Abstract
Rationale
Cue reactivity is a key factor in modulating motivational and goal-directed behaviors associated with compulsive drug intake and relapse. Smoking-associated cues produce smoking urges and cravings and are accompanied by the activation of brain regions involved in attention, motivation, and reward.
Objectives
We investigated whether acupuncture ameliorates cravings induced by smoking-related visual cues, and we explored the neural mechanisms underlying the effects of acupuncture on modulating smoking urges.
Methods
After 36 h of smoking abstinence, 25 right-handed male smokers underwent fMRI, during which smoking-related and neutral visual cues were presented. Twelve subjects were treated with real acupuncture (RA) at HT7 and 13 subjects received sham acupuncture (SA). During the scanning sessions, craving scores to smoking-related visual cues were assessed before and after RA or SA treatment. The differences in brain responses to smoking vs. neutral cues after treatment between the RA and SA groups were detected using three-way ANOVAs (Cue × Session × Group).
Results
After treatment, the craving scores were significantly decreased in the RA group, as compared to the SA group. When we explored the neural substrates of acupuncture on the modulation of cravings induced by smoking cues, significant differences were found in the medial prefrontal cortex, the premotor cortex, the amygdala, the hippocampus, and the thalamus.
Conclusions
These findings suggest that acupuncture alleviates cue-induced cravings through the regulation of activity in brain regions involved in attention, motivation, and reward relative to craving scores in the initial abstinence phase.
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References
Abrams DB, Monti PM, Carey KB, Pinto RP, Jacobus SI (1988) Reactivity to smoking cues and relapse: two studies of discriminant validity. Behav Res Ther 26:225–233
Albanese A, Minciacchi D (1983) Organization of the ascending projections from the ventral tegmental area: a multiple fluorescent retrograde tracer study in the rat. J Comp Neurol 216:406–420
Baxter MG, Murray EA (2002) The amygdala and reward. Nat Rev Neurosci 3:563–573
Chae Y, Yang CH, Kwon YK, Kim MR, Pyun KH, Hahm DH, Lee H, Shim I (2004) Acupuncture attenuates repeated nicotine-induced behavioral sensitization and c-Fos expression in the nucleus accumbens and striatum of the rat. Neurosci Lett 358:87–90
Chae Y, Yeom M, Han JH, Park HJ, Hahm DH, Shim I, Lee HS, Lee H (2008) Effect of acupuncture on anxiety-like behavior during nicotine withdrawal and relevant mechanisms. Neurosci Lett 430:98–102
Chae Y, Kang OS, Lee HJ, Kim SY, Lee H, Park HK, Yang JS, Park HJ (2010) Effect of acupuncture on selective attention for smoking-related visual cues in smokers. Neurol Res 32(Suppl 1):27–30
Chae Y, Park HJ, Kang OS, Lee HJ, Kim SY, Yin CS, Lee H (2011) Acupuncture attenuates autonomic responses to smoking-related visual cues. Complement Ther Med 19(Suppl 1):S1–7
Cheng HM, Chung YC, Chen HH, Chang YH, Yeh ML (2012) Systematic review and meta-analysis of the effects of acupoint stimulation on smoking cessation. Am J Chin Med 40:429–442
Chiamulera C (2005) Cue reactivity in nicotine and tobacco dependence: a "multiple-action" model of nicotine as a primary reinforcement and as an enhancer of the effects of smoking-associated stimuli. Brain Res Brain Res Rev 48:74–97
David SP, Munafo MR, Johansen-Berg H, Smith SM, Rogers RD, Matthews PM, Walton RT (2005) Ventral striatum/nucleus accumbens activation to smoking-related pictorial cues in smokers and nonsmokers: a functional magnetic resonance imaging study. Biol Psychiatry 58:488–494
Drummond DC (2000) What does cue-reactivity have to offer clinical research? Addiction 95(Suppl 2):S129–144
Due DL, Huettel SA, Hall WG, Rubin DC (2002) Activation in mesolimbic and visuospatial neural circuits elicited by smoking cues: evidence from functional magnetic resonance imaging. Am J Psychiatry 159:954–960
Field M, Duka T (2004) Cue reactivity in smokers: the effects of perceived cigarette availability and gender. Pharmacol Biochem Behav 78:647–652
Franklin T, Wang Z, Suh JJ, Hazan R, Cruz J, Li Y, Goldman M, Detre JA, O'Brien CP, Childress AR (2011) Effects of varenicline on smoking cue-triggered neural and craving responses. Arch Gen Psychiatry 68:516–526
Fuller JA (1982) Smoking withdrawal and acupuncture. Med J Aust 1:28–29
Janes AC, Pizzagalli DA, Richardt S, De BFB, Chuzi S, Pachas G, Culhane MA, Holmes AJ, Fava M, Evins AE, Kaufman MJ (2010) Brain reactivity to smoking cues prior to smoking cessation predicts ability to maintain tobacco abstinence. Biol Psychiatry 67:722–729
Kang OS, Chang DS, Jahng GH, Kim SY, Kim H, Kim JW, Chung SY, Yang SI, Park HJ, Lee H, Chae Y (2012) Individual differences in smoking-related cue reactivity in smokers: an eye-tracking and fMRI study. Prog Neuropsychopharmacol Biol Psychiatry 38:285–293
Kim MR, Kim SJ, Lyu YS, Kim SH, Lee Y, Kim TH, Shim I, Zhao R, Golden GT, Yang CH (2005) Effect of acupuncture on behavioral hyperactivity and dopamine release in the nucleus accumbens in rats sensitized to morphine. Neurosci Lett 387:17–21
McClernon FJ, Kozink RV, Rose JE (2008) Individual differences in nicotine dependence, withdrawal symptoms, and sex predict transient fMRI-BOLD responses to smoking cues. Neuropsychopharmacology 33:2148–2157
McClernon FJ, Kozink RV, Lutz AM, Rose JE (2009) 24-h smoking abstinence potentiates fMRI-BOLD activation to smoking cues in cerebral cortex and dorsal striatum. Psychopharmacology 204:25–35
Mihov Y, Hurlemann R (2012) Altered amygdala function in nicotine addiction: insights from human neuroimaging studies. Neuropsychologia 50:1719–1729
Moner SE (1996) Acupuncture and addiction treatment. J Addict Dis 15:79–100
Napadow V, Makris N, Liu J, Kettner NW, Kwong KK, Hui KK (2005) Effects of electroacupuncture versus manual acupuncture on the human brain as measured by fMRI. Hum Brain Mapp 24:193–205
Napadow V, Dhond RP, Kim J, LaCount L, Vangel M, Harris RE, Kettner N, Park K (2009) Brain encoding of acupuncture sensation–coupling on-line rating with fMRI. NeuroImage 47:1055–1065
Napadow V, Lee J, Kim J, Cina S, Maeda Y, Barbieri R, Harris RE, Kettner N, Park K (2012) Brain correlates of phasic autonomic response to acupuncture stimulation: An event-related fMRI study. Hum Brain Mapp (in press)
Robbins TW, Everitt BJ (1999) Drug addiction: bad habits add up. Nature 398:567–570
Sayette MA, Shiffman S, Tiffany ST, Niaura RS, Martin CS, Shadel WG (2000) The measurement of drug craving. Addiction 95(Suppl 2):S189–210
Tahiri M, Mottillo S, Joseph L, Pilote L, Eisenberg MJ (2012) Alternative smoking cessation aids: a meta-analysis of randomized controlled trials. Am J Med 125:576–584
Toll BA, Katulak NA, McKee SA (2006) Investigating the factor structure of the Questionnaire on Smoking Urges-Brief (QSU-Brief). Addict Behav 31:1231–1239
Volkow ND, Fowler JS, Wang GJ (2003) The addicted human brain: insights from imaging studies. J Clin Invest 111:1444–1451
Volkow ND, Fowler JS, Wang GJ (2004) The addicted human brain viewed in the light of imaging studies: brain circuits and treatment strategies. Neuropharmacology 47(Suppl 1):3–13
West R, Ussher M, Evans M, Rashid M (2006) Assessing DSM-IV nicotine withdrawal symptoms: a comparison and evaluation of five different scales. Psychopharmacology 184:619–627
White AR, Resch KL, Ernst E (1998) Randomized trial of acupuncture for nicotine withdrawal symptoms. Arch Intern Med 158:2251–2255
WHO Regional Office for the Western Pacific. WHO Standard Acupuncture Point Locations in the Western Pacific Region. Manila: World Health Organization, 2008
Wu P, Wilson K, Dimoulas P, Mills EJ (2006) Effectiveness of smoking cessation therapies: a systematic review and meta-analysis. BMC Publ Health 6:300
Yang CH, Yoon SS, Hansen DM, Wilcox JD, Blumell BR, Park JJ, Steffensen SC (2010) Acupuncture inhibits GABA neuron activity in the ventral tegmental area and reduces ethanol self-administration. Alcohol Clin Exp Res 34:2137–2146
Yoon SS, Kwon YK, Kim MR, Shim I, Kim KJ, Lee MH, Lee YS, Golden GT, Yang CH (2004) Acupuncture-mediated inhibition of ethanol-induced dopamine release in the rat nucleus accumbens through the GABAB receptor. Neurosci Lett 369:234–238
Yoon SS, Yang EJ, Lee BH, Jang EY, Kim HY, Choi SM, Steffensen SC, Yang CH (2012) Effects of acupuncture on stress-induced relapse to cocaine-seeking in rats. Psychopharmacology 222:303–311
Zhao RJ, Yoon SS, Lee BH, Kwon YK, Kim KJ, Shim I, Choi KH, Kim MR, Golden GT, Yang CH (2006) Acupuncture normalizes the release of accumbal dopamine during the withdrawal period and after the ethanol challenge in chronic ethanol-treated rats. Neurosci Lett 395:28–32
Acknowledgments
This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (No. 2009-0066863 & No. 2005-0049404).
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The authors have declared that no competing interests exist. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Kang, OS., Kim, SY., Jahng, GH. et al. Neural substrates of acupuncture in the modulation of cravings induced by smoking-related visual cues: an FMRI study. Psychopharmacology 228, 119–127 (2013). https://doi.org/10.1007/s00213-013-3015-y
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DOI: https://doi.org/10.1007/s00213-013-3015-y