Smoking and Drinking

Tobacco Use Among Adult Heavy Drinkers, Recovering Alcoholics
by National Institute of Health

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Tobacco Use Among Adult Heavy Drinkers

Smoking is especially prevalent among heavy drinkers, including people diagnosed with alcohol abuse or alcoholism. Until the early 1990s, about 90 percent of all such patients were regular smokers. More recent data suggest a marked decline in smoking prevalence in this population. Studies reported tobacco use rates among alcohol treatment patients of 75 and 71 percent, respectively.

Stress may influence levels of both smoking and drinking among heavy drinkers, as it does among moderate drinkers. In addition, depression has been associated with smoking and severity of nicotine dependence and with alcohol dependence, although research has not determined whether alcohol dependence precipitates depression or results from it.

In a national survey of adults, smoking and drinking were both associated with self-reported negative moods (depression, loneliness, restlessness, boredom, and feeling upset). Women who scored the highest on a scale of negative moods were almost three times more likely to smoke than were women who had a score of zero. Among men, the odds of smoking also increased with negative mood scores. Women with high negative mood scores were not significantly more likely to drink heavily (to consume an average of two or more drinks per day). However, among men, the odds of being a heavy drinker (of consuming an average of three or more drinks per day) more than tripled for those with the highest levels of negative moods compared with men with no negative moods. Negative moods also were associated with combined smoking and drinking. Men with the highest negative mood scores were four times more likely to combine smoking and heavy drinking than were men with no negative moods. The authors concluded that emotional health status and addictive behaviors were "sufficiently related to warrant increased public health initiatives that attempt to address both issues together rather than one at a time".

Tobacco Use Among Recovering Alcoholics

Although several studies have reported encouraging data on the ability of recovering alcoholics to quit smoking, randomized clinical trial data suggest that most smokers who receive intensive treatment for a history of alcohol abuse or alcoholism continue to smoke long after learning to control their drinking. In addition, many continue to smoke heavily. In a longitudinal study of 575 adult smokers who completed intensive residential treatment for alcohol problems in the Midwest in 1995, 92 percent were still daily smokers 12 months after discharge from treatment. About one-half smoked an average of one or more packs of cigarettes per day.

Historically, three sociocultural mechanisms have influenced continued smoking among recovering alcoholics and problem drinkers. The first of these can be attributed to the widespread impact of Alcoholics Anonymous on recovering alcoholics in the United States. In addition to its well-known 12-step program, AA uses a number of pithy aphorisms to guide everyday behavior. One of the most important of these is "First things first." AA teaches its members that their primary responsibility is to become and remain sober. Often, members are advised to avoid tackling new challenges, like quitting smoking, until they are confident about their ability to remain sober even when under additional stress. A popular book published by AA uses a tobacco-related anecdote to illustrate this principle. The story reviews the case of an alcoholic whose wife "nagged" him to quit smoking after he had successfully stopped drinking. Unfortunately, the reader learns, "her intolerance finally threw him into a fit of anger," which resulted in his becoming drunk. This vignette was used for many years to justify cigarette smoking during AA meetings. Although nonsmoking AA meetings are now available in most communities, they were rare until the mid-1980s.

Tobacco use policies at alcohol and other drug treatment centers constitute a second sociocultural factor that likely influences smoking among recovering alcoholics and problem drinkers. A 1982 survey of alcohol treatment inpatient facilities in Washington State found that more than one-half of the treatment staff believed a recovering alcoholic should not be encouraged to quit smoking until he or she had been sober for at least 1 year. About one-fourth of the treatment staff indicated that they did not believe an alcoholic should ever be encouraged to quit smoking. Opinions were strongly associated with a personal history of smoking and alcoholism. Staff members who identified themselves as recovering alcoholics and current smokers were far less likely than staff members who self-identified themselves as nonsmokers with no histories of alcohol problems to report that they had ever personally encouraged an alcoholic to quit smoking.

Paralleling the profound shift in attitudes toward smoking that occurred across most U.S. communities in the 1980s, a marked change in acceptance of tobacco use was evident in alcohol and other drug treatment facilities by the early 1990s. A 1991 survey of 771 treatment personnel in Nebraska found that only 3 percent of the treatment personnel actively discouraged patients or clients who wanted to quit smoking. However, only 35 percent of the staff members said that they thought recovering alcoholics who smoked should be encouraged to quit early in their sobriety. The most common reason given for a reluctance to encourage smoking cessation was the concern that the stress of trying to quit might adversely affect the patient's ability to remain sober.

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.