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L. Elliot Hong, MD; Hong Gu, PhD; Yihong Yang, PhD; Thomas J. Ross, PhD; Betty Jo Salmeron, MD; Brittany Buchholz, BS; Gunvant K. Thaker, MD; Elliot A. Stein, PhD

Arch Gen Psychiatry. 2009;66(4):431-441.

Context  Understanding the mechanisms underlying nicotine addiction to develop more effective treatment is a public health priority. Research consistently shows that nicotine transiently improves multiple cognitive functions. However, using nicotine replacement to treat nicotine addiction yields generally inconsistent results. Although this dichotomy is well known, the reasons are unclear. Imaging studies showed that nicotine challenges almost always involve the cingulate cortex, suggesting that this locus may be a key region associated with nicotine addiction and its treatment.

Objective  To identify cingulate functional circuits that are associated with the severity of nicotine addiction and study how nicotine affects them by means of region-specific resting-state functional magnetic resonance imaging.

Design  Double-blind, placebo-controlled study.

Setting  Outpatient clinics.

Participants  Nineteen healthy smokers.

Intervention  Single-dose (21- or 35-mg) nicotine patch.

Main Outcome Measures  Correlation of nicotine addiction severity and cingulate resting-state functional connectivity, and effects of short-term nicotine administration on connectivity strength.

Results  Clearly separated pathways that correlated with nicotine addiction vs nicotine’s action were found. The severity of nicotine addiction was associated with the strength of dorsal anterior cingulate cortex (dACC)–striatal circuits, which were not modified by nicotine patch administration. In contrast, short-term nicotine administration enhanced cingulate-neocortical functional connectivity patterns, which may play a role in nicotine's cognition-enhancing properties.

Conclusions  Resting-state dACC-striatum functional connectivity may serve as a circuit-level biomarker for nicotine addiction, and the development of new therapeutic agents aiming to enhance the dACC-striatum functional pathways may be effective for nicotine addiction treatment.

Author Affiliations: Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine (Drs Hong and Thaker and Ms Buchholz), and Neuroimaging Research Branch, National Institute on Drug Abuse, National Institutes of Health (Drs Gu, Yang, Ross, Salmeron, and Stein), Baltimore.

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