarettes per day) and 20 nonsmoking control subjects underwent 2 fluorine 18–fluorodeoxyglucose positron emission tomography scans 10 days apart in randomized order: one while watching a videotape that presented cigarette-related cues and handling a cigarette, and the other while watching an educational (nature) videotape and handling a neutral object (pen).

Results  From the neutral to the cigarette cue scan, heavy smokers had greater increases than nonsmoking controls in relative glucose metabolism in the perigenual anterior cingulate gyrus spanning the midline. Significant positive correlations were found between intensity of craving and metabolism in the orbitofrontal cortex, dorsolateral prefrontal cortex, and anterior insula bilaterally. An unexpected positive association was found between craving and metabolism in the right sensorimotor cortex.

Conclusions  Brain regions associated with arousal, compulsive repetitive behaviors, sensory integration, and episodic memory are activated during exposure to cigarette-related cues and cigarette craving. These regional brain activations and associations with craving are similar to findings with other addictive substances.

From the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (Drs Brody, London, Saxena, Baxter, and Jarvik, Ms Lee, and Messrs Ho and Madsen); the Greater Los Angeles Veterans Affairs Healthcare System Positron Emission Tomography Center, Los Angeles (Drs Brody, Mandelkern, Bota, and Jarvik and Mr Madsen); the Department of Physics, University of California at Irvine (Dr Mandelkern); the Department of Psychiatry, University of Pennsylvania, Philadelphia (Dr Childress); and the Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (Dr Baxter).

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