Brain Scans Reveal Why Stress Makes It Hard to Quit Smoking
A large body of research identifies the insula as a critical brain region involved in maintaining tobacco use disorder (TUD). The insula integrates emotion, cognition, and distress identification, linking distress awareness to cognitive control networks. Among daily smokers, distress triggers cravings and decreases the capacity to tolerate negative emotions, a key predictor of long-term cessation success.
In this study, researchers investigated whether individual differences in distress-related functional connectivity were associated with short-term quit outcomes. The study included 58 participants who underwent an MRI scan while completing a distress tolerance task, subsequently initiating a planned quit attempt. Participants also received behavioral support and nicotine replacement therapy and began a planned quit attempt three days later.
Researchers assessed smoking status at five follow-up visits over 10 weeks. Participants were categorized based on their outcomes: those achieving seven or more consecutive days of abstinence, those reducing cigarette consumption for seven or more days, and those who continued smoking.
The findings revealed distinct patterns of distress-related brain connectivity among the groups:
Individuals who successfully abstained exhibited negative distress-related connectivity between the insula and other brain regions.
In contrast, those who continued to smoke demonstrated positive distress-related connectivity.
This positive association among connectivity strength, negative affect, and smoking suggests a neurobiological profile that could be targeted by neuromodulation therapies. Ultimately, such interventions could reduce the cognitive-affective effort required to resist stress-induced cravings
The Study
Addicott, M., Spry, K., James, J., Ip, E., Oliveto, A. H., Daughters, B., & Beckham, J. C. (2026). Functional connectivity response to distress-inducing auditory feedback associated with short-term smoking abstinence. Drug and alcohol dependence, 283, 113142. https://doi.org/10.1016/j.drugalcdep.2026.113142
