Alcohol magnifies the rewarding effects of smoking / NC&T/UC

(NC&T/UC) "Data from epidemiological studies have shown that people who drink alcohol are more likely to smoke, and the heavier the drinking pattern, the heavier the smoking," said Andrea C. King, a psychologist and associate professor in the department of psychiatry at the University of Chicago, and first author of the study.

"Prior to our study, research examining alcohol's effects on smoking urge included direct smoking 'cues,' such as having smokers hold a cigarette or view smoking images. However, these cues can exert their own effects on cigarette craving. We wanted to know about the direct effects of alcohol on smoking urges throughout the blood alcohol curve."

In addition, most studies that have examined associations between alcohol and smoking have looked at heavier smoking samples, people who smoke 10 or more cigarettes per day. "In contrast," said Jed E. Rose, director of the Center for Nicotine and Smoking Cessation Research at Duke University Medical Center, "by examining light smokers, the role of nicotine withdrawal symptoms is presumably minimized."

"Tobacco withdrawal effects could affect smoking urge ratings over the blood alcohol curve," said King. "We chose to test people who smoke just half a pack or less per day to see if alcohol would increase smoking urges. We also wanted to see if their desire to smoke while they drink is related to the amount of alcohol they consume during a drinking episode."

Researchers recruited 16 (11 males, 5 females) non-alcoholic, heavy social drinkers with light smoking backgrounds through local advertisements. Each participant was tested individually in three separate sessions where he or she received a placebo (with an alcohol taste), a low-dose (0.4 g/kg), or a high-dose (0.8 g/kg) alcoholic beverage in random order. Subjects were not allowed to smoke two hours prior to and during each session. A questionnaire was used to assess urge to smoke for both positive and negative reinforcing effects, and was given at baseline and during rising and declining portions of the blood alcohol curve (BAC).

Results support an alcohol dose-dependent increase in smoking urge in cigarette-deprived light smokers.

"Smoking urge ratings were higher after consuming four versus two alcohol drinks, and increases were not observed after consuming a placebo beverage," said King. "These findings were observed in a nonsmoking environment, which may indicate that alcohol directly produced these effects and they were not due to direct smoking cues triggering cigarette craving. In other words," she added, "the greater the alcohol consumption, the greater the urge to smoke."

Smoking urge increases occurred during the rising limb of the BAC and were maintained throughout the declining limb.

"One theory for why some people smoke when they drink is that nicotine may offset the sedative effects of alcohol," said King. "However, we showed that the desire to smoke sharply increased within a half hour after drinking, which is when alcohol's stimulant-like as opposed to sedative-like effects are usually observed. It also appears that smoking urges may increase rapidly after a person engages in binge drinking, that is, consuming four or more drinks relatively quickly. These urges remained elevated even when BACs were declining, so a person may be at increased risk for wanting to smoke for hours after drinking alcohol."

The researchers also found that smoking urges were greater for positive mood and stimulation (for example, "a cigarette would taste good now") than for relief from negative mood and/or withdrawal (for example, "smoking would make me feel less depressed").

"This finding implies that the main mechanism by which alcohol increases craving may be related to the immediate, positively reinforcing effects of nicotine," said Rose, "rather than the relief of a negative mood or other withdrawal symptoms."

Furthermore, the findings appear to indicate that alcohol drinking can trigger a desire to smoke even in a nonsmoking environment.

"Future studies may help us understand this association on a biological level," said King. "For people who are initially trying to quit smoking, it would be advised that they either abstain from drinking altogether, or drink only one or two drinks per occasion over a slow time course in order to avoid sharp rises in cigarette craving, which may increase their risk for smoking relapse."

Rose suggested that animal studies could measure the effects of alcohol on dopamine release or other effects of nicotine thought to mediate reinforcement. "Human studies might seek to examine whether nicotine replacement products that help people quit smoking are subject to the same interactions with alcohol," he added.

King and her colleagues next plan to examine what she calls "chipper" smokers, that is, nondependent smokers who smoke even less than the sample in this study. "These 'chippers' may only smoke when they drink or only smoke a few cigarettes a day," she said. "We will be examining their cigarette cravings after alcohol drinking compared to more frequent, regular smokers. We will also look at responses in men versus women, to see if gender differences exist. Finally, we have plans this year to study actual smoking behavior over the course of the BAC. We will be examining how alcohol affects preference for nicotine-containing versus non-nicotine containing cigarettes."

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