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Wednesday, April 4, 2007

ALCOHOL ALERT
No. 71 January 2007

ALCOHOL AND TOBACCO
Alcohol and tobacco1 are among the top causes of preventable deaths in the United States (1). Moreover, these substances often are used together: Studies have found that people who smoke are much more likely to drink, and people who drink are much more likely to smoke (2). Dependence on alcohol and tobacco also is correlated: People who are dependent on alcohol are three times more likely then those in the general population to be smokers, and people who are dependent on tobacco are four times more likely than the general population to be dependent on alcohol (3).
The link between alcohol and tobacco has important implications for those in the alcohol treatment field. Many alcoholics smoke, putting them at high risk for tobacco-related complications including multiple cancers, lung disease, and heart disease (i.e., cardiovascular disease) (4). In fact, statistics suggest that more alcoholics die of tobacco-related illness than die of alcohol-related problems (5). Also, questions remain as to the best way to treat these co-occurring addictions; some programs target alcoholism first and then address tobacco addiction, whereas others emphasize abstinence from drinking and smoking simultaneously. Effective treatment hinges on a better understanding of how these substances—and their addictions—interact.
Understanding just how alcohol and tobacco interact is challenging. Because co-use is so common, and because both substances work on similar mechanisms in the brain, it’s proving difficult to tease apart individual and combined effects of these drugs. In this Alcohol Alert, we examine the latest research on the interactions between these two substances, including the prevalence of co-occurring tobacco and alcohol use disorders (AUDs), some of the health consequences of combined use, biological mechanisms and genetic vulnerabilities to co-use and dependence, barriers to the treatment of tobacco dependence in patients with alcohol and other drug (AOD) use disorders,2 therapies that are proving effective in treating co-occurring tobacco and alcohol dependence in depressed patients, and treatment interventions for adolescent patients with co-occurring tobacco and AOD use disorder.


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