Toneatto, A.; Sobell, L.C.; Sobell, M.B.; et al. Effect of cigarette smoking on alcohol treatment outcome. Journal of Substance Abuse 7:245–252, 1995.
Fogg, B., and Borody, J. The Impact of Facility No Smoking Policies and the Promotion of Smoking Cessation on Alcohol and Drug Rehabilitation Program Outcomes: A Review of the Literature. Prepared for the Canadian Centre on Substance Abuse, Addictions Policy Working Group, September, 2001.
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Inclusion of smoking cessation treatment into other addiction programs does not negatively affect rates of treatment completion or motivation for abstinence (Sharp et al. 2003; Monti et al.1995).
Cigarettes kill thousands of people every year in the United States, but tobacco companies have never openly admitted it to the public that nicotine is bad or addictive.
Despite concerns to the contrary, the majority of empirical evidence indicates that smoking cessation (whether through formal treatment or self-initiated change) does not pose a risk to successful alcoholism treatment. Not only does smoking cessation not disrupt alcohol abstinence, it actually may enhance the likelihood of longer-term sobriety. Although research has yet to determine the extent to which smoking cessation is impeded by active alcohol use difficulties, the presence of these difficulties does not prohibit achievement of tobacco abstinence. Given the substantial negative health consequences of co-occurring cigarette smoking and alcoholism, smoking cessation efforts in the context of treatment for alcoholism are likely to yield important benefits to patients physically, emotionally, socially, and economically.
Unfortunately, even with today’s best interventions for tobacco cessation, smokers in alcohol treatment or recovery face particular challenges to their cessation efforts. On average, compared with smokers who do not abuse substances, alcoholic smokers are more addicted to nicotine, smoke higher nicotine cigarettes, smoke more per day, and score higher on nicotine dependence measures and on carbon monoxide assessment (Burling and Burling 2003; York and Hirsch 1995). Many smokers with alcoholism report that they use smoking to cope with their urges to use alcohol or other drugs (Rohsenow et al. 2005), so alcohol-dependent smokers may have stronger views about the benefits of continued tobacco use than do other smokers. In addition, nicotine positively influences information processing among alcoholics (i.e., nicotine use increases the speed and accuracy of information processing) (Ceballos et al. 2006), which may decease motivation to change. Thus, researchers and clinicians must take into account the characteristics of tobacco dependence in alcohol-dependent populations when determining how best to treat these patients’ tobacco dependence.
Burling, A.S., and Burling, T.A. A comparison of self-report measures of nicotine dependence among male drug/alcohol-dependent cigarette smokers. Nicotine and Tobacco Research 5:625–633, 2003.
Not only does the preponderance of evidence suggest that smoking cessation does not compromise alcohol abstinence, but multiple studies indirectly suggest that continued smoking may place alcohol-dependent smokers at risk for alcohol relapse (Taylor et al. 2000). These data are consistent with laboratory studies on cross-cue reactivity, which suggest that nicotine dependence and alcoholism may interact to increase drinking risk. For example, alcohol cues, such as the sight or smell of an alcoholic beverage, can increase smoking urges among smokers with alcohol use disorders (e.g., Cooney et al. 2003; Drobes 2002; Gulliver et al. 1995; Rohsenow et al. 1997), and the degree of nicotine dependence among alcoholic smokers is positively related to alcohol cue reactivity (Abrams and Biener 1992). In addition, a study of hazardous drinkers (i.e., those scoring 8 or above on the Alcohol Use Disorders Identification Test [Babor et al. 1992]) found that 6 hours of nicotine deprivation was associated with increased alcohol cravings during exposure to smoking cues (e.g., cigarette lighter, ashtray, pack of favorite cigarettes) as well as increased alcohol consumption during a taste test procedure (Palfai et al. 2000). Alcohol cravings also were increased during neutral cue exposure, suggesting that stopping one drug of abuse and not another may result in cross-cue reactivity that places a person in recovery at increased risk for relapse (Bobo et al. 1998; Toneatto el al. 1995).
Alcohol-dependent patients who quit smoking while in recovery from alcohol problems also do so without negative consequences to their alcohol or drug abstinence (Bien and Burge 1990; Bobo 1989; Hurt et al. 1993; Irving et al. 1994; Joseph et al. 2003; Sobell et al. 1990; Sullivan and Covey 2002). Data suggest that among alcohol- dependent smokers in early recovery, nicotine deprivation is not associated with an increased urge to drink. In addition, among people with significant alcohol abstinence, evidence suggests that smoking cessation does not increase the likelihood of relapse to alcohol use or increase alcohol-related cravings (Hughes et al. 2003). Data from Project MATCH, the largest alcoholism clinical trial published to date, indicates that alcohol-dependent smokers can quit smoking cigarettes without putting their sobriety at risk. In fact, those who quit smoking during their participation in Project MATCH drank less than those who did not quit smoking and significantly reduced their alcohol intake for the 6 months after quitting smoking (Friend and Pagano 2005). Similarly, Karam-Hage and colleagues (2005) studied smokers in alcohol treatment and found that participants who quit smoking on their own were more likely to report alcohol abstinence at 1- and 6-months’ followup than participants who did not quit smoking (though this may be a function of lower levels of nicotine dependence).
Cooney, J.L.; Cooney, N.L.; Pilkey, D.T.; et al. Effects of nicotine deprivation on urges to drink and smoke in alcoholic smokers. Addiction 98:913–921, 2003.