Smoking and Drinking

Alcohol Abstainers, Moderate and Drinkers
by National Institute of Health

(Page 3 of 5)

Research suggests that workplace smoking bans and other restrictions on where smoking is allowed, however, may reduce smoking prevalence among people subjected to them. In a review of studies of workplace smoking restrictions, Chapman and colleagues reported that daily smoking rates declined in 18 of 19 studies and that smoking prevalence declined in 17 studies. Both workplace and household smoking restrictions have also been associated with higher rates of quit attempts, lower rates of relapse among smokers who attempted to quit, and higher rates of light smoking among current daily smokers. Another study compared changes in smoking prevalence among smokers employed at smoke-free hospitals with changes in smoking among smokers in the community who were employed at non-smoke-free workplaces.1 Beginning with the smoking ban and continuing for 5 years after implementation, statistically significant differences in the postban quit ratio were observed between smokers employed at the smokefree hospitals and their counterparts in the community. The overall difference in postban quit ratios remained significant even after adjustment for socioeconomic, demographic, and smokingintensity variables.

The extent of tobacco and alcohol use may also be influenced by stress. One theory suggests that people are more likely to use drugs, especially multiple drugs, when unable to cope with stressful situations. A 1995 review of the literature concluded that adults often use alcohol and tobacco for similar reasons, but the coping functions for alcohol use are more likely to involve distraction and forgetting, whereas the coping functions for smoking were related to increased attention and concentration.

A recent review of the "smoke to cope" literature portrays a more complex relationship between stress and smoking. Although most smokers report that cigarettes help them relax, several studies indicate that smokers are more anxious overall than are nonsmokers and that former smokers who maintain complete nicotine abstinence for at least 6 months report significant reductions in their stress levels. These findings suggest that nicotine-dependent smokers must smoke on a regular basis to cope with the withdrawal symptoms experienced when nicotine blood levels drop between cigarettes. Smoking is thus a major contributor to stress and a conditioned response to adverse moods.

Although much has been learned about sociocultural influences on adult tobacco use, the available literature does not satisfactorily explain the substantial variability in prevalence of smoking within the alcohol use levels. Some insights on possible factors associated with this variability can be obtained by considering various levels of alcohol use sequentially.

Tobacco Use Among Adult Lifetime Alcohol Abstainers

Adults who have rarely or never consumed 12 or more drinks per year have tobacco-use patterns that differ markedly from moderate drinkers, heavy drinkers, and recovering alcoholics or problem drinkers. Smoking is relatively uncommon among nondrinkers. Factors that discourage tobacco use in this group have not been studied extensively to date, although the tendency for positive health behaviors to cluster in individuals is well established. In addition, several religious groups, including Mormons and Seventh Day Adventists, strongly oppose the use of both alcohol and tobacco.

Tobacco Use Among Adult Moderate Drinkers

The U.S. Government has defined moderate drinking as no more than one drink2 per day for women and no more than two drinks per day for men. Similar to findings among adolescents, the sociocultural factors responsible for higher rates of tobacco use among adult moderate drinkers are poorly understood. Like adolescents, moderate drinkers may receive more frequent cues to smoke than do nondrinkers if many of their peers, family members, and social acquaintances also drink and smoke. These cues, along with the addictive nature of tobacco, may encourage continued smoking and compromise efforts to quit.

Research with smokers who drink suggests that drinking prompts smoking. Participants in one study used small portable computers to record when they smoked and what else they were doing at the time. The computers also randomly "beeped" the participants to determine what they were doing during periods when they were not smoking. The participants were almost twice as likely to report recent drinking when they had been smoking. The results of this study are consistent with the theory that drinking influences smoking by releasing inhibitions that restrain smoking.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.