Nicotine dependence is the leading preventable cause of mortality in the world today. Cue-induced craving is likely to play an important role in relapse. The neural correlates of smoking cue-induced craving and extinction have been elucidated using fMRI. Recent advances make it possible to utilize real-time fMRI (rtfMRI) feedback to modify behavior, cognitions and regional brain activity. The purpose of this proposal is to develop the imaging parameters, brain-computer interface and standardized procedures for using rtfMRI with visual feedback to help nicotine-dependent individuals decrease craving when presented with smoking cues. The exploratory nature of this study requires a phased approach. Phase 1 will focus on the development of the technology and study paradigm. In order to proceed to Phase 2, there must be convincing evidence that a substantial proportion of nicotine-dependent individuals can manipulate brain activity in critical brain regions associated with smoking cue-induced craving based on rtfMRI visual feedback. If this is established, a controlled comparison and duration of effect will be explored in Phase 2. This project will set the stage for clinical trials investigating a very innovative approach to the treatment of nicotine dependence and other substance use disorders. The study will provide critical information about optimal techniques, durability and """"""""transferability"""""""" of the effects to situations outside of the scanner. The findings of this study can be used to inform the design of a clinical trial to investigate the use of rtfMRI neuromodulation training in smoking cessation.

Public Health Relevance

Improving treatment for nicotine dependence will provide substantial public health benefit as nicotine dependence is the leading preventable cause of mortality in the world today. Moreover, if individuals can learn to modulate activity in critical brain regions that control urges and craving states, this could have applicability in a broad range of disease states with major public health significance (i.e. other substance use disorders, obesity).

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Exploratory/Developmental Grants Phase II (R33)
Project #
Application #
Study Section
Special Emphasis Panel (ZAA1-GG (33))
Program Officer
Bjork, James M
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Medical University of South Carolina
Schools of Medicine
United States
Zip Code
Hartwell, Karen J; Hanlon, Colleen A; Li, Xingbao et al. (2016) Individualized real-time fMRI neurofeedback to attenuate craving in nicotine-dependent smokers. J Psychiatry Neurosci 41:48-55
Moran-Santa Maria, Megan M; Hartwell, Karen J; Hanlon, Colleen A et al. (2015) Right anterior insula connectivity is important for cue-induced craving in nicotine-dependent smokers. Addict Biol 20:407-14
Stoeckel, L E; Garrison, K A; Ghosh, S et al. (2014) Optimizing real time fMRI neurofeedback for therapeutic discovery and development. Neuroimage Clin 5:245-55
Hartwell, Karen J; Prisciandaro, James J; Borckardt, Jeffery et al. (2013) Real-time fMRI in the treatment of nicotine dependence: a conceptual review and pilot studies. Psychol Addict Behav 27:501-9
Li, Xingbao; Hartwell, Karen J; Borckardt, Jeffery et al. (2013) Volitional reduction of anterior cingulate cortex activity produces decreased cue craving in smoking cessation: a preliminary real-time fMRI study. Addict Biol 18:739-48
Hanlon, Colleen A; Hartwell, Karen J; Canterberry, Melanie et al. (2013) Reduction of cue-induced craving through realtime neurofeedback in nicotine users: the role of region of interest selection and multiple visits. Psychiatry Res 213:79-81
Canterberry, Melanie; Hanlon, Colleen A; Hartwell, Karen J et al. (2013) Sustained reduction of nicotine craving with real-time neurofeedback: exploring the role of severity of dependence. Nicotine Tob Res 15:2120-4
Johnson, Kevin A; Hartwell, Karen; LeMatty, Todd et al. (2012) Intermittent ""real-time"" fMRI feedback is superior to continuous presentation for a motor imagery task: a pilot study. J Neuroimaging 22:58-66
Hartwell, Karen J; Johnson, Kevin A; Li, Xingbao et al. (2011) Neural correlates of craving and resisting craving for tobacco in nicotine dependent smokers. Addict Biol 16:654-66