The New Placebo Effect: Beliefs & Cigarettes

The tobacco industry is notorious for its great advertising power. Iconic campaigns starring mascots like the Marlboro Man and Joe Camel have given tobacco a reputation for monolithic influence in brand presentation and consumer perception. For decades, the ability of these companies to change people’s beliefs surrounding tobacco products has contributed to an upswing in various health detriments including nicotine addiction, and increased risk of cardiovascular disease, respiratory disorders, and cancer. Recent work by Dr. Read Montague and his research team at Virginia Tech Carilion Research Institute, however, is challenging the role of beliefs and cigarette consumption, suggesting that subjective belief could one day be a novel target for addiction treatment.

Montague and his team were interested in evaluating the effect of belief on reward-based learning. To do this, participants were assigned to one inhalation condition (i.e. inhale either a nicotine or placebo cigarette), as well as one belief condition (i.e. told that either the cigarette contained nicotine or did not contain nicotine). Immediately after smoking, the participants’ brain responses were tracked using functional magnetic resonance imaging while performing a reward-based investment task. The study revealed that, in participants that inhaled nicotine, beliefs about nicotine intake modulated ventral striatum activation, but not visual attentional area activation. In other words, despite consuming the same nicotinic compound, those told that the cigarette they smoked contained nicotine showed differing brain activity in the reward-based learning circuit than those told they smoked a placebo cigarette. This result led to the conclusion that beliefs about nicotine consumption specifically modulate striatal learning signals. Therefore, much like the way placebo drugs can improve well-being without chemical input, Montague and his team have shown that belief can also work to overcome chemical input.

The finding that belief can modulate reward-based learning may have vast implications for future chronic drug abuse research, particularly for learning and choice behavior. Given the acceptable, but not exceptional efficacy of current treatments for nicotine addiction (e.g. nicotine replacement therapy, bupropion, nortriptyline, clonidine), providing a novel target for intervention is an exciting, new development for addiction research. In the coming years, if scientists are able to decipher and alter the belief system in a way that results in selective physiological changes, the reverse-engineering of nicotine addiction would be a possibility to combat the detrimental disease.

Hopeful for the future, Montague offers that, “Just as drugs micromanage the belief state, maybe we can micromanage beliefs to better effect behavior change in addiction.” Maybe one day, the belief systems that tobacco companies manipulated in smokers will be the solution to their addiction ills.

Works Cited:

Gu, X., Lohrenz, T., Salas, R., Baldwin, P. R., Soltani, A., Kirk, U., … & Montague, P. R. (2015). Belief about nicotine selectively modulates value and reward prediction error signals in smokers. Proceedings of the National Academy of Sciences, 201416639.

Kotlyar, M., & Hatsukami, D. K. (2002). Managing nicotine addiction. Journal of Dental Education, 66(9), 1061-1073.

Press release:

John Oliver // Last Week Tonight (Tobacco):

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