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Smokers Not Swayed By Regret Over Missed Opportunities
> 3/21/2008 1:21:32 PM

The dangers of cigarettes have been recognized for decades, but smokers are still extremely resistant to admonitions that they should quit. Doctors and therapists who try to intervene are often ignored or even met with hostility. While this has been understood as a resistance born only of physical addiction, new evidence in the March issue of Nature Neuroscience opens the possibility that what seems like stubbornness is actually a distinct way of evaluating costs and benefits.

Dr. Read Montague led a team of researchers from Baylor College in an experiment on gambling behavior. Subjects were given money to invest in a simulated stock market, and they had the opportunity to alter their investment strategy after hearing the results of each preceding round. Both smokers and non-smokers invested similarly when they were told only how much money they made each round, but their behavior diverged when experimenters told them how much money they would have made if they had invested varying amounts of money, hypotheticals called "fictive outcomes".

Non-smokers changed their investment pattern to incorporate knowledge of what would have happened in the past, but smokers did not alter their behavior. MRIs showed that both groups had equivalent brain activations when receiving fictive outcomes, so large-scale neural dysfunction cannot be responsible for the unresponsiveness.

Smokers are processing the same information but failing to act on it. This means that any attempts at encouraging quitting must work around this blind-spot. This latest finding illuminates the ongoing effort to determine the most convincing way to frame smoking information. There have been numerous interesting, and sometimes perplexing, studies on this issue. A Yale study published last December found that emphasizing potential gains was more potent than stressing negative consequences, and we recently covered a study that demonstrated that the revelation of apparent lung age was much more effective than breakdowns of breathing capacity. Researchers in the lung age study were bewildered by the fact that while getting smokers to think about future aging to their lungs strongly altered their behavior, it did not matter to smokers whether their lungs had actually prematurely aged or not. While that made little sense before, we may now be able to understand this as part of the abnormal way that smokers fail to learn from disclosures of what could have been.

As we come to better understand the best ways to phrase verbal interventions, we will learn how to maximize the chance that a smoker will listen to and act on the copious evidence that smoking is a bad choice.

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