The effects of alcohol on smoking cessation

Jonathan Foulds has two posts (here and here) on the relationship between drinking and alcohol consumption:

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.