Motivation_and_the_Brain__Quitting_Smoking

Motivation and the Brain: Quitting Smoking Judith Prince PSY/355 July 29, 2013 Dr. Donnetta Hawkins Motivation and the Brain: Quitting Smoking Smoking cigarettes is the leading cause of preventable deaths in the world, responsible for nearly a third of all cancer deaths and is a serious risk factor in cardiovascular and pulmonary diseases (Munafo & Johnstone, 2008). Nicotine activates reward systems in the brain much the same way that other drugs, such as heroin, do while sharing the same effects of addiction such as sensitization, physical dependence, and euphoria (Baker, Brandon, & Chassin, 2004). To understand better the addictive nature of nicotine in tobacco, it is important to understand the brain structures and functions involved in the behavior as well as intrinsic and extrinsic motivational factors that maintain the behavior. Following these explanatory paragraphs will be a plan of action for the nicotine dependent individual to quit smoking and stay quit. Brain Structures and Functions In the addiction research field, most consider the brain the base of nicotine addiction (Clarks & Lancet, 1998). The interaction of smoking cues and the anticipation of smoking leads to neural activity in regions of the brain known to take part in seeking and consuming the drug (McBride, Barrett, Kelly, Aw, & Dagher, 2006). The mesolimbic dopamine pathway is a neural pathway that is part of the reward system in the brain comprising itself of the ventral tegmental area (VTA), nucleus accumbens (NA), and the prefrontal cortex (McBride, Barrett, Kelly, Aw, & Dagher, 2006). Nicotine attaches itself to and activating the nicotonic acetylcholine receptors (nAchRs) on dopamine neurons in the VTA, thus releasing dopamine in the NA acting as a reinforcer to the behavior of smoking (McBride, Barrett, Kelly, Aw, & Dagher, 2006). This is similar to the reaction seen in other drugs and is an important feature of brain addiction mechanisms (Jarvis, 2004). The Orbitofrontal Cortex is another part of the brain involved in addiction to nicotine and is part of numerous processes involving rewards and reinforcements as well as taking part in the expectancy, cravings, and decision-making aspects of drug use (Spinella, 2002). There is evidence that suggests that a dysfunction of the orbitofrontal cortex is prevalent in substance abusers and damage to this area causes difficulties in learning and reversing reward associations (Spinella, 2002). Though the more someone smokes points to a greater impairment of this region, it is not considered a causal relationship because nicotine usually enhances cognitive functioning, especially in activities involving the prefrontal cortex (Spinella, 2002). Last, the Dorsolateral Prefrontal Cortex (DLPFC) is an area of the brain that serves an important role in processing the craving of smoking cigarettes and the general use of drugs (Fregni, Liguori, Fecteau, Nitsche, Pascual-Leone, & Boggio, 2008). McBride and associates assert the DLPFC is vital to high-level planning, and in this capacity it collects information about the internal state of an individual as well as motivations, expectancy, and cues (2006). It uses this information to regulate and plan either to seek out ways to get the drug or to avoid the drug (McBride, Barrett, Kelly, Aw, & Dagher, 2006). Extrinsic and Intrinsic Motivations Though the brain plays a critical role in the addiction process, there are extrinsic and intrinsic motivations that assist in the maintenance of the addiction to nicotine. One of these factors is heredity. Though there is not concrete evidence as of yet to whether or not addiction to nicotine is hereditary, researchers have found a possible link. In one study the D2 genotype, which is prevalent in the mesolimbic system and plays a role in the reinforcing effects of the drug has an effect on all three stages of smoking addiction: initiation, maintenance, and cessation (Clarks & Lancet, 1998). Margaret Spitz, found that a particular type of inherited dopamine receptor found in a gene on the 11th chromosome could be responsible for individual differences in response to nicotine and that variant alleles in this receptor, specifically the B1 variant could point to an individuals’ nicotine addiction vulnerability (Brust, 1998). Another factor contributing to addiction to nicotine is the environment surrounding an individual, which plays a critical part in the initiation of smoking but also can be significant to the maintenance of the behavior. The first environmental factor is that of parental influence. The parental units serve as models for behavior and adolescents are more likely to smoke if one or both parents smoke (World Health Organization, 2010). Additionally, peer tobacco use plays both a role in initiation and maintenance and a teenager with at least one close friend who smokes is four times more likely to start smoking (World Health Organization, 2010). Peers also provide social reinforcement of the behavior through a sharing in a function that provides important functions of socialization (World Health Organization, 2010). Another source of environmental influence lies in marketing and advertising with exposure to its tactics doubling the odds of the initiation of tobacco use in teenagers (World Health Organization, 2010). Though some smokers state that smoking is positive reinforcement in that they smoke for pleasure or relaxation, one of the strongest motivations for the continuation of smoking is the alleviation of the withdrawal symptoms, which is a negative reinforcer (Jarvis, 2004). Some smokers also state that they smoke as a method of controlling their environment, which would point to effectance motivation (Jarvis, 2004;Deckers, 2010). In short, any instance of smoking by an individual may be a result of multiple motivations that can change and have varying external or internal factors (Jarvis, 2004). Quitting Smoking As the previous paragraphs have shown, nicotine is not a simple habit, it is an addiction that affects an individuals’ brain and behavior. It has dire consequences on the body and therefore a smoker should make every effort to quit. The first step in the process for quitting smoking is to determine the motivation to quit (Sheahan, 2002).. It can be family reasons, health reasons, or any other motivation; however, the intrinsic motivation to quit is the most successful in maintaining the quit status (Curry, Wagner, & Grothaus, 1990). The second step is to determine the dependence on nicotine in the individual, for example if a person smokes within 30 minutes of waking he or she is highly dependent (Sheahan, 2002). Additionally, the person would need to see a doctor to discuss nicotine replacement to alleviate the withdrawal and also discuss medications for the relief psychological reactions to quitting such as bupoprion (Sheahan, 2002). After setting the person’s quit date, Sheahan recommends the smoker tell family members so he or she can gain support as well as begin preparing the person’s environment by getting rid of any smoking materials (2002). Sometimes after a person quits smoking he or she may suffer from boredom or weight gain. An ideal method to address these issues would be to start an exercise regimen, such as walking that would promote the sense of well-being and reduce anxiety that often comes with the quitting process (Sheahan, 2002). Finally, a system of meaningful rewards for milestones reached in the person’s quit journey may provide an external incentive to stay quit. Smoking cigarettes increases the likelihood of developing serious, often deadly illnesses, yet many people continue to smoke. The preceeding paragraphs highlight the evidence of how pervasive nicotine is in the brain of the smoker. It is found in most parts of the brain responsible for decision-making processes as well as the reward systems. The susceptibility to addiction to nicotine may have a basis in heredity but the initiation of the smoking behavior finds influence from the external environment, including parental and peer smoking. The reasons for maintenance of the behavior most often point to alleviation of withdrawal symptoms however in some individuals an exertion of control over their environment is the source of their motivation. Whatever the motivation for smoking may be, for health reasons it is important for a person to quit smoking and consulting a doctor to prescribe medications in addition to finding support in family and friends are important steps in the process of ridding oneself of this deadly behavior. References Baker, T., Brandon, T., & Chassin, L. (2004). Motivational Influences on Cigarette Smoking. Annual Review of Psychology, 55, 463-491. Brust, J. (1998, Summer). Study Finds Possible Hereditary Component to Nicotine Addiction. The Conquest. Clarks, P., & Lancet, B. (1998). Tobacco Smoking, Genes, and Dopamine. 352(9122), 84-5. Curry, S., Wagner, E., & Grothaus, L. (1990). Intrinsic and Extrinsic Motivation for Smoking Cessation. 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