Available online 21 October 2022, 111555

Delay discounting is an index of preference for smaller-immediate rewards

Steeper delay discounting was associated with poorer smoking cessation outcomes

Neural activation patterns differed based on discounting choice difficulty

Activation in smoking relapse and non-relapse groups differed in several regions

Results implicate prefrontal, parietal, and striatal regions in smoking relapse

Large proportions of smokers are unsuccessful in evidence-based smoking cessation treatment and identifying prognostic predictors may inform improvements in treatment. Steep discounting of delayed rewards (delay discounting) is a robust predictor of poor smoking cessation outcome, but the underlying neural predictors have not been investigated. Forty-one treatment-seeking adult smokers completed a functional magnetic resonance imaging (fMRI) delay discounting paradigm prior to initiating a 9-week smoking cessation treatment protocol. Behavioral performance significantly predicted treatment outcomes (verified 7-day abstinence, n = 18; relapse, n = 23). Participants in the relapse group exhibited smaller area under the curve (d = 1.10) and smaller AUC was correlated with fewer days to smoking relapse (r = .56, p<.001) Neural correlates of discounting included medial and dorsolateral prefrontal cortex, posterior cingulate, precuneus, and anterior insula, and interactions between choice type and relapse status were present for the dorsolateral prefrontal cortex, precuneus, and the striatum. This initial investigation implicates differential neural activity in regions associated with frontal executive and default mode activity, as well as motivational circuits. Larger samples are needed to improve the resolution in identifying the neural underpinnings linking steep delay discounting to smoking cessation.

Nicotine dependence

Neuroeconomics

Delayed reward discounting

Treatment response

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