Neuromodulation of delay discounting, the reflection effect, and cigarette consumption

• Published in: Journal of substance abuse treatment Vol. 45; no. 2; pp. 206 - 214
• Main Authors: Sheffer, Christine E., Mennemeier, Mark, Landes, Reid D., Bickel, Warren K., Brackman, Sharon, Dornhoffer, John, Kimbrell, Timothy, Brown, Ginger
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2013; Elsevier; Elsevier Limited
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Biological and medical sciences; Choice Behavior - physiology; Cigarettes; Cognition & reasoning; Cognition - physiology; Consumption; Cortex; Decision making; Decision Making - physiology; Delay discounting; Desintoxication. Drug withdrawal; Discounting; Drug addiction; Female; Gambling - psychology; Humans; Impulsive Behavior - psychology; Intervention; Male; Medical sciences; Middle Aged; Miscellaneous; Prefrontal Cortex - metabolism; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reflection; Reward; Single-Blind Method; Smoking - epidemiology; Smoking - psychology; Smoking cessation; Stimulation; Substance abuse treatment; Time Factors; Transcranial magnetic stimulation; Transcranial Magnetic Stimulation - methods; Treatments; Young Adult; Smoking cessation; Transcranial magnetic stimulation; Delay discounting; Consumption; Human; Drug addiction; Poison withdrawal; Tobacco smoking; Reinforcement delay; Subjective evaluation; Cigarette; Tobacco; Addiction; Shutdown; Disintoxication; Value; Reward; Public health
• ISSN: 0740-5472; 1873-6483; 1873-6483
• DOI: 10.1016/j.jsat.2013.01.012

Cigarette smokers and substance users discount the value of delayed outcomes more steeply than non-users. Higher discounting rates are associated with relapse and poorer treatment outcomes. The left dorsolateral prefontal cortex (DLPFC) exerts an inhibitory influence on impulsive or seductive choices. Greater activity in the prefrontal cortex is associated with lower discounting rates. We hypothesized that increasing activity in the left DLPFC with high frequency repetitive transcranial magnetic stimulation (HF rTMS) would decrease delay discounting and decrease impulsive decision-making in a gambling task as well as decrease cigarette consumption, similar to other studies. In this single-blind, within-subjects design, smokers with no intention to quit (n=47) and nonsmokers (n=19) underwent three counterbalanced sessions of HF rTMS (20Hz, 10Hz, sham) delivered over the left DLPFC. Tasks were administered at baseline and after each stimulation session. Stimulation decreased discounting of monetary gains (F[3,250]=4.46, p<.01), but increased discounting of monetary losses (F[3,246]=4.30, p<.01), producing a reflection effect, normally absent in delay discounting. Stimulation had no effect on cigarette consumption. These findings provide new insights into cognitive processes involved with decision-making and cigarette consumption and suggest that like all medications for substance dependence, HF rTMS is likely to be most effective when paired with cognitive–behavioral interventions.