Smoking as a Brain Disease

Aug 31, 2023 | Uncategorized

Smoking cigarettes isn’t as popular as it used to be but many teenagers still experiment with tobacco products despite the obvious health risks. The Centers for Disease Control and Prevention (CDC) estimates that “If cigarette smoking continues at the current rate among youth in this country, 5.6 million of today’s Americans younger than 18 will die early from a smoking-related illness. That’s about 1 of every 13 Americans aged 17 years or younger who are alive today.”

Tobacco product use is typically started and established primarily during adolescence. In 2022, 4.5 percent of middle school students and 16.5 percent of high school students reported current use of a tobacco product, according to the CDC data. The year before, 11.3 percent of middle school students and 34 percent of high school students said they had ever tried a tobacco product. E-cigarettes have been the most commonly used tobacco product among young Americans since 2014.

A new study now suggests that the brains of teenagers who take up smoking may actually be different from those of adolescents who don’t take up the habit. Levels of gray matter in two parts of the brain may be linked to a desire to start smoking during adolescence and the strengthening of nicotine addiction, the study revealed.

A team of scientists, led by the universities of Cambridge and Warwick in the UK and Fudan University in China, analyzed brain imaging and behavioral data of over 800 young people at the ages of 14, 19, and 23. They found that, on average, teenagers who started smoking by 14 years of age had markedly less gray matter in a section of the left frontal lobe linked to decision-making and rule-breaking. 

Gray matter is the brain tissue that processes information and contains all of the organ’s neurons. While brain development continues into adulthood, gray matter growth peaks before adolescence. Gray matter plays a significant role in allowing humans to function normally as it allows us to control our movements, retain memories, and regulate our emotions, among many other functions.

Low gray matter volume in the left side of the ventromedial prefrontal cortex may be an “inheritable biomarker” for nicotine addiction, the researchers suggested, with significant implications for prevention and treatment. 

Equally interesting, the scientists discovered that the right part of the same brain region also had less gray matter in smokers. The loss of gray matter in that region appears to speed up only after someone has started smoking cigarettes. This region is linked to the seeking of sensations.

The team argues that less gray matter in the left forebrain could lower cognitive function and lead to “disinhibition,” i.e. impulsive, rule-breaking behavior arising from a limited ability to consider consequences. This may increase the chances of smoking at a young age.

Once nicotine use takes hold, gray matter in the right frontal lobe shrinks, which may weaken control over smoking by affecting “hedonic motivation,” the way pleasure is sought and managed. Excessive loss of gray matter in the right brain was also linked to binge drinking and marijuana use. 

These findings suggest an insidious vicious cycle. If you’re genetically predisposed to have a low gray matter volume in the left side of the ventromedial prefrontal cortex, the resulting disinhibition could lead to the misuse of nicotine and possibly other psychoactive substances which in turn shrinks the gray matter in the right frontal lobe, increasing the hedonic motivation to repeat the harmful behavior.

“The ventromedial prefrontal cortex is a key region for dopamine, the brain’s pleasure chemical. As well as a role in rewarding experiences, dopamine has long been believed to affect self-control,” explained co-author Barbara Sahakian from Cambridge’s Department of Psychiatry. “Less gray matter across this brain region may limit cognitive function, leading to lower self-control and a propensity for risky behavior, such as smoking.”

Dopamine also plays a central role in the neurochemistry of addiction. “Many studies have shown that neurons that release dopamine are activated, either directly or indirectly, by all addictive substances, but particularly by stimulants such as cocaine, amphetamines, and nicotine.,” Surgeon General Vivek Murthy wrote in his 2016 landmark report on addiction in America. 

“Smoking is perhaps the most common addictive behavior in the world and a leading cause of adult mortality,” said Professor Trevor Robbins, co-senior author from Cambridge’s Department of Psychology. “The initiation of a smoking habit is most likely to occur during adolescence. Any way of detecting an increased chance of this, so we can target interventions, could help save millions of lives.”

Some teenagers engaging in problematic substance use eventually require professional treatment or else risk developing a full-blown addiction and other serious health problems. There is a new treatment option for teenagers at risk in the Denver area. Avanti Behavioral Health offers an intensive outpatient program (IOP) for clients between the ages of 13 and 18 in Greenwood Village, Colorado. Our mission is to provide comprehensive, holistic, family-centered, and trauma-informed care for teens. 

For more information about our IOP and family programming call us at (720) 753-4030. 

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