Effects of alcohol on smoking cessation – 2
First of all we should define what we mean by “problem drinking”.
Men who consume 15 or more drinks a week, women who consume 12 or more drinks a week, or anyone who consumes 5 or more drinks per occasion at least once a week are considered to have a high probability of having alcohol problems or being a problem drinker. (One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor).
The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol abuse or dependence:
1. Have you felt that you should cut down on your drinking?
2. Do you ever drive when you have been drinking?
3. Is someone in your family concerned about your drinking?
4. Have you ever had any blackouts after drinking?
5. Have you ever been absent from work or lost a job because of drinking?
6. Do you have to drink more than before to achieve intoxication or the desired effect?
If your answer is “yes” to even one of these questions, this is a sign that you likely have an alcohol problem. Another online test for alcohol problems can be taken at: http://www.alcoholscreening.org/
Professor John Hughes (University of Vermont) reviewed the evidence on whether having a history of alcohol problems (but not current problems) reduces the chances of successfully quitting smoking. He found that smokers with past alcohol problems tend to be heavier smokers than those without alcohol problems, but that they can quit smoking about the same rate as those without past alcohol problems. He hypothesized that this may be because such smokers learned skills required to beat an addiction when they resolved their alcohol problems, and this helps them neutralized their increased nicotine dependence.
Not surprisingly, however, people with current alcohol problems tend to have poorer outcomes when it comes to quitting smoking. There is a fairly close association between smoking and problem drinking. For example, in a study published in 2000 based on a survey of almost 43,000 adults, Dr Deborah Dawson (National Institutes of Health) reported that the proportion of past-year smokers rose from 23.8% of those who never drank 5+ drinks on any drinking day to 61.8% of those who drank 5+ drinks weekly or more often. She also found that but drinking 5+ drinks at least once a month reduced the odds of smoking cessation by 42%.
A recent study by Leeman and colleagues from Yale University noted that many (46%) trials of medicines for smoking cessation exclude people with a current or post alcohol problem. It was also noticeable in their study that trials of new medicines were more likely to do so. Thus 45/125 (36%) trials of nicotine replacement therapies (gum, patch etc), 15/22 (68%) bupropion SR trials and 3/3 varenicline (Chantix) trials excluded participants with either current or recent alcohol problems. This is part of the reason that clinicians often want to wait for more studies when a new “wonder drug” comes out that appears to get better outcomes than previous medicines. Typically the first few studies of a new drug (usually sponsored by the company making the drug) include only “ideal” candidates for the drug, rather than typical patients who might use it in the real world.
So what does all this mean?
Firstly, if you think you may have a current alcohol problem you should get help with that immediately. If you scored in the “problem drinking” range on any of the questions mentioned above but still don’t think you have a problem, then here’s one more test. Starting tomorrow, go 30 consecutive days without drinking any alcohol. If you can do it, then fine, maybe your alcohol consumption isn’t currently a problem. If as soon as you think of it you perceive it to be too much trouble, or if you try it and can’t do it, take that as confirmation that you can’t control your alcohol consumption. You should then discuss this with your family doctor and attend a local AA meeting.
Secondly, whether or not you think you have a current alcohol problem, you should make plans to quit smoking. If you feel you would rather get the drinking under control first, that’s fine, but make a concrete plan to tackle the smoking very soon and mention this to your doctor and AA sponsor right from the start. More people with alcohol problems are killed by their smoking than their drinking, so this is not something to put on the back burner for long. Once you have 30 days without drinking under your belt then its time to talk to your doctor/sponsor again about quitting smoking and to set a quit date.
Finally, just because people with a history of alcohol problems were excluded from some trials of smoking cessation medicines doesn’t mean you shouldn’t use an FDA-approved smoking cessation medication. This should be discussed with your doctor but if anything, the evidence suggests that the more nicotine dependent you are the more helpful an approved medicine (nicotine replacement therapy, Zyban or Chantix) will be. But as always, your chances of successfully quitting smoking will also be improved if you get counseling from a trained provider.