Smoking and drinking: Statistics show that people who have one addiction often have the other.
Many alcoholics who have stopped drinking hesitate to tackle their smoking habit, believing the added stress could hurt their chances of staying sober.
A University of Vermont psychiatrist, however, believes that people who give up smoking could improve the chances of fighting their alcoholism.
"It's a myth that stopping (smoking) will make you relapse," said Dr. John Hughes, a professor at University of Vermont's College of Medicine who has been studying smokers and their efforts to quit for 20 years. "We've got the scientific evidence that shows this is not true."
For a study funded by the National Institute of Alcohol and Alcohol Abuse, Hughes is recruiting volunteers from the Burlington area who have successfully battled alcoholism and now want freedom from smoking. He hopes his research will uncover new ways of helping recovering alcoholics give up cigarettes, too.
Studies show people who smoke are more likely to have drinking problems, Hughes said. In the population at large, the likelihood is 7 percent. Among people who have never smoked, it's .2 percent. For heavy smokers, the probability is 18 percent.
Nobody knows why drinking and smoking so frequently go together, but most doctors agree they do.
"Almost all alcoholics are smokers," said Dr. Neil Benowitz, an internal medicine professor at the University of California in San Francisco who has studied nicotine addiction. "But there's been very little systematic research of how to treat someone who has both diagnoses."
Alcohol is a depressant and smoking is a stimulant; one might be used to balance the effects of the other, Hughes said. Studies on animals show smoking can mitigate some of drinking's negative effects, like nausea or sedation.
"So smoking may allow people to drink more," Hughes said.
With his study, which is being carried out concurrently at the University of Minnesota at
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Minneapolis, Hughes hopes to replicate findings that he stumbled upon during earlier research on nicotine substitutes.
In that study, some subjects were given a nicotine patch and some were given a placebo. The patch helped both drinkers and nondrinkers to quit smoking more than the placebo did. What interested Hughes was the placebo's effect: None of the recovering alcoholics given the placebo managed to quit smoking.
"They found that smokers that did have a history of alcohol dependency were much more dependent on nicotine," Hughes said of that study. But the stress of quitting smoking didn't necessarily harm their sobriety; "none went back to drinking," he said.
In the current study, 75 recovering alcoholics will receive group behavior therapy and counseling to help them quit smoking. Then the earlier study will be repeated: Half the group will receive a nicotine substitute, and half a placebo.
"Now we want to know: Do they have more physical withdrawal symptoms?" Hughes said. The study will also shed more light on whether quitting smoking does threaten sobriety. Hughes thinks giving up cigarettes might actually help recovering alcoholics stay sober. "When people stop drinking or stop smoking, many times it's part of an overall life change," he said.
Research on the connections between nicotine and alcoholics is badly needed, said Dr. Jack Henningfield, a researcher in drug addiction at the National Institutes of Health.
"The sad thing is that this population just hasn't been studied much," Henningfield said. "That's sad because the chances are a lot of those people may kick their so-called primary drug and die a miserable tobacco-related death."
Vermont funds cocaine and alcohol abuse hotlines and helps support treatment programs for many different types of addictions. But there is no state support for fighting smoking, Hughes said, because tobacco doesn't appear as dangerous to society as other drugs. But it should, he said.
"These (smokers) who have worked all their lives … when it's time for retirement, they come down with heart attack or emphysema," Hughes said. "That's the tragic part."
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Exercise 9.3
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2007 McGraw-Hill Higher Education