Concurrent Alcohol and Tobacco Dependence
January 04, 2005
While smoking prevalence in the United States varies somewhere between 15 to 30% of the population by state, the co-occurance of alcohol and nicotine dependence runs 80 - 90%.
Historically, alcohol treatment programs have not treated nicotine dependence for a whole bunch of reasons. However, now days we are learning that treatment outcomes are enhanced for alcoholism treatment if nicotine dependence is treated at the same time.
Dr. David Drobes from the University of South Florida has written an interesting article which is posted on the National Institute on Alcohol Abuse and Alcoholism web site entitled, "Concurrent Alcohol and Tobacco Dependence: Mechanisms and Treatment".
In his article Dr. Drobes gives an overview of genetic and neurobiological mechanisms as well as conditioning mechanisms and psychosocial factors.
Dr. Drobes then turns to the treatment of smoking in alcoholics and states that for people addicted to both alcohol and nicotine outcomes are worse than people addicted to only one of the drugs. He also points out if patients are successfully treated for both drugs, relapse to smoking is a risk factor for relapse to alcohol.
Dr. Drobes points out the reasons to support concurrent treatment for both nicotine dependence and alcoholism.
"Despite longstanding fears from treatment providers that smoking cessation would interfere with alcoholism treatment, there are several reasons to anticipate that combined treatment for both addictions may lead to more favorable outcomes for both drugs. First, at a neurobiological level, alcohol and nicotine act, at least in part, on the same brain pathways involved in reward and craving. Therefore, it may be advantageous to cease using both drugs to reverse the effects on these pathways. One important caveat here is that nicotine appears to serve an acute protective function concerning certain neurotoxic effects of alcohol withdrawal. Therefore, extreme caution must be exercised in determining the optimal sequence of drug removal for patients desiring treatment for both addictions. Second, as discussed above, continued smoking or alcohol use may elicit or exacerbate craving for the other drug. Third, behavioral treatments based on coping–skill attainment may be more effective when developing skills are generalized to both types of addictive behavior. For instance, people may be able to obtain more practice at using coping skills if they apply them to both alcohol consumption and smoking. And fourth, a treatment approach that encourages an overall milieu of healthy lifestyle changes would be more generally consistent with abstinence from both drugs.
Another reason to support concurrent treatment for smoking and alcoholism is that more alcoholics will die from smoking–related illnesses than from alcohol–related causes (e.g., Hurt et al. 1996). The numerous problems associated with smoking are well documented, and most alcoholics entering treatment are aware of these problems and appear quite willing to receive concurrent smoking cessation treatment (e.g., Saxon et al. 1997). Even without formal smoking cessation treatment, smoking rates appear to decrease and the motivation to quit smoking increases following successful alcoholism treatment (e.g., Monti et al. 1995). Researchers have begun to evaluate the effectiveness of explicit smoking cessation attempts during alcoholism treatment as well as the impact of such attempts on the outcome of the alcoholism treatment (e.g., Martin et al. 1997). Findings to date generally do not confirm the traditional notion that only one addiction should be treated at a given time. It is still too early to tell what treatment configuration will be most effective for smoking alcoholics."
When we look at mortality rates it is clear that nicotine dependence is America's largest and most deadly drug problem. 30,000 Americans die every year from street drugs, 100,000 Americans die from alcoholism, and 430,000 Americans die from tobacco. How can responsible substance abuse professionals ignore the treatment of co-occuring nicotine dependence any longer?
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