Why do some people who want to quit smoking succeed and others fail? The problem could be “in their heads” — literally.

A recent study conducted by Penn Medicine researchers indicates that disruptions in memory-related brain function could hold the key and actually lead to new treatment strategies for smokers.

That’s because quitting smoking “sets off a series of changes in the brain” that the Penn research team believes could single out the smokers who will start smoking again—all based on an MRI scan of brain activity in the early days of cessation attempts.

“James Loughead, PhD, associate professor of Psychiatry, and Caryn Lerman, PhD, a professor of Psychiatry and director of Penn’s Center for Interdisciplinary Research on Nicotine Addiction, found that smokers who relapsed within seven days from their target quit date had specific disruptions in the brain’s working memory system during abstinence that separated them from the group who successfully quit,” noted a University of Pennsylvania news release on the research.

In other words, neural activity — clearly visible on the MRIs — can be isolated, and suggests that decreases in the part of the brain that supports self-control distinguishes the unsuccessful quitters from those who more easily succeed.

In addition to helping design proper treatments based on the brain imaging, it could also mean that many could forego some of the commonly recommended aids, such as nicotine replacements and other strategies.

“This is the first time abstinence-induced changes in the working memory have been shown to accurately predict relapse in smokers,” said senior author Lerman, who also serves as deputy director of Penn’s Abramson Cancer Center.

Loughead, the lead author of the study, agrees.

“The neural response to quitting even after one day can give us valuable information that could inform new and existing personalized intervention strategies for smokers, which is greatly needed,” Loughead explained.

While smoking has declined among the U.S.population, there are still 42 million Americans who have the unhealthy habit, including a great many teenagers and young adults.

What defined the relapsers?

“Those who relapsed had decreased activity in the left dorsolateral prefrontal cortex, which controls executive functions, like working memory, compared to those who quit,” noted the study. “Working memory is an essential cognitive function necessary for staying focused, blocking distractions, and completing tasks. They also had reduced suppression of activation in the posterior cingulate cortex, a central part of the default mode network of the brain, which is more active when people are in a so-called “introspective” or “self-referential” state.”

In successful quitters, working memory got more active after that first cigarette-less day and the posterior cingulate cortex less active.

The new study is the first to suggest that brain activity data can be used to help predict relapse in smokers — and to intercede with treatments that might work better.

It’s also one of the first to unabashedly suggest that addiction should be analyzed and treated like other ailments.

“Many of us believe that addiction is a disease that should be treated just like a broken bone or a tumor,” agreed Joseph Frascella, division director for the National Institute on Drug Abuse (NIDA), who deemed the study valuable for revelations about “potential new paths for treatment.”