Damage to the insula disrupts addiction to cigarette smoking - PubMed (original) (raw)

Damage to the insula disrupts addiction to cigarette smoking

Nasir H Naqvi et al. Science. 2007.

Abstract

A number of brain systems have been implicated in addictive behavior, but none have yet been shown to be necessary for maintaining the addiction to cigarette smoking. We found that smokers with brain damage involving the insula, a region implicated in conscious urges, were more likely than smokers with brain damage not involving the insula to undergo a disruption of smoking addiction, characterized by the ability to quit smoking easily, immediately, without relapse, and without persistence of the urge to smoke. This result suggests that the insula is a critical neural substrate in the addiction to smoking.

PubMed Disclaimer

Figures

Fig. 1

Fig. 1

Number (N) of patients with lesion in each of the regions identified in this study, mapped onto a reference brain. Boundaries of anatomically defined regions are drawn on the brain surface. Regions names are provided in the Materials and Methods. Regions not assigned a color contained no lesions. (Top) All patients. The horizontal line marks the transverse section of the brain shown in the top row. The vertical line marks the coronal section shown in the bottom row. (Middle) Patients with lesions that involved the insula. (Bottom) Patients with lesions that did not involve the insula.

Fig. 2

Fig. 2

Patients who quit smoking after lesion onset and patients who underwent a disruption of smoking addiction after lesion onset. (A) Tree diagram showing the behavioral classification of patients. (B) Pie charts illustrating the proportion of patients in each anatomical group who fell into each of the behavioral categories. The colors correspond to the behavioral group depicted in (A). These actual proportions are shown in the Materials and Methods. The proportion of patients with a disruption of smoking addiction was higher among both left insula–lesioned patients and right insula–lesioned patients compared with among noninsula-lesioned patients.

Fig. 3

Fig. 3

Whole-brain region-by-region logistic regression analysis. The color of each region corresponds to a χ2 statistic given the sign of regression coefficient obtained from the logistic regression analysis. The only regions that were assigned a color were those for which the number of patients was sufficient to detect a statistically significant effect (Materials and Methods). Regions for which there was a statistically significant association between a lesion and a disruption of smoking addiction (P < 0.05, uncorrected) are highlighted in red. The insula is the only region on either side of the brain where a lesion was significantly associated with a disruption of smoking addiction. There were nonsignificant effects in regions on the left side that are adjacent to the insula; however, patients with damage in these regions also tended to have damage in the insula (Materials and Methods). The likelihood of having a disruption of smoking addiction was not increased after damage in the orbitofrontal cortex.

Comment in

Similar articles

Cited by

References

    1. Peto R, Lopez AD, Boreham J, Thun M, Heath C., Jr Lancet. 1992;339:1268. - PubMed
    1. American Psychiatric Association (A.P.A.) Diagnostic and Statistical Manual of Mental Disorders Text Revision: DSM-IV-TR. 4. A.P.A; Washington, DC: 2000. pp. 191–296.
    1. U.S. Department of Health and Human Services. 1988 Surgeon General’s Report: The Health Consequences of Smoking: Nicotine Addiction. chap 6. U.S. Government Printing Office; Rockville, MD: 1988. pp. 377–458.
    1. Everitt BJ, Robbins TW. Nat Neurosci. 2005;8:1481. - PubMed
    1. Pontieri FE, Tanda G, Orzi F, Di Chiara G. Nature. 1996;382:255. - PubMed

Publication types

MeSH terms

Grants and funding

LinkOut - more resources