Smoking cessation and alcohol abstinence: What do the data tell us?

Department of Psychiatry, Boston University, Boston, Massachusetts, United States
Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism (Impact Factor: 0.58). 02/2006; 29(3):208-12.
Source: PubMed
ABSTRACT
Cigarette smoking and nicotine dependence commonly co-occur with alcohol dependence. However, treatment for tobacco dependence is not routinely included in alcohol treatment programs, largely because of concerns that addressing both addictions concurrently would be too difficult for patients and would adversely affect recovery from alcoholism. To the contrary, research shows that smoking cessation does not disrupt alcohol abstinence and may actually enhance the likelihood of longer-term sobriety. Smokers in alcohol treatment or recovery face particular challenges regarding smoking cessation. Researchers and clinicians should take these circumstances into account when determining how best to treat these patients' tobacco dependence.

Full-text

Available from: Suzy Bird Gulliver, Apr 09, 2014
Smoking Cessation and
Alcohol Abstinence:
What Do the Data Tell Us?
Suzy Bird Gulliver, Ph.D.; Barbara W. Kamholz, Ph.D.; and Amy W. Helstrom, Ph.D.
S
UZY BIRD GULLIVER, PH.D., is out-
patient mental health site director at the
VA Boston Healthcare System, Brockton
Campus, Brockton, Massachusetts, and
associate professor in the Departments of
Psychiatry and Psychology at Boston
University, Boston, Massachusetts.
B
ARBARA W. KAMHOLZ, PH.D., is co-
director, VA Boston Healthcare System
Mood Disorders Clinic, Jamaica Plain,
Massachusetts, and assistant professor of
Psychiatry and Psychology at Boston Uni-
versity, Boston, Massachusetts.
A
MY W. HELSTROM, PH.D., is a clinical
psychologist at the VA Boston Healthcare
System and Research Associate at Boston
University, Boston, Massachusetts.
Cigarette smoking and nicotine dependence commonly co-occur with alcohol dependence. However,
treatment for tobacco dependence is not routinely included in alcohol treatment programs, largely
because of concerns that addressing both addictions concurrently would be too difficult for patients and
would adversely affect recovery from alcoholism. To the contrary, research shows that smoking
cessation does not disrupt alcohol abstinence and may actually enhance the likelihood of longer-term
sobriety. Smokers in alcohol treatment or recovery face particular challenges regarding smoking
cessation. Researchers and clinicians should take these circumstances into account when determining
how best to treat these patients’ tobacco dependence. K
EY WORDS: Alcohol and tobacco; alcohol,
tobacco, and other drug (ATOD) use, abuse, and dependence; alcohol and other drug (AOD) craving;
AOD use pattern; AOD abstinence; alcohol and tobacco; alcohol abuse; alcoholism; smoking; cigarette
smoking; nicotine; treatment program; co-treatment; treatment outcome; AOD abstinence; cue reactivity;
alcohol and other drug use disorders (AODD) relapse
C
igarette smoking and alcohol
dependence co-occur at high
rates. Research indicates that
approximately 80 percent of people
with alcoholism smoke cigarettes and
that most of these smokers are nicotine
dependent (Hughes 1996). Conversely,
smokers are at two to three times
greater risk for alcohol dependence
than nonsmokers (Breslau 1995).
Smoking Cessation and
Treatment for Alcoholism
Despite the fact that 60 to 75 percent
of patients in alcoholism treatment are
tobacco dependent and about 40 to 50
percent are heavy smokers (Hughes
1995), treatment for tobacco depen-
dence is not routinely included in
alcohol treatment programs. Smoking
cessation treatment (as well as bans
on smoking) during the course of treat-
ment for alcohol dependence has been
avoided largely out of concern that
concurrently addressing both addic-
tions (or restricting smoking during
treatment for alcoholism) poses too
great a difficulty for the patient and
would adversely affect recovery from
alcoholism. Such concerns are apparent
both in the United States and around
the world (e.g., Walsh et al. 2005;
Zullino et al. 2003). Myths surround-
ing concurrent treatment for smoking
and alcoholism also include the ideas
that smoking is a benign problem rela-
tive to alcoholism, that patients with
comorbid alcoholism have either no
interest or no ability to quit smoking,
and that patients will relapse to alcohol
if they quit smoking. This article
summarizes the scientific findings
that address these issues and provides
evidence-based responses to common
concerns about smoking cessation dur-
ing alcoholism treatment.
Myth: Smoking is more benign than
alcoholism. The shor
t-term effects of
alcoholism may appear more dangerous
Alcohol Research & Health 208
Page 1
Smoking Cessation and Alcohol Abstinence
than those of cigarette smoking.
However, mortality statistics suggest that
more people with alcoholism die from
smoking-related diseases than from alco-
hol-related diseases (Hurt et al. 1996). In
addition, the greater prevalence of smok-
ing in alcohol-dependent versus other
populations exacerbates health risks
(Bien and Burge 1990; York and Hirsch
1995). Researchers have demonstrated
synergistic carcinogenic effects for dual
substance dependence. For example, the
relative risk of laryngeal cancer has been
estimated at 2.1 in heavy smokers, 2.2 in
heavy drinkers, and 8.1 in people who
are both heavy drinkers and heavy smok-
ers (Hinds et al. 1979).
Myth: Smokers with comorbid alco-
holism have either no interest or no
ability to quit smoking. It is interesting
to note that although addiction treatment
programs routinely address multiple
substances of addiction (e.g., alcohol,
marijuana, heroin, cocaine), tobacco is
frequently the sole excluded substance.
The scientific literature also frequently
describes treatment of multiple nonto-
bacco substances simultaneously, mak-
ing it difficult to evaluate the impact of
smoking cessation on alcoholism treat-
ment per se (cf. Prochaska et al. 2004).
Still, evidence contradicts the notion
that smokers with comorbid alcoholism
are not interested in quitting smoking
and that addictions need to be treated
one at a time (e.g., Kalman 1998).
Up to 80 percent of people in addiction
treatment are interested in quitting
smoking (cf. Prochaska et al. 2004).
Consistent with this, Flach and Diener
(2004) found that among dual users,
approximately 75 percent wanted to quit
both smoking and alcohol use (though
the desire to quit alcohol use was rated as
higher). Furthermore, many people
entering treatment for alcoholism are
willing to quit smoking (e.g., Saxon et al.
1997). In fact, one study found that 75
percent of substance-dependent inpa-
tients accepted concurrent tobacco treat-
ment (Seidner et al. 1996).
Inclusion of smoking as a target for
intervention does not appear to reduce
patients’ commitment to broader addic-
tion treatment. For example, incorpo-
rating smoking cessation treatment
into inpatient addiction treatment cen-
ters has not substantially reduced long-
term treatment completion (e.g., a
minimal drop from 75 to 70 percent at
one site) (Sharp et al. 2003). In addition,
Monti and colleagues (1995) found
that smoking rates actually decrease and
the motivation to quit smoking increases
following successful alcohol treatment.
Evidence suggests that a history of
alcohol use difficulties may not impede
a specific smoking cessation attempt,
though it does seem to reduce the likeli-
hood of quitting smoking during ones
lifetime (Hughes and Kalman 2005).
Research has yet to determine the
extent to which smokers with current
alcohol use difficulties are able to quit
smoking. Though early research has
suggested that quitting smoking would
be more difficult for these patients (e.g.,
Hughes 1996), the answer is now less
clear. The only two studies evaluating
this issue separate from other substances
of abuse and co-occurring psychiatric
disorders yielded mixed findings and
did not include more severe alcohol-
dependent individuals (cf. Hughes and
Kalman 2005). However, studies based
on smokers in substance abuse treat-
ment, and those in early recovery, sug-
gest that cigarette abstinence is possible,
though challenging (Martin et al. 1997;
Prochaska et al. 2004).
Myths and Data Related to Smoking Cessation
and Alcohol Abstinence
Myth: Smoking is more benign than alcoholism.
• More people with alcoholism die from smoking-related diseases
than from alcohol-related illness (Hurt et al. 1996).
Comorbid smoking and alcoholism result in synergistic exacerbation of
health risks (Bien and Burge 1990; York and Hirsch 1995; Hinds
et al. 1979).
Myth: Smokers with comorbid alcoholism have either
no interest or no ability to quit smoking.
The majority (up to 80 percent) of individuals in addiction treatment
are interested in quitting smoking (cf. Prochaska et al. 2004).
• Inclusion of smoking cessation treatment into other addiction pro-
grams does not negatively affect rates of treatment completion or
motivation for abstinence (Sharp et al. 2003; Monti et al.1995).
Alcoholism does not seem to impede specific attempts at quitting
smoking (Hughes and Kalman 2005).
Alcoholism may make lifetime cigarette abstinence more challenging,
but it remains possible (Martin et al. 1997; Prochaska et al. 2004).
Myth: Smoking cessation will impede successful alcohol use outcomes.
The majority of research indicates that smoking cessation is unlikely
to compromise alcohol use outcomes (cf. Fogg and Borody 2001).
• Participation in smoking cessation efforts while engaged in other
substance abuse treatment has been associated with a 25 percent
greater likelihood of long-term abstinence from alcohol and other
drugs (Prochaska et al. 2004).
Data indirectly suggest that continued smoking increases the risk of
alcohol relapse among alcohol-dependent smokers (Taylor et al. 2000).
Vol. 29, No. 3, 2006 209
Page 2
Myth: Smoking cessation will impede
successful alcohol use outcomes. Perhaps
most important is the concern among
treatment providers (and patients) that
patients must choose between abstinence
from cigarettes and abstinence from
alcohol. In contrast to this concern,
research suggests that treating tobacco
dependence within broader addiction
programs does not adversely influence
recovery from alcoholism (or illicit sub-
stances). Although not universal (e.g.,
Joseph et al. 2004), the majority of
findings indicate that smoking cessation
efforts and smoking abstinence are
unlikely to negatively influence alcohol
use outcomes (cf. Fogg and Borody
2001). In a recent meta-analysis,
Prochaska and colleagues (2004) evalu-
ated the outcomes of smoking cessation
interventions in 19 randomized con-
trolled trials with people in addiction
treatment or recovery. At the end of
treatment, no differences in substance
use outcomes were found between
patients who engaged in smoking cessa-
tion treatment and those who did not.
Looking at long-term abstinence from
substances, an even more important
finding emerged. That is, at long-term
follow-up, participation in a smoking
cessation intervention provided during
substance abuse treatment was associ-
ated with a 25 percent greater likelihood
of long-term abstinence from alcohol
and other drugs. Consistent with these
findings, data suggest that 1 year after
treatment, smokers who participated in
a substance abuse treatment program
and initiated smoking cessation on their
own were less likely to be diagnosed as
alcohol dependent and had more days
abstinent from alcohol and other sub-
stances than those who started or contin-
ued smoking during the follow-up
period (Kohn et al. 2003). Thus, empir-
ical evidence suggests that smoking ces-
sation efforts may result in improved
alcohol-related outcomes (even if those
efforts do not yield substantial smoking
abstinence).
The mechanisms of action responsi-
ble for the potential benefits of smok-
ing cessation interventions provided
during alcoholism treatment remain
largely unexplored. However, possible
explanatory factors may include greater
clinical contact time, reduced exposure
to substance use cues, relapse prevention
and/or coping skills practice, increased
mastery or self-efficacy, and broader
healthy lifestyle choices (Prochaska et
al. 2004). Self-initiated efforts to reduce
smoking also may reflect increased patient
motivation or lower levels of nicotine
dependence (Karam-Hage et al. 2005).
Alcohol-dependent patients who
quit smoking while in recovery from
alcohol problems also do so without
negative consequences to their alcohol
or drug abstinence (Bien and Burge
1990; Bobo 1989; Hurt et al. 1993;
Irving et al. 1994; Joseph et al. 2003;
Sobell et al. 1990; Sullivan and Covey
2002). Data suggest that among alcohol-
dependent smokers in early recovery,
nicotine deprivation is not associated
with an increased urge to drink. In
addition, among people with signifi-
cant alcohol abstinence, evidence sug-
gests that smoking cessation does not
increase the likelihood of relapse to
alcohol use or increase alcohol-related
cravings (Hughes et al. 2003). Data
from Project MATCH, the largest alco-
holism clinical trial published to date,
indicates that alcohol-dependent smok-
ers can quit smoking cigarettes without
putting their sobriety at risk. In fact,
those who quit smoking during their
participation in Project MATCH drank
less than those who did not quit smoking
and significantly reduced their alcohol
intake for the 6 months after quitting
smoking (Friend and Pagano 2005).
Similarly, Karam-Hage and colleagues
(2005) studied smokers in alcohol
treatment and found that participants
who quit smoking on their own were
more likely to report alcohol abstinence
at 1- and 6-months’ followup than
participants who did not quit smoking
(though this may be a function of
lower levels of nicotine dependence).
Not only does the preponderance of
evidence suggest that smoking cessation
does not compromise alcohol abstinence,
but multiple studies indirectly suggest
that continued smoking may place
alcohol-dependent smokers at risk for
alcohol relapse (Taylor et al. 2000).
These data are consistent with laboratory
studies on cross-cue reactivity, which
suggest that nicotine dependence and
alcoholism may interact to increase
drinking risk. For example, alcohol
cues, such as the sight or smell of an
alcoholic beverage, can increase smok-
ing urges among smokers with alcohol
use disorders (e.g., Cooney et al. 2003;
Drobes 2002; Gulliver et al. 1995;
Rohsenow et al. 1997), and the degree
of nicotine dependence among alco-
holic smokers is positively related to
alcohol cue reactivity (Abrams and
Biener 1992). In addition, a study of
hazardous drinkers (i.e., those scoring 8
or above on the Alcohol Use Disorders
Identification Test [Babor et al. 1992])
found that 6 hours of nicotine depri-
vation was associated with increased
alcohol cravings during exposure to
smoking cues (e.g., cigarette lighter,
ashtray, pack of favorite cigarettes) as
well as increased alcohol consumption
during a taste test procedure (Palfai et
al. 2000). Alcohol cravings also were
increased during neutral cue exposure,
suggesting that stopping one drug of
abuse and not another may result in
cross-cue reactivity that places a person
in recovery at increased risk for relapse
(Bobo et al. 1998; Toneatto el al. 1995).
Challenges in Treating
Co-Occurring Smoking
and Alcoholism
Unfortunately, even with todays best
interventions for tobacco cessation,
smokers in alcohol treatment or recov-
ery face particular challenges to their
cessation efforts. On average, compared
with smokers who do not abuse sub-
stances, alcoholic smokers are more
addicted to nicotine, smoke higher
nicotine cigarettes, smoke more per
day, and score higher on nicotine
dependence measures and on carbon
monoxide assessment (Burling and
Burling 2003; York and Hirsch 1995).
Many smokers with alcoholism report
that they use smoking to cope with
their urges to use alcohol or other drugs
(Rohsenow et al. 2005), so alcohol-
dependent smokers may have stronger
views about the benefits of continued
tobacco use than do other smokers.
In addition, nicotine positively influ-
ences information processing among
Alcohol Research & Health 210
Page 3
Smoking Cessation and Alcohol Abstinence
alcoholics (i.e., nicotine use increases
the speed and accuracy of information
processing) (Ceballos et al. 2006),
which may decease motivation to
change. Thus, researchers and clini-
cians must take into account the char-
acteristics of tobacco dependence in
alcohol-dependent populations when
determining how best to treat these
patients’ tobacco dependence.
Summary
Despite concerns to the contrary, the
majority of empirical evidence indi-
cates that smoking cessation (whether
through formal treatment or self-initiated
change) does not pose a risk to success-
ful alcoholism treatment. Not only does
smoking cessation not disrupt alcohol
abstinence, it actually may enhance the
likelihood of longer-term sobriety.
Although research has yet to determine
the extent to which smoking cessation
is impeded by active alcohol use diffi-
culties, the presence of these difficulties
does not prohibit achievement of
tobacco abstinence. Given the substantial
negative health consequences of co-
occurring cigarette smoking and alco-
holism, smoking cessation efforts in the
context of treatment for alcoholism are
likely to yield important benefits to
patients physically, emotionally, socially,
and economically.
Acknowledgements
This work was supported by the fol-
lowing grants: DA016138 awarded to
Barbara W. Kamholz, Ph.D; 1R01–
AA013727 awarded to Domenic Ciraulo,
M.D.; 2R01–AA1164201A awarded to
Dena Davidson, Ph.D.; and the Veterans
Administration Research Enhancement
Award Program (REAP) awarded to
Ronald Goldstein, M.D.
Financial Disclosure
The authors declare that they have no
competing financial interests.
References
ABRAMS, D.B., AND BIENER, L. Motivational char-
acteristics of smokers at the workplace: A public
health challenge. Preventative Medicine 21:679–
687, 1992. PMID: 1438114
B
ABOR, T.F.; DE LA FUENTE, J.R.; SAUNDERS, J.; ET
AL. The alcohol use disorders identification test:
Guidelines for use in primary health care. Geneva:
World Health Organization, 1992.
B
IEN, T.H., AND BURGE, R. Smoking and drink-
ing: A review of the literature. International Journal
of the Addictions 25:1429–1454, 1990. PMID:
2094682
B
OBO, J.K. Nicotine dependence and alcoholism:
Epidemiology and treatment. Journal of
Psychoactive Drugs 21:323–329, 1989. PMID:
2681630
B
OBO, J.K.; MCILVAN, H.E.; LANDO, H.A.; ET AL.
Effect of smoking cessation counseling on recovery
from alcoholism: Findings from a randomized
community intervention trial. Addiction 93:877–
887, 1998. PMID: 9744123
B
RESLAU, N. Psychiatric comorbidity of smoking
and nicotine dependence. Behavior Genetics 25:95–
101, 1995. PMID: 7733862
B
URLING, A.S., AND BURLING, T.A. A comparison
of self-report measures of nicotine dependence
among male drug/alcohol-dependent cigarette
smokers. Nicotine and Tobacco Research 5:625–633,
2003. PMID: 14577979
C
EBALLOS, N.A.; TIVI, S.R.; LAWTON-CRADDOCK,
A.;
ET AL. Nicotine and cognitive efficiency in alco-
holics and illicit stimulant abusers: Implications of
smoking cessation for substance users in treatment.
Substance Use Misuse 41:265–281, 2006. PMID:
16467005
C
OONEY, J.L.; COONEY, N.L.; PILKEY, D.T.; ET AL.
Effects of nicotine deprivation on urges to drink
and smoke in alcoholic smokers. Addiction 98:913–
921, 2003. PMID: 12814497
D
ROBES, D.J. Cue reactivity in alcohol and tobacco
dependence. Alcoholism: Clinical and Experimental
Research 26:1928–929, 2002. PMID: 12500123
F
LACH, S.D., AND DIENER, A. Eliciting patients’
preferences for cigarette and alcohol cessation: An
application of conjoint analysis. Addictive Behaviors
29:791–799, 2004. PMID: 15135562
F
OGG, B., AND BORODY, J. The Impact of Facility
No Smoking Policies and the Promotion of Smoking
Cessation on Alcohol and Drug Rehabilitation Program
Outcomes: A Review of the Literature. Prepared for the
Canadian Centre on Substance Abuse, Addictions
Policy Working Group, September, 2001.
F
RIEND, K.B., AND PAGANO, M.E. Smoking cessa-
tion and alcohol consumption in individuals in
treatment for alcohol use disorders. Journal of
Addictive Diseases 24:61–75, 2005. PMID: 15784524
G
ULLIVER, S.B.; ROHSENOW, D.J.; COLBY, S.M.;
ET AL. Interrelationship of smoking and alcohol
dependence, use and urges to use. Journal of Studies
on Alcohol 56:202–206, 1995. PMID: 7760567
H
INDS, M.W.; THOMAS, D.B.; AND O’REILLY,
H.P. Asbestos, dental x-rays, tobacco and alcohol in
the epidemiology of laryngeal cancer. Cancer
44:114–1120, 1979. PMID: 476588
H
UGHES, J.R. Combining behavioral therapy and
pharmacotherapy for smoking cessation: An
update. NIDA Research Monograph 150:92–109,
1995. PMID: 8742774
H
UGHES, J.R. Treating smokers with current or
past alcohol dependence. American Journal of
Health Behavior 20:286–290, 1996.
H
UGHES, J.R.; NOVY, P.; HATSUKAMI, D.K.; ET AL.
Efficacy of nicotine patch in smokers with a history
of alcoholism. Alcoholism: Clinical and Experimen-
tal Research 27:946–954, 2003. PMID: 12824815
H
UGHES, J.R., AND KALMAN, D. Do smokers with
alcohol problems have more difficulty quitting?
Drug and Alcohol Dependence 82:91–102, 2005.
PMID: 16188401
H
URT, R.D.; EBERMAN, K.M.; SLADE, J.D.; ET AL.
Treating nicotine dependence in patients with
other addictive disorders. Nicotine Addiction:
Principles and Management. Orleans, C.T.; and
Slade, J.D., eds. New York: Oxford University
Press, 1993, pp. 310–326.
H
URT, R.D.; OFFORD, K.P.; CROGHAN, I.T.; ET
AL
. Mortality following inpatient addictions treat-
ment. Journal of the American Medical Association:
JAMA 275:1097–1103, 1996. PMID: 8601929
I
RVING, L.M.; SEIDNER, A.L.; BURLING, T.L.; ET
AL
. Drug and alcohol abuse inpatients’ attitudes
about smoking cessation. Journal of Substance Abuse
6:267–278, 1994. PMID: 7703704
J
OSEPH, A.M.; NELSON, D.B.; NUGENT, S.M.; ET
AL
. Timing of alcohol and smoking cessation
(TASC): Smoking among substance use patients
screened and enrolled in a clinical trial. Journal of
Addictive Diseases 22:87–107, 2003. PMID: 14723480
J
OSEPH, A.M.; WILLENBRING, M.L.; NUGENT,
S.M.;
ET AL. A randomized trial of concurrent ver-
sus delayed smoking intervention for patients in
alcohol dependence treatment. Journal of Studies on
Alcohol 65:681–691, 2004. PMID: 15700504
K
ALMAN, D. Smoking cessation treatment for sub-
stance misusers in early recovery: A review of the
literature and recommendations for practice.
Substance Use and Misuse 33:2021–2047, 1998.
PMID: 9744841
K
ARAM-HAGE, M.; POMERLEAU, C.S.; POMERLEAU,
O.F.;
ET AL. Unaided smoking cessation among
smokers in treatment for alcohol dependence.
Addictive Behaviors 30:1247–1253, 2005. PMID:
15925134
K
OHN, C.S.; TSOH, J.Y.; AND WEISNER, C.M.
Changes in smoking status among substance
abusers: Baseline characteristics and abstinence
from alcohol and drugs at 12-month follow-up.
Drug and Alcohol Dependence 69:61–71, 2003.
PMID: 12536067
Vol. 29, No. 3, 2006 211
Page 4
9103749
M
ARTIN, J.E.; CALFAS, K.J.; PATTEN, C.A.; ET AL.
Prospective evaluation of three smoking interven-
tions in 205 recovering alcoholics: One-year results
of Project SCRAP–Tobacco. Journal of Consulting
and Clinical Psychology 65:190–194, 1997. PMID:
M
ONTI, P.M.; GULLIVER, S.B.; AND MYERS, M.G.
Social skills training for alcoholics: Assessment and
treatment. Alcohol and Alcoholism 29:627–637,
1994. PMID: 7695776
P
ALFAI, T.P.; MONTI, P.M.; OSTAFIN, B.; ET AL.
Effects of nicotine deprivation on alcohol-related
information processing and drinking behavior.
Journal of Abnormal Psychology 109:96–105, 2000.
PMID: 10740940
P
ROCHASKA, J.L.; DELUCCHI, K.; AND HALL, S.M.
A meta-analysis of smoking cessation interventions
with individuals in substance abuse treatment or
recovery. Journal of Consulting and Clinical
Psychology 72:1144–1156, 2004. PMID: 15612860
R
OHSENOW, D.J.; MONTI, P.M.; COLBY, S.M.; ET
AL
. Effects of alcohol cues on smoking urges and
topography among alcoholic men. Alcoholism:
Clinical and Experimental Research 21:101–107,
1997. PMID: 9046380
R
OHSENOW, D.J.; COLBY, S.M.; MARTIN, R.A.; ET
AL
. Nicotine and other substance interaction
expectancies questionnaire: Relationship of
expectancies to substance use. Addictive Behaviors
30:629–641, 2005. PMID: 15833569
S
AXON, A.J.; MCGUFFIN, R.; AND WALKER, R.D.
An open trial of transdermal nicotine replacement
therapy for smoking cessation among alcohol- and
drug-dependent inpatients. Journal of Substance
Abuse Treatment 14:333–337, 1997. PMID:
9368209
S
EIDNER, A.L.; BURLING, T.A.; GAITHER, D.E.; ET
AL
. Substance-dependent inpatients who accept
smoking treatment. Journal of Substance Abuse
8:33–44, 1996. PMID: 8743767
S
HARP, J.R.; SCHWARTZ, S.; NIGHTINGALE, T.; ET
AL
. Targeting nicotine addiction in a substance
abuse program. Science Practice and Perspectives
2:33–40, 2003.
S
OBEL, L.C.; SOBEL, M.B.; KOZLOWSKI, L.T.; ET
AL
. Alcohol or tobacco research versus alcohol and
tobacco research. British Journal of Addiction 85:
263–269, 1990. PMID: 2180509
S
ULLIVAN, M.A.; AND COVEY, L. S. Current per-
spectives on smoking cessation among substance
abusers. Current Psychiatry Report 4:388–396,
2002. PMID: 12230968
T
AYLOR, B.J.; GRAHAM, J.W.; CUMSILLE, P.; ET AL.
Modeling prevention program effects on growth in
substance use: Analysis of five years of data from
the Adolescent Alcohol Prevention Trial.
Prevention Science 1:183–197, 2000. PMID:
11523747
T
ONEATTO, A.; SOBELL, L.C.; SOBELL, M.B.; ET AL.
Effect of cigarette smoking on alcohol treatment
outcome. Journal of Substance Abuse 7:245–252,
1995. PMID: 7580233
W
ALSH, R.A.; BOWMAN, J.A.; TZELEPIS, F.; ET AL.
Smoking cessation interventions in Australian drug
treatment agencies: A national survey of attitudes
and practices. Drug and Alcohol Review 24:235–
244, 2005. PMID: 16096127
Y
ORK, J.L., AND HIRSCH, J.A. Drinking patterns
and health status in smoking and nonsmoking
alcoholics. Alcoholism: Clinical and Experimental
Research 19:666–673, 1995. PMID: 7573791
Z
ULLINO, D.F.; BESSON, J.; FAVRAT, B.; ET AL.
Acceptance of an intended smoking ban on an
alcohol dependence clinic. European Psychiatry
18:255– 257, 2003. PMID: 12927327
Alcohol Research & Health 212
Page 5
  • Source
    • "Chronic ethanol consumption is associated with cardiovascular dysfunctions independent of other known risk factors (Katia Colombo Marchi et al., 2014). Regular use of ethanol is associated with inadequate control of blood pressure in treating hypertensive patients (Gulliver SB et al., 2006; De Biasi M and Salas R, 2008). Epidemiological and clinical studies have established a positive relationship between long-term ingestion of ethanol leads to development of hypertension (Malhi H et al., 2010), brain ischemia, and stroke (Nagata K et al., 2007; Deaciuc IV et al., 2001; Dey A, Cederbaum AI, 2006 ). "
    [Show description] [Hide description] DESCRIPTION: Pharmacological research has shown that chronic alcohol consumption has a serious effects on hepatic enzymes as evidenced on a Wister rat liver.
    Full-text · Research · Jul 2015
  • Source
    • "This would imply that the beneficial effect of drinking cessation is higher among smokers than nonsmokers . The other side of this issue is that drinking cessation has a tendency to lead to smoking cessation [33]. As the current dose-risk estimation was based on summarised data, it was not possible to account for either of these issues in the current study. "
    [Show abstract] [Hide abstract] ABSTRACT: In the Bagnardi et al. (2001) meta-analysis, it was found that alcohol consumption increases the risk of stomach cancer (OR = 1.32 for heavy drinkers). However, it is unknown if drinking cessation reverses this alcohol-elevated risk. A systematic literature review was performed to provide the information for a meta-analysis where the dose-risk trend was estimated for years since drinking cessation and the risk of stomach cancer. A random effect generalised least squares model for trend estimation was used, employing study characteristics to control for heterogeneity. Nineteen observational studies were identified in the literature review, of which five studies quantified duration of cessation and risk of stomach cancer, giving a total of 1947 cancer cases. No significant effect of drinking cessation on the risk of stomach cancer could be found (OR = 0.99 CI: 0.97-1.02). This result should be interpreted with caution due to the limited number of studies in this area. Recent findings suggest a link between heavy drinking and stomach cancer, especially gastric noncardia, but not for moderate drinking. Since all but one of the included studies in this meta-analysis failed to control for consumption level, the current study could not test if the risk decline following drinking cessation differs between moderate and high consumers.
    Full-text · Article · Jun 2013 · BMC Public Health
  • Source
    • "A significant part of this heterogeneity was explained by two studies, both of which were published before 2000 [27,28]; one did not control for smoking [28], and the other did not use matching between cases and controls [27]. It has previously been shown that there is an interaction effect between smoking and alcohol consumption in two forms: a multiplicative risk increase [31], and a higher chance of quitting smoking after drinking cessation [32]. Hence, if a study does not control for smoking, the alcohol cessation coefficient will include the interaction effect and the slope is likely to be steeper compared to studies that control for smoking; our results showed that this was indeed the case. "
    [Show abstract] [Hide abstract] ABSTRACT: To evaluate the effect of alcohol cessation on the risk of developing laryngeal and pharyngeal cancers, combining available evidence in the scientific literature in a meta-analysis. A systematic literature review was conducted, and a meta-analysis was applied on the retrieved studies. The generalised least squares method was used to estimate the trend from dose-response data to assess changes in the risks of laryngeal and pharyngeal cancers after drinking cessation. A total of 9 case-control studies were included in the meta-analysis (4 and 8 estimates for laryngeal and pharyngeal cancers, respectively). On average, alcohol drinking cessation was associated with a 2% yearly reduction in the risk of developing laryngeal and pharyngeal cancers. There was a considerable heterogeneity between the studies of pharyngeal cancer, but this was mostly due to two studies. The increased risk of laryngeal and pharyngeal cancers caused by alcohol was reversible; the time periods until the risks became equal to those of never drinkers were 36 (95% CI 11-106) and 39 (95% CI 13-103) years, respectively. Moreover, 5 years of drinking cessation was associated with a reduction of around 15% in the alcohol-related elevated risk of laryngeal and pharyngeal cancers. Although a long time period is required to completely eliminate the alcohol-related elevated risk of laryngeal and pharyngeal cancers, a substantial risk reduction can be seen in the short term (5-10 years), and drinking cessation should therefore be encouraged to reduce the incidence of these cancers.
    Full-text · Article · Mar 2013 · PLoS ONE
Show more