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Despite the popularity of smoking cessation over-the-counter (OTC) and prescription drugs, many people still have a hard time quitting. In fact, on average, smokers try to quit eight times before they succeed. If smoking were a purely physical addiction, it seems pharmaceutical drugs would be more successful than they are. But smokers know that getting off cigarettes is about more than just bypassing the nicotine craving. Smoking becomes an imprinted habit, which researchers now know can actually create neural connections in the brain.

So how can a smoker succeed at becoming an ex-smoker? Several studies show that each individual must address not only the physical addiction, but the mental urge to turn to a cigarette when doing an activity usually associated with smoking. In other words, what's really required is a rewiring of the brain.

MRI Scans Show: Activating Certain Brain Regions Improves Self Control
Two recent studies by Elliot T. Berkman and colleagues show which areas in the brain are involved in the process of quitting. In the first study, researchers used magnetic resonance imaging (MRI) to map areas of the brain where the "battle" to control the impulse to smoke takes place. They asked participants to do something that involved self-control, such as pushing or pulling a lever in response to certain letters and refraining from doing so in response to the letter X. Meanwhile, the MRI machine scanned the activity in their brains.

In a second related study, researchers provided eight text messages a day for three weeks to remind participants to document their cravings, mood, and cigarette use. In response to the text, the participants answered three questions:

  1. How many cigarettes did you smoke since the last text?
  2. How intense is your craving?
  3. How positive is your overall mood?

After a 21-day period, participants were called back to go through the same MRI tests again.

Results of the study showed that certain parts of the brain, when activated, helped people resist the urge to smoke. "The more you activate those three brain regions where you are engaging successfully in stopping," said lead researcher Elliot Berkman, "the more likely you are to successfully deal with your cravings in real life."

Personal Messages Help Rewire Old Pathways
Another recent study published in Nature Neuroscience used MRI testing to show that individualized messages can actually help change the brain's neural pathways. Though health professionals have long known that personal support throughout the quitting process can help a person succeed, it's news that such attention can actually help rewire the brain. "Individualized messages" might include empathetic statements such as, "You are worried that when angry or frustrated, you may light up."

Researchers at the University of Michigan found that quit-smoking messages tailored to an individual's personal life activated two specific brain regions known as the medial prefrontal cortex (associated with regulating emotion) and the posterior cingulated region (associated with human awareness, possibly self-awareness). Those individuals who showed stronger activity in these two brain regions were more likely to quit smoking during the four months of the study.

Concentration Exercises May Help Change Brains
Science is a long way from solving the issues involved in smoking addiction. The University of Pennsylvania announced in April 2011 that it's conducting a new study for quitting smoking called MAPS (Memory, Attention, and Planning Skills). In the study, researchers plan to use concentration exercises to help smokers identify their triggers and learn to resist urges. The principal researcher Caryn Lerman explains that it's important to identify behavior patterns--such as reaching for a cigarette while getting in the car or talking on the phone--because the neural connections in the brain between those activities is strong.

"We believe that practicing certain exercises will actually improve some brain circuitry involved in controlling behavior," Lerman said. According to Lerman, "exercises can actually change people's brains and ...help them quit." As in previous studies, this research will include brain scans to see how the concentration exercises affect brain function.

If you want to quit smoking, what can you take away from these studies? Bottom line: drugs by themselves may not be enough. Whatever method you choose to help you quit, committing to a regular behavioral-therapy program will increase your odds of succeeding.