Alcohol and Tobacco

Extensive research supports the popular observation that "smokers drink and drinkers smoke." Moreover, the heaviest alcohol consumers are also the heaviest consumers of tobacco. Concurrent use of these drugs poses a significant public health threat. A survey of persons treated for alcoholism and other drug addictions revealed that 222 of 845 subjects had died over a 12-year period; one-third of these deaths were attributed to alcohol-related causes, and one-half were related to smoking (1). This Alcohol Alert explores the association between alcohol and tobacco use, possible mechanisms of their combined health effects, and some implications for alcoholism treatment.

The Co-Occurrence of Alcoholism and Smoking

Between 80 and 95 percent of alcoholics smoke cigarettes (2), a rate that is three times higher than among the population as a whole. Approximately 70 percent of alcoholics are heavy smokers (i.e., smoke more than one pack of cigarettes per day), compared with 10 percent of the general population (3). Drinking influences smoking more than smoking influences drinking. Nevertheless, smokers are 1.32 times as likely to consume alcohol as are nonsmokers (4).

Most adult users of alcohol or tobacco first tried these drugs during their early teens (5). Among smoking alcoholics, the initiation of regular cigarette smoking typically precedes the onset of alcoholism by many years, although data are inconsistent (6). Adolescents who begin smoking are 3 times more likely to begin using alcohol (7), and smokers are 10 times more likely to develop alcoholism than are nonsmokers (6).