Self-control may be the new research target in addition to motivation to quit.
A will to stop, however, is often seen as a requirement for enrolling into smoking cessation treatment programs.
"Early evidence suggests that exercises aimed at increasing self-control, such as mindfulness meditation, can decrease the unconscious influences that motivate a person to smoke," say the experts, including senior study author Dr. Nora Volkow, director of the US National Institute on Drug Abuse.
Recent brain scanning studies have shown that smokers have less activity in areas associated with self-control. Could targeting these neurobiological circuits be a way to treat addiction?
"We are interested in trying to probe how repeated use of drugs ultimately influences our ability to control our desires," says Dr. Volkow.
"We are starting to work through how drugs affect areas of the brain that normally enable us to self-regulate," she adds, "to create goals and to be able to achieve them, and how those changes influence the behavior of the person addicted."
Subconscious smoking reduction
In one study cited by the review, an "integrative body-mind training program that included relaxation training techniques" was examined to see how improving self-control could help smokers with their cravings.
Texas Tech University and University of Oregon researchers recruited 60 undergraduate students (27 cigarette smokers and 33 non-smokers) to the training program.
Each of the students came into the program expecting to learn meditation and relaxation techniques for stress reduction and cognitive improvement.
Half of them received mindfulness meditation training (becoming self-aware of one's experience) and half received a relaxation technique.
Over 2 weeks, the participants had a total of 5 hours of 30-minute sessions. Before and at the end, their brains were scanned and self-report questionnaires were completed. Each student also had their smoking objectively measured with carbon monoxide testing.
Even though many of the students said they had smoked the same number of cigarettes before and after the training, for those who had received mindfulness meditation, an objective measure of carbon dioxide percentage in their lungs showed a 60% reduction in smoking in the 2 weeks after the study.
Lead study author Yi-Yuan Tang, a professor of psychological sciences at Texas Tech in Lubbock, explains:
"The students changed their smoking behavior but were not aware of it. When we showed the data to a participant who said they had smoked 20 cigarettes, this person checked their pocket immediately and was shocked to find 10 left."
"We then measured intention to see if it correlated with smoking changes and found there was no correlation," adds Prof. Tang. "But if you improve the self-control network in the brain and moderate stress-reactivity, then it's possible to reduce smoking."
Other studies reviewed by the authors showed how integrative body-mind training such as mindfulness meditation could reduce the levels of the stress hormone cortisol, as well as increase immune reactivity. Specific changes in the brain have also been identified, showing stronger connectivity between regions linked to self-control.
Not all questions are answered, however, and more research is needed.
"Mindfulness meditation, as well as other strategies that are aimed at strengthening self-control, are likely to be useful for the management of addiction, but not necessarily for everybody," Dr. Volkow says, adding:
"However, understanding how our brain works when we do interventions that strengthen self-control can also have multiple implications that relate to behaviors that are necessary for health and wellbeing."