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Multiple Addictions: Drinking, Smoking © Copyright page!

Question: Do NOT copy this page!!!

Is it better to give up smoking and drinking at the same time, or is it better to tackle one addiction at a time.

Anyone who's attended an Alcoholics Anonymous meeting knows instinctively what research confirms: People who are dependent on alcohol are also likely to smoke cigarettes. Depending on the cohort, anywhere from 35 percent to 95 percent of alcohol-dependent adults smoke cigarettes, compared with 21 percent of adults in the U.S. population.

Many experts believe that it's important to counsel people who are alcohol-dependent to give up smoking as well as drinking. First, most evidence indicates that giving up both habits will increase the chances of someone remaining sober. Second, it's better for overall health.

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One study of 1,508 adults found that as alcohol use increased, the odds increased that a person would begin smoking daily and develop nicotine dependence. Roughly 90 percent of people who were severely dependent on alcohol were also dependent on tobacco.

It's not clear why the two addictions seem to go hand in hand. One theory is that alcohol and nicotine, the addictive component of tobacco, somehow interact in the brain to increase dependency to both substances. Alcohol appears to enhance nicotine's pleasurable effects, boosting the urge to smoke. People who are alcohol-dependent may also rely on nicotine's ability to improve attention and cognition.

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A major and still largely unresolved question is whether it's better to give up smoking and drinking at the same time, or whether it's better to tackle one addiction at a time.

The Timing of Alcohol and Smoking Cessation (TASC) study was the first large randomised controlled study to compare concurrent and delayed smoking cessation treatment in people who are alcohol-dependent. Both interventions consisted of the same behavioural and pharmacological treatment, but one was administered a week after alcohol treatment started (the concurrent arm) and the other six months later (the delayed arm).
TASC researchers first reported that participants who received delayed smoking cessation treatment were more likely to remain sober than those who received concurrent treatment. But a follow-up analysis found that this was true only for a small sample of participants.

It may be that no one approach is best for every person who is struggling with addiction to both alcohol and nicotine. Even so, it's important to remember that many people who are dependent on alcohol die from tobacco-related disorders, such as lung cancer, heart attacks, and chronic obstructive pulmonary disease. Whether smoking cessation is accomplished before, during or after alcohol treatment, either option is much healthier than continuing to smoke.

Summary Do NOT copy this page!!!

A common worry is that trying to quit smoking and drinking at the same time will undermine treatment for both alcohol dependence and nicotine dependence. However, most studies have reported that smoking cessation efforts either have no impact on maintaining sobriety, or actually improve outcomes for alcohol treatment, whereas smoking cessation aids those with alcohol addictions to quit alcohol.

People dependent on alcohol do face particular challenges when it comes to quitting smoking. Alcohol-dependent adults tend to smoke more than other adults, become more dependent on nicotine, and may experience more intense nicotine withdrawal.

The smoking cessation guidelines designed specifically for alcohol-dependent adults recommend the following:
For light drinkers the smoking cessation precede the alcohol withdrawal and
For heavy drinkers the alcohol withdrawal come first.

Sources: Do NOT copy this page!!!

Harvard Health Publications; smoke-freecommunity.org

Cooney NL, et al. "Concurrent Brief Versus Intensive Smoking Intervention During Alcohol Dependence Treatment," Psychology of Addictive Behaviors (Dec. 2007): Vol. 21, No. 4, pp. 570–75.

Fu SS, et al. "Ethnic Differences in Alcohol Treatment Outcomes and the Effect of Concurrent Smoking Cessation Treatment," Drug and Alcohol Dependence (Jan. 1, 2008): Vol. 92, No. 1–3, pp. 61–68.

For more references, please see www.health.harvard.edu/mentalextra.

Resourced by Dr Lionel Hartley ©2008 Do NOT copy this page!!!

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