The Role of Cognitive Control in the Self-Regulation and Reinforcement of Smoking Behavior

Abstract

Cognitive control (CC)-the ability to regulate attention and memory-plays an important role in a variety of health behaviors, including smoking behavior. In this theoretical review of the literature, we propose a CC and smoking behavior framework that includes (1) the positive influence of CC on the self-regulation of smoking, (2) nicotine-induced improvements in CC that may indirectly reinforce smoking (including withdrawal reversal effects), and (3) the long-term effects of smoking on the brain that may result in reduced CC. Integration of these literatures suggests that CC contributes to both self-regulation (ie, brake pedal) and nicotine-related reinforcement (ie, gas pedal) amid the catastrophic effects of long-term smoking, which may reduce self-regulatory control over smoking while also enhancing indirect reinforcement. Supportive evidence and limitations of this approach will be presented, as well as ideas for future research directions that may fully examine this multifaceted modeling of CC in relation to smoking behavior.

Implications: There is substantial evidence that CC contributes to self-regulation (ie, brake pedal) and reinforcement (ie, gas pedal) of smoking behavior as well as evidence that long-term smoking may cause reduced CC. The proposed model delineates how these opposing influences of CC may mask the unique contribution of self-regulation and reinforcement in maintaining smoking behavior. Targeting CC for treating nicotine dependence will require more nuanced approaches that consider the independent and combined effects of self-regulation and reinforcement to improve smoking cessation success rates.

Figure 1.

Model of cognitive control (CC) in relation to smoking behavior. Our proposed model suggests both nicotine withdrawal–related disruption of CC as a state factor and trait CC (gray rectangles) impact current CC functioning, which in turn impacts self-regulation and smoking reinforcement (white rectangles). Depending on whether these factors increase or decrease self-regulation (ie, brake pedal) and/or smoking reinforcement (ie, gas pedal), this will lead to a decision point: smoke or not smoke. This decision influences whether smoking behavior or smoking abstinence is maintained. Finally, long-term smoking may have detrimental effects on CC, thus creating a negative feedback loop (dashed line), which may also impact CC-related indirect reinforcement of smoking behavior.