Smoking and Drinking

Tobacco Use Among Recovering Alcoholics, Part 2
by National Institute of Health

(Page 5 of 5)

To address this concern, during 1995 researchers conducted a randomized community intervention trial in 12 residential treatment facilities in Iowa, Kansas, and Nebraska.

Patients in one-half of the treatment centers received a four-part intervention to encourage smoking cessation. Patients in the remaining six centers (the control group) received the usual care provided by those facilities. The results of the study clearly showed that alcoholic patients who smoked could benefit from smoking cessation counseling. After 1 year of followup, 43 percent of the patients who were encouraged to quit smoking were still abstaining from alcohol, compared with 29 percent of the patients in the control centers. These findings do not suggest that smoking cessation efforts among recovering alcoholics will be free of stress, but they do indicate that alcohol treatment facilities can safely provide a sociocultural climate that explicitly encourages smoking cessation. Findings from other studies have shown that instituting smoking cessation programs in alcohol treatment centers is acceptable to treatment staff and does not adversely affect patient enrollment.

Evidence of a third sociocultural influence on tobacco use among recovering alcoholics and problem drinkers was suggested by an unanticipated finding in the 12-site randomized community intervention trial previously described. Two of the twelve sites (one tobacco intervention site and one control group site) restricted admission to their programs to alcoholics who were either Native American or Alaska Native. The smoking cessation rates among patients in these programs were nearly twice as high as those observed among all other racial and ethnic groups in the study. Treatment staff in the Native American programs attributed the difference in quit rates to frequent discussions with their patients about the sacred role of tobacco in many Native American communities and its traditional use in various religious ceremonies.

Public Health Implications

The information reviewed in this article on the sociocultural influences on smoking and drinking suggests several strategies that health care providers and public health practitioners could use to discourage alcohol and tobacco use and alcohol abuse. In addition to ongoing efforts to restrict adolescent exposure to tobacco and alcohol advertising and discourage sales of these products to minors, intervention efforts targeted toward the well-established association between smoking and drinking could prove beneficial. People with histories of problem drinking should be screened for tobacco use, informed of the added health risks of tobacco use for heavy drinkers, and encouraged to quit smoking. New media campaigns to educate the general public on the additional dangers of smoking for moderate and heavy drinkers would also be appropriate. Dedicating some public health research dollars to the development of smoking cessation programs tailored to the needs and interests of recovering alcoholics would also be useful. The National Institute on Alcohol Abuse and Alcoholism has supported some work in this area, but many important clinical questions remain unanswered.

Other innovative strategies could be considered as well. State legislatures could be urged to pass laws prohibiting smoking and tobacco purchases in bars and taverns. The entertainment and advertising industries could be encouraged to avoid images of people smoking cigarettes in scenes portraying alcohol use and vice versa. And finally, alcohol treatment facilities could be instructed to completely ban all tobacco use on their premises and require all their employees to be nonsmokers.

Conclusion

This article has reviewed key findings from the large body of literature on sociocultural mechanisms that encourage tobacco and alcohol use among adolescents and adults. Many of these mechanisms exert similar effects on both alcohol and tobacco use behaviors. Sociocultural factors that encourage smokers to drink and drinkers to smoke have not received extensive study, but they may account for some of the substantial variation in adult tobacco use rates seen among different levels of alcohol consumption.

Although studies based on samples of problem drinkers and recovering alcoholics suggest a recent weakening of the association between drinking and smoking that is consistent with changes in societal attitudes toward tobacco and standards of care in alcoholism treatment facilities, the connection may continue to be quite strong among some populations (polydrug users and depressed adults). "Hard-core" smokers and drinkers may particularly benefit from additional research on sociocultural mechanisms that strengthen the association between these behaviors. Such research may identify new opportunities for treatment and prevention and promote changes in public health policy that would further discourage concurrent use of tobacco and alcohol.

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.