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Smoking and Drinking: A Deadly Combination

Smoking and drinking are seen by many as complimentary: two habits that go hand in hand. while people who smoke are more likely to drink and vice-versa, this definitely isn’t a good idea. smoking is dangerous, drinking is dangerous, and doing both is even worse..

Around 8.5 million people die each year as a result of alcohol and tobacco, according to the World Health Organization . Both alcohol and cigarettes represent serious risks to public health, but for many users, there is an unavoidable sense that these two habits are linked, or even complement each other. This perception may be based on a grain of truth, but smoking and drinking in combination are more likely to kill you than either one individually, but there is evidence that smokers drink more than non-smokers and vice-versa. Finding out more about the link between smoking and drinking shows why it’s a combination we should take seriously.

The Link Between Smoking and Drinking

People who both smoke and drink often say that they two habits complement each other, and feel more like smoking when they have an alcoholic drink and vice-versa. This perception is supported by studies – for example, a study looking at the socio-cultural influences on smoking and drinking found that 36.9 % of adults who were current drinkers were also current smokers, compared to just 17.5 % of never-smokers. This study used data from 1997, and it’s worth noting that more recent polls have shown less of a difference between smoking rates between drinkers and non-drinkers, though drinkers were still more likely to smoke.

This may leave you wondering why smoking and drinking appear to be so closely related. Although there isn’t a definite answer on this yet, research does suggest that nicotine enhances the pleasurable effects of alcohol, and this has been confirmed in research. Another important factor is that nicotine and alcohol work on the same brain systems, which may mean they interact when taken together. Finally, the same genes may be responsible for predisposition to both smoking and drinking, so this could make it more likely for a drinker to smoke and vice-versa.

The Health Risks of Smoking

The health risks of smoking are so well-known that they scarcely even need to be repeated. Smoking causes lung cancer, heart disease, stroke, COPD, many other cancers and a multitude of health problems. It’s been called the leading preventable cause of death in the world.

The Health Risks of Drinking

Although drinking is much more socially accepted that smoking, it too carries serious health risks. Drinking heavily is known to cause mouth, throat and breast cancer, stroke, brain damage, heart disease and liver disease. While low-risk drinkers drastically reduce their risk of developing such health problems as a result of their drinking, no level of alcohol consumption can be considered safe.

The Risks of Smoking and Drinking

With plenty of risks associated with the individual substances, the fact that combining alcohol and tobacco creates even bigger risk shouldn’t come as much of a surprise. However, since these conditions have many risk factors (things which increase your risk of developing them), it can be difficult to estimate what the effect of combining smoking and drinking will be.

One area where there is solid evidence is for mouth and throat cancers. Both smoking and drinking increase the risks of these conditions, and studies show that people who do both are much more likely to get mouth cancer. Even worse, the risk of mouth cancer from smoking multiplies the existing risk from drinking, rather than just adding to it.

Other conditions – like cardiovascular disease and liver cancer – are both affected by alcohol and tobacco, but it’s unclear whether the risk is bigger than the risks from drinking and smoking added together. For liver cancer, there is some suggestion that the combined effect is worse than the sum of the individual parts, but for cardiovascular disease there doesn’t seem to be such “synergistic” effects.

Overall, research has shown that people who both smoke and drink increase their risk of all-cause death more than non-smokers and non-drinkers, or people who drink or smoke without doing the other.

Staying Safe: Reducing Your Risks From Smoking and Drinking

The risks of smoking and drinking are serious, especially if you combine the two habits. This is why reducing your risk is essential, and the best approach is to quit one or (ideally) both habits, or at very least cut back or switch to less harmful alternatives.

Quitting smoking is the more crucial goal, particularly if you aren’t a heavy drinker. There are many approaches to quitting, including alternative nicotine products like patches, gums, inhalers, smokeless tobacco or e-cigarettes, and medications such as Chantix. If you want to maximize your chances of quitting smoking, combining one of these strategies with behavioral counseling gives you the best chance.

Although there may be more of a social expectation that you will drink alcohol at some social gatherings, stopping drinking or cutting down is still important to minimize your health risks. If you can’t or don’t want to stop drinking entirely, simple tips like drinking more slowly, alternating between alcoholic and non-alcoholic drinks and drinking with food can help you drink a lot less.

Overall, quitting smoking and drinking is the best thing you can do for your health, but if you can’t do either or both of these, minimizing the risks to your health should be the next big priority.

Home — Essay Samples — Nursing & Health — Alcohol Abuse — The Issue of Smoking and Alcohol Drinking Among Adolescents

The Issue of Smoking and Alcohol Drinking Among Adolescents

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The Effects of Smoking and Drinking on Cardiovascular Disease and Risk Factors

Kenneth j mukamal , m.d..

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Research on how tobacco and alcohol use interact to influence risk for cardiovascular disease is limited. Alcohol consumption of three or more drinks per day and cigarette smoking share similar, and probably additive, effects on some forms of cardiovascular disease. There is relatively little evidence, however, that the effects are worse when smoking and drinking occur together than would be expected from their independent effects. In most cases, moderate drinking does not share these risks and even has opposite effects of cigarette smoking on some risk factors. Ongoing public health efforts to minimize tobacco use and harmful drinking should result in clear and important gains to the nation’s cardiovascular well-being.

Keywords: Alcohol and tobacco, alcohol and other drug (AOD) consumption, smoking, tobacco in any form, comorbidity, risk factors, beneficial moderate alcohol consumption, risk and protective factors, cardiovascular disorder, stroke, coronary artery disorder, congestive heart failure, high blood pressure, hypertension, cholesterol, alcoholic cardiomyopathy

An extraordinary body of research has sought to understand the links between smoking cigarettes and drinking alcohol, and an equally substantial body of evidence has demonstrated their synergy in causing cancer, birth defects, and other medical problems. In contrast, there generally has been little evidence that they interact to influence cardiovascular disease. Indeed, one recent review found only a single article that identified a probable interaction between alcohol and tobacco on risk of heart disease resulting from narrowing of the arteries that supply blood and oxygen to the heart (i.e., coronary heart disease) ( Taylor and Rehm 2006 ). This article seeks to examine more broadly the ways that tobacco and alcohol may jointly affect risk of cardiovascular disease.

A Complicated Issue

Several factors complicate the interactions between tobacco and alcohol on cardiovascular disease. First, dose matters. The relationship between smoking and risk of cardiovascular disease is dose dependent—more tobacco leads to more disease. For alcohol consumption, however, the issue is more complex. Most evidence suggests that consumption in the range of 3 to 14 drinks per week is associated with lower risk of heart attack (i.e., myocardial infarction) and possibly of other forms of cardiovascular disease, such as blockage in an artery that supplies blood to the brain, resulting in a deficiency in blood flow (i.e., ischemic stroke) or failure of the heart to pump blood sufficiently throughout the body (i.e., congestive heart failure). However, intake of three or more drinks per day clearly increases the risk of ischemic stroke, and heavier drinking may well increase the risk of myocardial infarction.

Second, cardiovascular disease encompasses a variety of conditions with a diverse set of causes or origins. Smoking is clearly linked to a higher risk of nearly all forms of cardiovascular disease, including myocardial infarction, ischemic stroke and bleeding into the brain (i.e., hemorrhagic stroke), congestive heart failure, and narrowing of the arteries in the extremities (i.e., peripheral arterial disease) ( Burns 2003 ). The relationship between alcohol use and cardiovascular risk factors is not so clear. Moderate drinking has been associated with a consistently lower risk of myocardial infarction, but only a modestly lower risk of ischemic stroke, and a higher risk of hemorrhagic stroke. Simply combining all of these conditions together as “cardiovascular disease” will tend to blur these distinctions.

Third, even those types of cardiovascular disease directly linked to the gradual build-up of fatty deposits (i.e., plaques) in the arteries, such as myocardial infarction and stroke, represent acute events superimposed on the background process of the gradual narrowing and hardening of the arteries (i.e., atherosclerosis). Atherosclerosis itself is dynamic and involves cholesterol transport into and out of cells in the blood vessel wall, the entry of inflammatory cells, and abnormal function of the cells lining the vessel surface (i.e., endothelial cells). The final trigger in this pathway is often a blood clot that forms at the site of a plaque whose cap has ruptured, exposing the blood to irritants within the plaque. Tobacco and alcohol use may have chronic effects on several steps in the gradual atherosclerotic process and more acute effects on the formation of blood clots that often trigger actual clinical events.

Fourth, and perhaps most difficult to address, is the nature of the relationship between alcohol consumption and cigarette smoking and how it bears on our understanding of each. In both experimental and observational studies of alcohol consumption and cardiovascular disease, cigarette smoking is treated as a confounder or nuisance parameter. That is, researchers recognize that smoking is common among drinkers and that it is a strong risk factor for heart disease that could cloud the true effect of alcohol consumption. Investigators typically study the effect of alcohol independent of smoking, either by mathematical adjustment or by examining smokers and nonsmokers separately. This approach implicitly views smoking and drinking as shared consequences of specific lifestyle or behavior patterns and ignores the possibility that alcohol consumption itself makes individuals more likely to smoke cigarettes ( Shiffman and Balabanis 1995 ). If alcohol consumption itself leads to cigarette smoking to even some degree, then understanding the full effects of alcohol will require accounting for a difficult complexity—cigarette smoking among alcohol drinkers may be related both to shared lifestyle habits and to direct effects of alcohol. This complexity is equally important for studies of tobacco use, as they need to incorporate the possibility that smoking may lead to alcohol consumption ( Madden et al. 2000 ). This issue will challenge researchers for the foreseeable future.

An Important Public Health Issue

Potential relationships of alcohol use and smoking on cardiovascular disease are of great public health importance. The American Heart Association (2005) estimates that in 2003, over 71 million Americans had some form of cardiovascular disease, representing more than 34 percent of the United States population. In 2002, cardiovascular disease caused or contributed to more than 1.4 million deaths in the United States, representing about 58 percent of all mortality. Tobacco use is an important contributor to this burden. About 21 percent of adult Americans reported using tobacco in 2004. Although tobacco use rates generally have declined over the last 40 years, some 4,000 individuals become new regular smokers every day. Given that more than 85 percent of smokers drink alcohol, and that drinkers are 75 percent more likely to smoke than are abstainers, the public health ramifications of joint use of alcohol and tobacco may be substantial indeed.

Effects on Cardiovascular Risk Factors

Alcohol and tobacco use both have important effects on cardiovascular risk factors. Overall, the two generally do not affect the same risk factors in the same way, although levels of blood pressure and triglycerides (i.e., fats in the blood) may be important exceptions.

Proposed Qualitative Relationships of Light to Moderate or Heavier Alcohol Consumption (Relative to Abstention) and Cigarette Smoking to Cardiovascular Disease and Its Risk Factors

Alcohol consumption of three or more drinks per day clearly raises blood pressure, one of the most important cardiovascular risk factors ( Klatsky 1996 ). As a result, consumers of three to five drinks per day have a roughly 50 percent higher risk of high blood pressure (i.e., hypertension); risk increases even more with heavier intake. Lighter intake, however, has generally not been associated with blood pressure and, in a few studies, has actually been associated with a modestly lower risk of hypertension ( Thadhani et al. 2002 ). The relationship between smoking and blood pressure is less clear, in part because smokers tend to be leaner than nonsmokers. However, in some laboratory studies and well-controlled population studies, smoking appeared to raise blood pressure or risk of hypertension to a modest degree ( Niskanen et al. 2004 ).

There are similar relationships between alcohol and tobacco use and levels of triglycerides, a fat in the blood that has been linked to risk of coronary heart disease in some studies. Alcohol intake has long been known to increase triglyceride levels, apparently in a dose-dependent manner ( Rimm et al. 1999 ). Interestingly, many clinical trials of alcohol consumption have documented this increase in triglyceride levels, but it may pertain only to men. Some recent trials among women have surprisingly found that moderate consumption may reduce triglyceride levels ( Davies et al. 2002 ). Cigarette smoking also increases triglyceride levels, and studies of young adults have identified early use of alcohol and tobacco as key determinants of subsequent levels of serum triglycerides ( Croft et al. 1987 ).

The other fat (i.e., lipid) most closely associated with alcohol intake is high-density lipoprotein cholesterol (HDL-C), which increases with greater alcohol intake until fairly high levels of consumption. HDL-C is involved with reverse cholesterol transport, the process of returning cholesterol from the peripheral tissues back to the liver for disposal, and higher levels of HDL-C are very strongly related to lower risk of myocardial infarction. Given the connections of alcohol and HDL-C, it is thought that HDL-C accounts for about half of the apparent benefit of alcohol consumption on the risk of cardiovascular disease. Although alcohol intake is the lifestyle factor most closely correlated with HDL-C levels at a population level, smoking also is correlated with HDL-C but in the opposite direction ( Ellison et al. 2004 ).

Several other cardiovascular risk factors are affected by smoking and drinking, often in opposite ways. For example, alcohol consumption, both in moderation and at excessive levels, tends to inhibit the activity of platelets, the blood cells that form clots, and to reduce levels of fibrinogen, a blood protein involved in clotting. This blood “thinning” may explain why even moderate drinking can increase the risk of certain bleeding complications, such as hemorrhagic strokes, while lowering the risk of heart attacks and other diseases characterized by blood clots. In contrast, cigarette smoking activates platelets and renders them more likely to form clots. In a somewhat similar fashion, moderate drinking has been linked to lower levels, and heavier drinking to higher levels, of C-reactive protein (CRP) ( Imhof et al. 2001 ), a marker of inflammation in the body, whereas cigarette smoking consistently appears to increase CRP levels.

Effects on Risk of Cardiovascular Disease

As noted above, there are many types of cardiovascular disease. This section will review the effects of alcohol and tobacco use on three of the most common manifestations of clinical cardiovascular disease—coronary heart disease, stroke, and congestive heart failure.

Alcohol intake in the range of 3 to 14 drinks per week consistently has been associated with decreased risk of myocardial infarction in observational studies, both among men and women and in a variety of countries ( Corrao et al. 2000 ). In nearly all studies, this association has been similar among smokers and nonsmokers, suggesting that although smoking clearly increases coronary risk two- to four-fold ( American Heart Association 2005 ), alcohol acts similarly whether or not an individual smokes. Even the few studies that have identified apparent smoking-related differences in how alcohol use is associated with coronary heart disease do not agree on whether smokers or nonsmokers are most likely to demonstrate the lower coronary risk linked to moderate drinking. However, few of these population studies enrolled sufficient numbers of heavy drinkers to understand their risk of myocardial infarction with certainty or to examine how heavy drinking might interact with smoking. In addition, the magnitude of risk related to smoking is far larger than any ostensible benefit related to moderate drinking, so even those current smokers who drink moderately remain at high risk for myocardial infarction.

Another manifestation of coronary heart disease is angina, or chest pain related to an imbalance between oxygen need and oxygen delivery to the heart muscle, especially during exercise. Interestingly, heavy alcohol consumption acutely appears to worsen this imbalance and shortens the amount of time that a person can exercise before signs of oxygen deficiency (i.e., ischemia) occur ( Rossinen et al. 1996 ). Likewise, cigarette smoking acutely decreases blood flow and decreases the amount of time a person can exercise before the onset of angina ( Deanfield et al. 1986 ). Alcohol and cigarette smoking also have additive effects on heart rate and blood pressure ( Benowitz et al. 1986 ).

Stroke occurs when blood flow to the brain is acutely interrupted by local occlusion of blood vessels in the brain, dislocation of blood clots elsewhere that then lodge in the brain, or blood vessel rupture. Both regular alcohol intake of three or more drinks per day and cigarette smoking are strong, unequivocal risk factors for ischemic stroke (the most common type) ( Goldstein et al. 2006 ), although little evidence exists that the combination raises risk more than expected from their independent effects. In addition, intake of three or more drinks appears to raise the risk of stroke acutely for at least 24 hours afterward ( Hillbom et al. 1999 ). Even moderate drinking and cigarette smoking also increase the risk for hemorrhagic stroke, a very common type of stroke in Asia. Finally, light drinking has been associated with a lower risk of ischemic stroke than abstention in both men and women ( Reynolds et al. 2003 ), but even this association has undergone revision in recent years. Although older studies initially suggested lowered risk of ischemic stroke among moderate drinkers of a magnitude comparable to the association seen with myocardial infarction, more recent, better designed studies have established that consuming even one drink per day is not associated with lower risk and that intake of one to six drinks per week is likely to be associated with only a modestly lower risk ( Reynolds et al. 2003 ).

The most rapidly increasing form of cardiovascular disease is congestive heart failure, a syndrome in which pressure and fluid accumulate in the lungs because the heart is unable to generate sufficient output, either because of weakened heart muscle (e.g., after a myocardial infarction or from direct heart muscle toxins or infections) or muscle thickening that prevents the heart from filling normally. Alcohol consumed to excess over several years can produce an alcoholic cardiomyopathy, in which alcohol acts as a toxin to weaken the heart muscle directly and hence may improve with abstention. Cigarette smoking also is a strong risk factor for congestive heart failure in the general population ( Klatsky et al. 2005 ), and research with dogs has shown that oral nicotine administration increases the degree of scarring that accompanies alcoholic cardiomyopathy ( Rajiyah et al. 1996 ).

However, more than 20 years ago, Greenberg and colleagues (1982) showed that even the consumption of four to five drinks leads to relaxation of the peripheral blood vessels and could potentially “unload” the failing heart. Subsequently, population-based studies have shown that alcohol intake up to one to two drinks per day might be associated with a lower risk of congestive heart failure ( Klatsky et al. 2005 ). Although this association is partly explained by the lower risk of myocardial infarction linked to moderate drinking, it persisted even among those cases of heart failure that did not appear related to previous myocardial infarction. This association, like that of moderate drinking with myocardial infarction, also appears to be similar among smokers and nonsmokers.

Lessons from the Russian “Natural Experiment”

Despite the limited evidence that alcohol consumption and tobacco use interact directly to cause or exacerbate cardiovascular disease, the example of the Russian transition from Soviet State to independent nation hints at the extraordinary harm that these substances can potentially produce in combination when consumed in excess, at least during periods of social upheaval ( Notzon et al. 1998 ). Between 1990 and 1994, male life expectancy in Russia declined by an almost unimaginable 6.1 years, coinciding with a 35.7 percent increase in overall mortality rates. Although information on cause of death often is incorrect, alcohol-related causes and injuries alone appeared to account for 29.4 percent of this increase, while heart disease and stroke accounted for another 33.4 percent. Both alcohol use and tobacco imports rose sharply during that period, while other aspects of diet did not clearly deteriorate (i.e., nutritious food did not necessarily become less available). The juxtaposition of the steep increases in alcohol and tobacco use with the marked increase in cardiovascular mortality provides circumstantial evidence that, at least at the extremes, these two substances may interact to precipitate cardiovascular disease with alarming rapidity.

Conclusions

In summary, alcohol consumption and tobacco use have been associated with a wide variety of cardiovascular diseases, although these associations include both detrimental and (at least for moderate drinking) some potentially beneficial effects. Alcohol intake of three or more drinks per day and cigarette smoking share similar, and probably additive, adverse effects on some forms of cardiovascular disease. Examples of these adverse effects include increases in blood pressure and levels of triglycerides in the blood and higher risks of stroke and congestive heart failure. On the other hand, there is relatively little evidence that the two act synergistically or that the effects are worse when smoking and drinking occur together than would be expected from their independent effects. In most cases, more moderate drinking does not share these risks and even has effects opposite those of cigarette smoking on HDL-C and blood clotting. Nonetheless, because alcohol and tobacco are used together and in excess so commonly, their joint effects are encountered widely throughout the U.S. population. Ongoing public health efforts to minimize tobacco use and harmful drinking should result in clear and important gains to the nation’s cardiovascular well-being.

Financial Disclosure

The author declares that he has no competing financial interests.

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How to Stop Smoking When You Drink Alcohol

Armeen Poor, MD, is a board-certified pulmonologist and intensivist. He specializes in pulmonary health, critical care, and sleep medicine.

Karen Cilli is a fact-checker for Verywell Mind. She has an extensive background in research, with 33 years of experience as a reference librarian and educator.

altrendo images / Stockbyte / Getty Images

The habit of smoking a cigarette when drinking alcohol is common—and difficult to break. Alcohol decreases the ability to resist the  urge to smoke , so for many, drinking triggers smoking.

Despite the challenges, you can quit successfully. This requires understanding why you smoke when you drink and reconditioning your response to cigarettes. Experts advise strategies such as avoiding triggers, cutting back on overall alcohol intake, and planning.

Why Alcohol Triggers Cigarette Cravings

Alcohol reduces inhibitions, which increases the risk of a smoking relapse . Once you've had a couple of drinks, staying true to your goal of quitting cigarettes can become far more difficult.

Simply being around cigarettes can make restraint a challenge. Drinking alcohol is often a social thing, so you're likely to be around others—and they might be smoking. You might encounter smokers (and smoke) as you walk past designated smoking areas. They might ask you to join them or offer you a cigarette. Planning your responses in such situations can be helpful.

Understanding Nicotine Addiction

Nicotine addiction has two components: physical addiction and psychological dependence.

• Physical addiction : While it can be challenging, you can overcome physical addiction when you quit smoking and cope with the symptoms of nicotine withdrawal , including cigarette cravings .
• Psychological dependence : Over time, people who smoke build a mental association between smoking and daily life, from having a smoke with their morning coffee to lighting up when stressed .

For many people, it is the psychological dependence of smoking that ties them most strongly to nicotine addiction. Those who link smoking only with drinking may have an advantage: They can concentrate on quitting in this one area alone rather than having to face triggers in many daily situations.

Avoid Triggers

It's perfectly OK to avoid a situation if you feel it'll trigger a cigarette craving. During nicotine withdrawal, cravings can be intense. You don't have to feel bad about putting yourself first.

Start by asking family or friends to avoid smoking around you. Let them know you're serious about quitting and you would appreciate their support.

If they don't respect your wishes, set some healthy boundaries and spend less time around them. Avoid bars after you quit smoking, too. If you're afraid you're going to relapse, you can eliminate the risk by staying away from places that will trigger you.

Go Alcohol-Free First

Although your goal is to be able to enjoy a drink without smoking, going alcohol-free when you first quit smoking has its advantages.

Many bars have a list of alcohol-free drinks or "mocktails," so you can still feel included in the night's festivities.

If you start drinking alcohol again, avoid binge drinking . The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends that daily drink consumption does not exceed four drinks for men and three drinks for women.

Going out? Alcohol lowers your inhibitions, so try practicing how you'll behave at a bar beforehand.

Find New Activities

Find some new smoke-free activities and like-minded people who don't smoke so that you're not tempted. You can even keep a journal to track the benefits of spending time in new places and with new people. For example, your health improves when you quit smoking . You're also not inhaling secondhand smoke as you do when you stand near people who are smoking.

Making new associations when you quit smoking is important. When you have fun without smoking, you learn that you don't need a cigarette to have a good time.

Make a Plan

Have an escape plan for those moments when you feel like you're about to smoke a cigarette. Get up and head to the bathroom or step outside for some fresh air (avoiding the outdoor smoking area, if there is one). Reach out to a supportive friend or support quitline . If that doesn't do the trick, you may want to consider calling it a night and going home earlier than usual.

Go to a Smoke-Free Bar

Most public meeting places are smoke-free, but of course, you may encounter a bar that allows people to smoke inside. If this is the case, suggest to your friends that you go somewhere else instead.

Or, maybe you suggest that you try somewhere else altogether. You are guaranteed that no one will be smoking inside a movie theater or a museum, for instance. You can find ways to spend quality time with friends without cigarettes and alcohol.

Find a Replacement

You might find yourself missing the feeling of having a cigarette in your hand, especially if you're around other people who are smoking. There are different ways people swap out a cigarette for a healthier option.

Try holding on to a pencil, paper clip, or marble—anything small that you can fidget with to occupy your hand. If you miss having something in your mouth, you can try:

• Sugarless gum or a sugarless lollipop
• A toothpick
• A crunchy snack like a carrot or celery stick

Practice Makes Perfect

You are teaching yourself new healthy habits  each time you successfully navigate the situations that trigger the urge to smoke. Practice will cement them in place.

Be patient and give yourself time to replace old associations with new ones that don't include smoking.

Smoking even a few cigarettes is dangerous to your health. If you find that you're struggling to quit smoking, be sure to reach out to a healthcare professional who can help you find methods of quitting such as nicotine replacement therapy (NRT) , counseling, a support group, or a medication like Zyban (bupropion) or Chantix (varenicline).

Research has found that alcohol and nicotine use are closely related. People who have a dependence on one substance commonly have a dependence on the other. If you are struggling with how much you drink, talk to your doctor.

There are resources available to assess your drinking level and take action steps to reduce your drinking.

If you or a loved one are struggling with substance use or addiction, contact the  Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline  at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our  National Helpline Database .

The Takeaways

Remember: Many people take more than one attempt to quit smoking for good. If you smoke a cigarette when you're out drinking, don't let it stop you from continuing on your journey to stay smoke-free. With these tips in mind, you'll be more prepared for next time to let the craving pass without smoking a cigarette.

National Institutes of Health. Alcohol & smoking .

National Center for Complementary and Integrative Health. Quitting smoking with complementary health approaches: What you need to know .

Adams S. Psychopharmacology of tobacco and alcohol comorbidity: A review of current evidence . Curr Addict Rep . 2017;4(1):25-34. doi:10.1007/s40429-017-0129-z

National Institutes of Health. Know your triggers .

American Cancer Society. Help for cravings and tough situations while you're quitting tobacco .

Sharma R, Lodhi S, Sahota P, Thakkar MM. Nicotine administration in the wake-promoting basal forebrain attenuates sleep-promoting effects of alcohol .  J Neurochem . 2015;135(2):323-331. doi:10.1111/jnc.13219

By Terry Martin Terry Martin quit smoking after 26 years and is now an advocate for those seeking freedom from nicotine addiction.

Essay on Smoking And Drinking Alcohol

Students are often asked to write an essay on Smoking And Drinking Alcohol in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Smoking And Drinking Alcohol

Smoking: a harmful habit.

Smoking cigarettes is a harmful habit that can lead to many health problems, including cancer, heart disease, and lung disease. Cigarettes contain nicotine, an addictive drug that makes it hard to quit smoking. Nicotine also increases your risk of addiction to other drugs. Smoking is one of the leading causes of preventable death in the world.

Alcohol: A Depressant

Alcohol is a depressant, which means it slows down your body’s functions. Alcohol can cause problems with your coordination, judgment, and memory. It can also lead to liver damage, heart disease, and cancer. Drinking alcohol in excess can lead to addiction, which can have serious consequences for your health and relationships.

The Dangers of Mixing Smoking and Drinking

Mixing smoking and drinking alcohol is especially dangerous. The combination of nicotine and alcohol can increase your risk of cancer, heart disease, and stroke. It can also lead to addiction and other health problems. If you smoke and drink alcohol, you should quit both habits to improve your health.

250 Words Essay on Smoking And Drinking Alcohol

Smoking and drinking alcohol.

Smoking and drinking alcohol are two of the most common addictive behaviors in the world. They are both harmful to our health and can lead to serious health problems.

Smoking is the leading cause of preventable death in the world. It kills more people than car accidents, AIDS, and breast cancer combined. Smoking is responsible for a number of health problems, including cancer, heart disease, stroke, and lung disease. It can also damage our teeth and gums, and cause wrinkles and premature aging.

Drinking Alcohol

Drinking too much alcohol can also have serious health consequences. It can lead to liver damage, heart disease, stroke, and cancer. It can also cause mental health problems, such as depression and anxiety. Drinking too much alcohol can also lead to addiction.

Smoking and drinking alcohol are both harmful to our health. They can lead to serious health problems, including cancer, heart disease, stroke, and lung disease. They can also damage our teeth and gums, and cause wrinkles and premature aging. If you are thinking about starting to smoke or drink alcohol, please reconsider. These habits are not worth the risk to your health.

500 Words Essay on Smoking And Drinking Alcohol

Smoking: a detrimental habit.

Smoking is a harmful practice that can have severe consequences for one’s health. Cigarettes contain nicotine, a highly addictive substance that can lead to dependency and addiction. Smoking increases the risk of various health problems, including lung cancer, heart disease, stroke, and various types of cancer. It can also harm the lungs, leading to chronic respiratory diseases such as emphysema and bronchitis. Furthermore, smoking can cause premature aging, wrinkles, and other skin problems.

Alcohol: A Double-Edged Sword

Alcohol consumption can have both positive and negative effects on health. Moderate drinking, defined as one drink per day for women and two drinks per day for men, has been associated with a reduced risk of heart disease, stroke, and type 2 diabetes. However, excessive alcohol consumption can lead to severe health problems, including liver damage, heart disease, stroke, and various types of cancer. It can also impair cognitive function, leading to problems with memory, attention, and decision-making. Moreover, excessive alcohol consumption can result in addiction, social problems, and relationship difficulties.

The Dangers of Combining Smoking and Drinking

Combining smoking and drinking alcohol amplifies the negative effects of both habits. The toxins in cigarettes and alcohol can interact, increasing the risk of certain health problems, such as mouth, throat, and esophageal cancers. Smoking can also irritate the stomach lining, making it more susceptible to damage from alcohol. Furthermore, smoking and drinking together can impair judgment and coordination, increasing the risk of accidents and injuries.

The Importance of Prevention and Cessation

Preventing smoking and drinking alcohol is crucial for maintaining good health. Parents, educators, and healthcare providers play a vital role in educating young people about the dangers of these habits. Schools should implement comprehensive health education programs that address the risks of smoking and drinking alcohol. Parents should have open and honest conversations with their children about these topics. Cessation programs and support groups can help individuals who are struggling with smoking or drinking alcohol addiction. These programs provide guidance, support, and resources to help individuals quit these harmful habits and improve their overall health and well-being.

Smoking and drinking alcohol are harmful habits that can have severe consequences for one’s health. Both habits can lead to various health problems, including cancer, heart disease, stroke, and respiratory diseases. Combining smoking and drinking amplifies the negative effects of both habits and increases the risk of certain health problems. Prevention and cessation are crucial for maintaining good health. Comprehensive health education programs, open communication, and access to cessation programs can help individuals avoid or quit these harmful habits and improve their overall well-being.

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Smoking Cessation and Alcohol Abstinence: What Do the Data Tell Us?

Suzy bird gulliver , ph.d., barbara w kamholz , ph.d., amy w helstrom , ph.d..

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Unless otherwise noted in the text, all material appearing in this journal is in the public domain and may be reproduced without permission. Citation of the source is appreciated.

Cigarette smoking and nicotine dependence commonly co-occur with alcohol dependence. However, treatment for tobacco dependence is not routinely included in alcohol treatment programs, largely because of concerns that addressing both addictions concurrently would be too difficult for patients and would adversely affect recovery from alcoholism. To the contrary, research shows that smoking cessation does not disrupt alcohol abstinence and may actually enhance the likelihood of longer-term sobriety. Smokers in alcohol treatment or recovery face particular challenges regarding smoking cessation. Researchers and clinicians should take these circumstances into account when determining how best to treat these patients’ tobacco dependence.

Keywords: Alcohol and tobacco; alcohol, tobacco, and other drug (ATOD) use, abuse, and dependence; alcohol and other drug (AOD) craving; AOD use pattern; AOD abstinence; alcohol and tobacco; alcohol abuse; alcoholism; smoking; cigarette smoking; nicotine; treatment program; co-treatment; treatment outcome; AOD abstinence; cue reactivity; alcohol and other drug use disorders (AODD) relapse

Cigarette smoking and alcohol dependence co-occur at high rates. Research indicates that approximately 80 percent of people with alcoholism smoke cigarettes and that most of these smokers are nicotine dependent ( Hughes 1996 ). Conversely, smokers are at two to three times greater risk for alcohol dependence than nonsmokers ( Breslau 1995 ).

Smoking Cessation and Treatment for Alcoholism

Despite the fact that 60 to 75 percent of patients in alcoholism treatment are tobacco dependent and about 40 to 50 percent are heavy smokers ( Hughes 1995 ), treatment for tobacco dependence is not routinely included in alcohol treatment programs. Smoking cessation treatment (as well as bans on smoking) during the course of treatment for alcohol dependence has been avoided largely out of concern that concurrently addressing both addictions (or restricting smoking during treatment for alcoholism) poses too great a difficulty for the patient and would adversely affect recovery from alcoholism. Such concerns are apparent both in the United States and around the world (e.g., Walsh et al. 2005 ; Zullino et al. 2003 ). Myths surrounding concurrent treatment for smoking and alcoholism also include the ideas that smoking is a benign problem relative to alcoholism, that patients with comorbid alcoholism have either no interest or no ability to quit smoking, and that patients will relapse to alcohol if they quit smoking. This article summarizes the scientific findings that address these issues and provides evidence-based responses to common concerns about smoking cessation during alcoholism treatment.

Smoking is more benign than alcoholism. The short-term effects of alcoholism may appear more dangerous than those of cigarette smoking. However, mortality statistics suggest that more people with alcoholism die from smoking-related diseases than from alcohol- related diseases ( Hurt et al. 1996 ). In addition, the greater prevalence of smoking in alcohol-dependent versus other populations exacerbates health risks ( Bien and Burge 1990 ; York and Hirsch 1995 ). Researchers have demonstrated synergistic carcinogenic effects for dual substance dependence. For example, the relative risk of laryngeal cancer has been estimated at 2.1 in heavy smokers, 2.2 in heavy drinkers, and 8.1 in people who are both heavy drinkers and heavy smokers ( Hinds et al. 1979 ).

Smokers with comorbid alcoholism have either no interest or no ability to quit smoking. It is interesting to note that although addiction treatment programs routinely address multiple substances of addiction (e.g., alcohol, marijuana, heroin, cocaine), tobacco is frequently the sole excluded substance. The scientific literature also frequently describes treatment of multiple nontobacco substances simultaneously, making it difficult to evaluate the impact of smoking cessation on alcoholism treatment per se ( cf. Prochaska et al. 2004 ). Still, evidence contradicts the notion that smokers with comorbid alcoholism are not interested in quitting smoking and that addictions need to be treated one at a time (e.g., Kalman 1998 ). Up to 80 percent of people in addiction treatment are interested in quitting smoking ( cf. Prochaska et al. 2004 ). Consistent with this, Flach and Diener (2004) found that among dual users, approximately 75 percent wanted to quit both smoking and alcohol use (though the desire to quit alcohol use was rated as higher). Furthermore, many people entering treatment for alcoholism are willing to quit smoking (e.g., Saxon et al. 1997 ). In fact, one study found that 75 percent of substance-dependent inpatients accepted concurrent tobacco treatment ( Seidner et al. 1996 ).

Inclusion of smoking as a target for intervention does not appear to reduce patients’ commitment to broader addiction treatment. For example, incorporating smoking cessation treatment into inpatient addiction treatment centers has not substantially reduced longterm treatment completion (e.g., a minimal drop from 75 to 70 percent at one site) ( Sharp et al. 2003 ). In addition, Monti and colleagues (1995) found that smoking rates actually decrease and the motivation to quit smoking increases following successful alcohol treatment.

Evidence suggests that a history of alcohol use difficulties may not impede a specific smoking cessation attempt, though it does seem to reduce the likelihood of quitting smoking during one’s lifetime ( Hughes and Kalman 2005 ). Research has yet to determine the extent to which smokers with current alcohol use difficulties are able to quit smoking. Though early research has suggested that quitting smoking would be more difficult for these patients (e.g., Hughes 1996 ), the answer is now less clear. The only two studies evaluating this issue separate from other substances of abuse and co-occurring psychiatric disorders yielded mixed findings and did not include more severe alcohol-dependent individuals ( cf. Hughes and Kalman 2005 ). However, studies based on smokers in substance abuse treatment, and those in early recovery, suggest that cigarette abstinence is possible, though challenging ( Martin et al. 1997 ; Prochaska et al. 2004 ).

Myths and Data Related to Smoking Cessation and Alcohol Abstinence.

Myth: Smoking is more benign than alcoholism.

More people with alcoholism die from smoking-related diseases than from alcohol-related illness ( Hurt et al. 1996 ).

Comorbid smoking and alcoholism result in synergistic exacerbation of health risks ( Bien and Burge 1990 ; York and Hirsch 1995 ; Hinds et al. 1979 ).

Myth: Smokers with comorbid alcoholism have either no interest or no ability to quit smoking.

The majority (up to 80 percent) of individuals in addiction treatment are interested in quitting smoking ( cf. Prochaska et al. 2004 ).

Inclusion of smoking cessation treatment into other addiction programs does not negatively affect rates of treatment completion or motivation for abstinence ( Sharp et al. 2003 ; Monti et al. 1995).

Alcoholism does not seem to impede specific attempts at quitting smoking ( Hughes and Kalman 2005 ).

Alcoholism may make lifetime cigarette abstinence more challenging, but it remains possible ( Martin et al. 1997 ; Prochaska et al. 2004 ).

Myth: Smoking cessation will impede successful alcohol use outcomes.

The majority of research indicates that smoking cessation is unlikely to compromise alcohol use outcomes ( cf . Fogg and Borody 2001 ).

Participation in smoking cessation efforts while engaged in other substance abuse treatment has been associated with a 25 percent greater likelihood of long-term abstinence from alcohol and other drugs ( Prochaska et al. 2004 ).

Data indirectly suggest that continued smoking increases the risk of alcohol relapse among alcohol-dependent smokers ( Taylor et al. 2000 ).

Smoking cessation will impede successful alcohol use outcomes. Perhaps most important is the concern among treatment providers (and patients) that patients must choose between abstinence from cigarettes and abstinence from alcohol. In contrast to this concern, research suggests that treating tobacco dependence within broader addiction programs does not adversely influence recovery from alcoholism (or illicit substances). Although not universal (e.g., Joseph et al. 2004 ), the majority of findings indicate that smoking cessation efforts and smoking abstinence are unlikely to negatively influence alcohol use outcomes ( cf. Fogg and Borody 2001 ). In a recent meta-analysis, Prochaska and colleagues (2004) evaluated the outcomes of smoking cessation interventions in 19 randomized controlled trials with people in addiction treatment or recovery. At the end of treatment, no differences in substance use outcomes were found between patients who engaged in smoking cessation treatment and those who did not. Looking at long-term abstinence from substances, an even more important finding emerged. That is, at long-term follow-up, participation in a smoking cessation intervention provided during substance abuse treatment was associated with a 25 percent greater likelihood of long-term abstinence from alcohol and other drugs. Consistent with these findings, data suggest that 1 year after treatment, smokers who participated in a substance abuse treatment program and initiated smoking cessation on their own were less likely to be diagnosed as alcohol dependent and had more days abstinent from alcohol and other substances than those who started or continued smoking during the follow-up period ( Kohn et al. 2003 ). Thus, empirical evidence suggests that smoking cessation efforts may result in improved alcohol-related outcomes (even if those efforts do not yield substantial smoking abstinence).

The mechanisms of action responsible for the potential benefits of smoking cessation interventions provided during alcoholism treatment remain largely unexplored. However, possible explanatory factors may include greater clinical contact time, reduced exposure to substance use cues, relapse prevention and/or coping skills practice, increased mastery or self-efficacy, and broader healthy lifestyle choices ( Prochaska et al. 2004 ). Self-initiated efforts to reduce smoking also may reflect increased patient motivation or lower levels of nicotine dependence ( Karam-Hage et al. 2005 ).

Alcohol-dependent patients who quit smoking while in recovery from alcohol problems also do so without negative consequences to their alcohol or drug abstinence ( Bien and Burge 1990 ; Bobo 1989 ; Hurt et al. 1993 ; Irving et al. 1994 ; Joseph et al. 2003 ; Sobell et al. 1990 ; Sullivan and Covey 2002 ). Data suggest that among alcohol-dependent smokers in early recovery, nicotine deprivation is not associated with an increased urge to drink. In addition, among people with significant alcohol abstinence, evidence suggests that smoking cessation does not increase the likelihood of relapse to alcohol use or increase alcohol-related cravings ( Hughes et al. 2003 ). Data from Project MATCH, the largest alcoholism clinical trial published to date, indicates that alcohol-dependent smokers can quit smoking cigarettes without putting their sobriety at risk. In fact, those who quit smoking during their participation in Project MATCH drank less than those who did not quit smoking and significantly reduced their alcohol intake for the 6 months after quitting smoking ( Friend and Pagano 2005 ). Similarly, Karam-Hage and colleagues (2005) studied smokers in alcohol treatment and found that participants who quit smoking on their own were more likely to report alcohol abstinence at 1- and 6-months’ followup than participants who did not quit smoking (though this may be a function of lower levels of nicotine dependence).

Not only does the preponderance of evidence suggest that smoking cessation does not compromise alcohol abstinence, but multiple studies indirectly suggest that continued smoking may place alcohol-dependent smokers at risk for alcohol relapse ( Taylor et al. 2000 ). These data are consistent with laboratory studies on cross-cue reactivity, which suggest that nicotine dependence and alcoholism may interact to increase drinking risk. For example, alcohol cues, such as the sight or smell of an alcoholic beverage, can increase smoking urges among smokers with alcohol use disorders (e.g., Cooney et al. 2003 ; Drobes 2002 ; Gulliver et al. 1995 ; Rohsenow et al. 1997 ), and the degree of nicotine dependence among alcoholic smokers is positively related to alcohol cue reactivity ( Abrams and Biener 1992 ). In addition, a study of hazardous drinkers (i.e., those scoring 8 or above on the Alcohol Use Disorders Identification Test [ Babor et al. 1992 ]) found that 6 hours of nicotine deprivation was associated with increased alcohol cravings during exposure to smoking cues (e.g., cigarette lighter, ashtray, pack of favorite cigarettes) as well as increased alcohol consumption during a taste test procedure ( Palfai et al. 2000 ). Alcohol cravings also were increased during neutral cue exposure, suggesting that stopping one drug of abuse and not another may result in cross-cue reactivity that places a person in recovery at increased risk for relapse ( Bobo et al. 1998 ; Toneatto el al. 1995 ).

Challenges in Treating Co-Occurring Smoking and Alcoholism

Unfortunately, even with today’s best interventions for tobacco cessation, smokers in alcohol treatment or recovery face particular challenges to their cessation efforts. On average, compared with smokers who do not abuse substances, alcoholic smokers are more addicted to nicotine, smoke higher nicotine cigarettes, smoke more per day, and score higher on nicotine dependence measures and on carbon monoxide assessment ( Burling and Burling 2003 ; York and Hirsch 1995 ). Many smokers with alcoholism report that they use smoking to cope with their urges to use alcohol or other drugs ( Rohsenow et al. 2005 ), so alcohol-dependent smokers may have stronger views about the benefits of continued tobacco use than do other smokers. In addition, nicotine positively influences information processing among alcoholics (i.e., nicotine use increases the speed and accuracy of information processing) ( Ceballos et al. 2006 ), which may decease motivation to change. Thus, researchers and clinicians must take into account the characteristics of tobacco dependence in alcohol-dependent populations when determining how best to treat these patients’ tobacco dependence.

Despite concerns to the contrary, the majority of empirical evidence indicates that smoking cessation (whether through formal treatment or self-initiated change) does not pose a risk to successful alcoholism treatment. Not only does smoking cessation not disrupt alcohol abstinence, it actually may enhance the likelihood of longer-term sobriety. Although research has yet to determine the extent to which smoking cessation is impeded by active alcohol use difficulties, the presence of these difficulties does not prohibit achievement of tobacco abstinence. Given the substantial negative health consequences of co-occurring cigarette smoking and alcoholism, smoking cessation efforts in the context of treatment for alcoholism are likely to yield important benefits to patients physically, emotionally, socially, and economically.

Acknowledgements

This work was supported by the following grants: DA016138 awarded to Barbara W. Kamholz, Ph.D; 1R01–AA013727 awarded to Domenic Ciraulo, M.D.; 2R01–AA1164201A awarded to Dena Davidson, Ph.D.; and the Veterans Administration Research Enhancement Award Program (REAP) awarded to Ronald Goldstein, M.D.

Financial Disclosure

The authors declare that they have no competing financial interests.

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Smoking and alcohol: Double trouble for the brain?

Along with many other harmful health consequences, smoking tobacco causes chemical changes, oxidative stress and inflammation in the brain. Excessive alcohol use can have similar effects. Surprisingly, however, very few studies have examined the combined impact of smoking and alcohol on the brain. Now, researchers reporting in ACS Chemical Neuroscience have shown that in rats, the joint use of tobacco and alcohol could increase neural damage in particular brain regions.

According to the National Institute on Alcohol Abuse and Alcoholism, many people who smoke tobacco also drink alcohol excessively, and vice versa. Therefore, studying the combined effects of the two drugs on the central nervous system could yield valuable insights. But most previous studies have examined the consequences of one or the other in isolation. That's why Alana Hansen and colleagues wanted to find out how drinking and smoking together affect regions of the rat brain involved in drug addiction.

The researchers treated rats with alcohol, tobacco smoke or both twice a day for 28 days and then compared their brains with control animals that didn't receive either substance. They found that the combined alcohol and smoking treatment increased the level of reactive oxygen species in the hippocampus compared with control animals or rats given tobacco smoke alone. In all of the brain areas studied, combined alcohol and smoking increased the levels of specific pro-inflammatory cytokines more than either treatment alone. And in the striatum and frontal cortex, rats with both treatments showed lower levels of brain-derived neurotrophic factor, a growth factor that helps existing neurons survive and stimulates the growth of new ones. These results suggest that alcoholics who smoke could be at additional risk for neural damage, the researchers say.

• Birth Defects
• Psychology Research
• Nervous System
• Smoking Addiction
• Neuroscience
• Tobacco smoking
• Blood alcohol content
• Brain damage
• Fetal alcohol spectrum disorder
• Anticonvulsant

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Materials provided by American Chemical Society . Note: Content may be edited for style and length.

Journal Reference :

• Dayane A. Quinteros, Alana Witt Hansen, Bruna Bellaver, Larissa D. Bobermin, Rianne R. Pulcinelli, Solange Bandiera, Greice Caletti, Paula E. R. Bitencourt, André Quincozes-Santos, Rosane Gomez. Combined Exposure to Alcohol and Tobacco Smoke Changes Oxidative, Inflammatory, and Neurotrophic Parameters in Different Areas of the Brains of Rats . ACS Chemical Neuroscience , 2019; DOI: 10.1021/acschemneuro.8b00412

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