Although between 80 and 95 percent of alcoholics smoke cigarettes, a rate that is three times higher than the general population, and 70 percent of alcoholics are heavy smokers compared with just 10 percent of the population, very few studies have been done about the association between the two.
However, a study in the November 2000 issue of Alcoholism: Clinical & Experimental Research closely examined this association to see if smokers with a past history of alcoholism are more nicotine dependent than smokers with no problem drinking history.
Predisposed?"There are many theories of why smoking and alcoholism go together," said John R. Hughes, professor of psychiatry at the University of Vermont and lead author of the study in a news release. "Some studies suggest that the same genes that predispose people to alcoholism also predispose them to smoking. Some have thought there is an 'addictive personality' that becomes addicted to many things, but research suggests this is not so."
"Another idea is that since smoking stimulates and alcohol relaxes, smokers use alcohol to prevent over-stimulation from smoking and alcoholics use cigarettes to prevent sedation," he said. "Yet another idea is that those who become alcoholics are people who use substances for the drugs within them, for example, to get high or to cope with life. This theory would predict that alcoholic smokers use tobacco mostly for the nicotine in it."
Using nicotine gum, Hughes' study examined if smokers with a past history of alcoholism would self-administer nicotine more often and in greater amounts than non-alcoholic smokers. They found that smokers with a history of alcoholism said they didn't enjoy nicotine more, but they did more often choose to use pure nicotine, and ingested greater levels of nicotine than smokers without this history.
"It may seem unusual," explained Hughes, "that we found a difference between the self-administration or rewarding effects of nicotine and the subjective effects or the liking of nicotine. Usually these two go hand in hand, but not always. In fact, many smokers state they can't understand their use of cigarettes because they feel they really don't get much out of it. Sometimes we can like something but not be able to express what it is we like about it."
Smoking More Dangerous"Many in the alcohol field did not feel smoking was an important problem for alcoholics, that maintaining sobriety was the critical factor," said Kenneth A. Perkins, professor of psychiatry at the University of Pittsburgh Medical Center. "Most studies in the smoking field would exclude those with current or past alcohol dependence. Furthermore, funding has typically come from different agencies - one for alcohol, another for smoking/nicotine - which allowed studies of alcohol and smoking to fall through the cracks."
But Hughes said recent data shows that smoking kills more alcoholics than alcohol does. According to the American Cancer Society, smoking is the most preventable cause of death in American society. Nearly one in five deaths in the U.S. results from the use of tobacco; more than 400,000 die from smoking in the U.S. each year.
"What this means," said Hughes, "is that we need to get alcoholics to stop smoking either while stopping their alcohol or soon after. Our study suggests these smokers especially need to use medications that fight nicotine dependence, like the patch, gum, an inhaler, or Zyban."