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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.

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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

It can be difficult to break the habit of smoking a cigarette when you drink alcohol. Not only can alcohol break your resolve and make it easy to give in to the  urge to smoke , but for many, there is a strong association between drinking and smoking making it a trigger.

There are helpful tips to keep in mind—like avoiding triggers, cutting back on your alcohol intake, and planning ahead—that can help you feel more prepared to avoid smoking if you have a drink.

Components of 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 only link smoking with drinking may have an advantage in that they are able to concentrate their efforts to quit smoking in this one area alone rather than having to face triggers in every area of their life. But quitting is still often a challenge.

Why Alcohol Triggers Cigarette Cravings

Alcohol reduces your inhibitions. For someone who is trying to quit smoking, reduced inhibitions increase the risk of a smoking relapse . Once you've had a couple of drinks, it may not feel important to stay true to your smoking cessation.

Additionally, you are likely to be around other people who are smoking. Maybe your friends smoke or you encounter other people outside of the bar smoking. How do you fight the urge to join them? What do you say if they offer you a cigarette?

Quitting can be done successfully. With a plan and some practice, you can recondition your response to cigarettes.

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.

You can start by asking any family or friends who smoke 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, you can set some healthy boundaries and spend less time around them. It's OK to 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 a place that will trigger you.

Go Alcohol-Free at First

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

Since alcohol lowers your inhibitions, you may want to practice being at a bar and not drinking or not smoking. This practice can help you learn how to overcome a cigarette craving if you do start to drink again.

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.

Find New Activities

You may feel like you're not able to have fun in the same way you used to when you were smoking and that's OK. Try finding new smoke-free activities and like-minded people who don't smoke so that you're not tempted to smoke.

You can even keep a journal of the ways you're benefitting from spending time in new places and with new people. For instance, 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.

Have an escape plan in mind 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 .

A Word From Verywell

Remember, it takes a lot of people more than one attempt to quit smoking before they're able to quit 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 .

National Institute on Alcohol Abuse and Alcoholism. Drinking levels defined .

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.

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.

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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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Article Contents

Introduction, addiction-related outcomes of co-use, what makes e-cigarettes different: an ever-changing landscape, supplementary material, declaration of interests, authors’ contribution.

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Addiction-Related Outcomes of Nicotine and Alcohol Co-use: New Insights Following the Rise in Vaping

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Jude A Frie, Caitlin J Nolan, Jennifer E Murray, Jibran Y Khokhar, Addiction-Related Outcomes of Nicotine and Alcohol Co-use: New Insights Following the Rise in Vaping, Nicotine & Tobacco Research , Volume 24, Issue 8, August 2022, Pages 1141–1149, https://doi.org/10.1093/ntr/ntab231

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Nicotine and alcohol-containing products are some of the most commonly used substances of abuse and are both leading causes of preventable death. These substances also have significant interactions that have additive and, in some cases, multiplicative effects on the health consequences of their use. Thus, to reduce these negative consequences, it is important to understand the abuse liability of nicotine and alcohol in combination, especially in the most relevant use cases among those who are most vulnerable. Specifically, as tobacco cigarette use is continually decreasing, vaping is quickly replacing cigarettes as the primary mode of nicotine use. This pattern is especially true in adolescent populations in which vaping has grown considerably. Particularly concerning is that adolescents are more vulnerable than adults to the negative consequences of substance use. It is therefore imperative to revisit the literature as it relates to the rising state of co-use of vaping products with alcohol. Here, we review the clinical outcomes of nicotine and alcohol co-use as they relate to the abuse liability of each individually. Special attention is paid to adolescent findings, where available, as well as investigations that use nontobacco nicotine products as these may more accurately reflect the more recent trends of co-use.

Though nicotine alone has previously been considered a proxy for tobacco and tobacco cigarette use, combustible routes of administration have been decreasing. They are, instead, being replaced by e-cigarettes that do not involve other tobacco constituents and contain additional nonnicotine constituents of their own. Unfortunately, the literature remains limited with regard to e-cigarettes and their interactions with other substances, especially their prevalent co-use with alcohol. This review attempts to discuss the current literature on nicotine and alcohol co-use in the context of the vaping epidemic, predominantly focusing on addiction-related outcomes and why e-cigarette use may be unique.

Tobacco and alcohol are the leading and third leading causes of preventable death in the United States, respectively, representing an exceedingly large economic burden and loss of human life. 1 , 2 Use disorders of these substances are also highly comorbid, with 80%–90% of patients with alcohol use disorder being smokers. 3 While each substance has their own associated risks, combined use may have additive effects on substance dependence, as well as negative physical and mental health outcomes including increased prevalence of certain cancers and psychiatric comorbidities. 4 It is therefore vital to understand the interactions between these substances such that the consequences of their use can be minimized both individually and in combination.

To understand this relationship, research must match the dynamic nature of substance use, adapting quickly to the changing landscape—particularly that of nicotine. Cigarette use has been steadily declining, while new forms of nicotine use have been growing at alarming rates, especially among vulnerable populations. 5 , 6 Past 30-day e-cigarette use among middle and high school students has grown from 0.6% and 1.5% to 4.7% and 19.6%, respectively, between 2011 and 2020. 7 , 8 Although adolescent alcohol use has been steadily decreasing during this period, its use remains high with adolescents reporting past 30-day use at 29.2% in 2019. 9 Nicotine and alcohol are also some of the most commonly co-used substances among adolescents, with nearly one in four adolescents reporting past 30-day use of both substances. 10 Despite these facts, there is very little research investigating the interactions specific to e-cigarette and alcohol co-use (for summaries of reported findings, see Supplementary Table 1 ), and investigations in adolescents is even more limited.

Excellent previous reviews have extensively evaluated the genetic, 11 , 12 pharmacological, 3 , 4 , 11 , 13–16 metabolic, 17 , 18 and behavioral, 4 , 11 , 15 , 19 , 20 mechanisms of interactions between nicotine and alcohol in great detail. Here, we have reviewed and updated the current state of knowledge in the field based on the clinical addiction-related outcomes of these interactions, and where available, the impact of sex and gender. Finally, we add our contention that further research must be carefully designed within the specific context of vaping, and how it might differ from previous investigations on the topic. As nicotine vaping and alcohol co-use is the focus, we attempt to give special attention to studies that use nontobacco nicotine routes of administration, though much of the research interchanges tobacco, particularly cigarettes, and nicotine. Throughout, we highlight adolescent co-use, where available, as this population is especially vulnerable to the consequences of substance use and is also where the most growth in vaping has been concentrated. 21–23

Reported Reward

Several studies have found interactions between the subjective experiences associated with alcohol and nicotine. The potentiation of the rewarding effects of nicotine by alcohol and vice versa has been linked to a shared reward pathway, with both substances increasing the perceived rewarding effects of the other via mesolimbic dopamine pathway stimulation (for review, see ref. 16 ).

Nicotine Effects on Alcohol Reward

The effects of alcohol are biphasic; that is, while blood alcohol levels are low and rising, alcohol acts as a stimulant; when they are high and decreasing, alcohol acts as a depressant. 24 Nicotine may increase the positive subjective experience of alcohol by either potentiating the stimulant or attenuating the depressant phases of the blood alcohol curve. 17 Several laboratory studies have investigated the subjective effects of nicotine on alcohol; however, these findings have been somewhat inconsistent and highly methodologically dependent.

When investigating the effects of nicotine without nonnicotine tobacco constituents, pretreatment via transdermal nicotine patches has been found to increase feelings of euphoria and feelings of intoxication 3 hours after acute alcohol consumption in moderate- to heavy drinking daily smokers. 25 Likewise, when light-smoking social drinkers were pretreated with a transdermal patch, ratings of alcohol-induced sedation were potentiated. 26 A similar study, however, found the opposite with transdermal nicotine patch pretreatment leading to a decrease in the reported subjective feeling of alcohol’s effects 6 hours later as measured using the Alcohol Effects Scale—an average of five reported subjective effects (high, like, rush, feel-good, intoxicated). 27 Similarly, nicotine administered by nasal spray reduced feelings of intoxication in a group of moderate drinking smokers. 28 It is important to note that in each of those studies, participants had been deprived of nicotine for several hours prior to experiments; thus, the subjective interactions of nicotine and alcohol may have been confounded by withdrawal and/or craving. When social drinking nonsmokers were administered nicotine and alcohol intravenously, nicotine significantly attenuated feelings of alcohol intoxication. 29 Further, if nonsmokers were administered the nonspecific nicotinic acetylcholine receptor antagonist, mecamylamine, the reports of stimulant and euphoric effects of alcohol were attenuated, consistent with the findings that nicotine increases the euphoric feelings associated with alcohol administration. 30

Ecological momentary assessments of smokers, in which participants are frequently assessed while in their natural environments, show a clearer picture, with smoking evoking a small but significant increase in pleasure following the last drink. 31 Of particular interest, smoking was only associated with enhanced alcohol buzz and excitement when estimated blood alcohol levels were high and descending, suggesting that interactions between alcohol and nicotine on subjective experience are influenced by the biphasic nature of alcohol, possibly explaining some of the contradictions seen in human laboratory findings. 32

Alcohol Effects on Nicotine Reward

Many studies examine the effects of alcohol on tobacco cigarette reward, but none have used pure nicotine, exposing a gap in the literature. Studies investigating these effects provide overwhelming evidence for potentiated subjective hedonic experiences when smoking followed alcohol. In an ad-lib smoking session, previous exposure to a priming dose of alcohol (0.5 g/kg) significantly increased reports of stimulant and calming tobacco effects as well as enhanced smoking satisfaction. 33 Alcohol pretreatment also results in higher ratings of enjoyable taste, 34 satisfaction, 33 , 35 liking, 33 , 36 calming, 33 pleasantness, 37 and greater positive and lower negative affect 36 in response to smoking. Like adults, young adult smokers and experimenters (<100 lifetime cigarettes) report greater pleasure for cigarettes when drinking. 38 Further, in heavy drinking young adults who were experimenting with tobacco, both alcohol and taste-masked placebo increased smoking satisfaction, calm, and taste, suggesting that expectancy of alcohol consumption partially mediates tobacco-potentiated reward. 39 The same study determined that alcohol but not alcohol expectancy resulted in decreased nausea associated with ad-lib cigarette smoking; thus, some of alcohol’s reward-potentiating effects on tobacco may be due to the attenuation of negative smoking affect.

Only two ecological momentary assessments have been conducted on alcohol and cigarette co-use that evaluated subjective feelings associated with tobacco reward. Alcohol use was associated with more frequent reports of good tobacco taste, rush/buzz, and increased smoking satisfaction and pleasantness when drinking in the preceding hour. 40 The authors suggested that alcohol may extend the euphoria associated with cigarette smoking, thus increasing the chances of the rush/buzz still being present when self-reports were conducted. Interestingly, another ecological momentary assessment found no effect of alcohol on smoking satisfaction, although there was a trend when alcohol preceded smoking by 15 minutes. 41 This may suggest that, like nicotine’s effect on alcohol reward, alcohol’s effect on cigarette, and possibly nicotine, reward may be contingent on the timing of the biphasic subjective alcohol experience.

Conclusions

Alcohol and nicotine can potentiate the rewarding properties of each other, and nicotine may attenuate the intoxicating and sedating properties of alcohol, although this effect is less straightforward. There is also evidence for increased addiction liability for each substance when used together, as the positive subjective properties of a drug are involved in the initial motivation for repeated exposures, and the formation of associated cues required for impulsive drug taking. 42 Though no clinical laboratory studies have investigated adolescents to our knowledge, reports from young adults were consistent with findings in older adults. 38 , 39 Unfortunately, the studies that used nontobacco nicotine produced mixed findings 25–29 ; thus, more studies investigating alcohol and nicotine reward that use nontobacco nicotine exposures (vaping, transdermal patch, intravenous infusion, etc.) are required.

Reinforcement

Laboratory studies have shown variable effects of nicotine on alcohol reinforcement, whereas alcohol consistently increases nicotine reinforcement. Further, there is evidence that alcohol consumption predicts nicotine use more strongly than the reverse relationship. 43

Nicotine Effects on Alcohol Reinforcement

Nicotine alone and nicotine from cigarettes increases alcohol reinforcement. Using a progressive ratio task in which participants were required to work harder for subsequent reinforcers, nicotinized cigarette self-administration increased alcohol consumption, compared with denicotinized cigarettes, as well as increased breakpoints in male occasional smokers. 44 Similarly, users of cigarettes with very low nicotine content showed lower alcohol use compared with moderate and normal nicotine cigarettes. 45 Further, there is no evidence of compensatory drinking or binge drinking in response to nicotine reduction, suggesting that reduced nicotine cigarettes could have positive consequences for public health. 45

Many studies, however, show mixed results in male and female participants. Responding for alcohol after daylong ad-lib smoking was significantly greater than after smoking abstinence in men, but not in women. 46 Furthermore, whilst comparing 7 or 14 mg of transdermal nicotine or a placebo on the effects of alcohol self-administration, men (14 mg nicotine) increased alcohol consumption, whereas in women (14 mg nicotine) decreased alcohol consumption, in response to a priming drink (0.2 g/kg). 26 In comparison, in heavy drinking daily smokers it was also found that both men and women participants who were administered 21 mg/day of transdermal nicotine, took longer to start drinking after a priming drink and consumed fewer drinks compared with a placebo patch. 47 It is of note that neither of these studies chose doses of nicotine considering body weight differences, however the former found that neither body weight nor body mass index were correlated with nicotine-induced nausea or with mood changes after nicotine administration, 26 and in the latter study comparisons between genders were underpowered. 47

Importantly, when comparing the use of e-cigarettes to that of combustible tobacco cigarettes, similar results have been found. Self-reported data show that the use of e-cigarettes increases alcohol reinforcement and leads to problematic alcohol use, 48 and heavy drinking. 49 E-cigarette users had increased risk of harmful alcohol use including hazardous drinking, alcohol use disorder, and binge drinking, compared with e-cigarette nonusers. 50 Additionally, combined e-cigarette and tobacco cigarette use was associated with an additive risk of harmful alcohol use, especially in nondaily users. Furthermore, e-cigarette users drink more alcohol than nonusers, but less than tobacco cigarette or dual e-cigarette/cigarette users. 51 In the same study, dual e-cigarette/cigarette users reported a higher number of drinks consumed in the past month than e-cigarette users alone, and they were more likely to meet hazardous drinking criteria at follow up. Both tobacco cigarette users and dual e-cigarette/cigarette users, however, showed higher total drinks in the past month compared with e-cigarette users, and there were no significant differences between cigarette and dual-cigarette users. 51 In contrast, while no differences in alcohol drinking were observed among tobacco cigarette, e-cigarette, or dual users, all three groups had higher rates of heavy drinking than nonnicotine users. 49

In adolescents, there is a bidirectional association, and sex difference, between e-cigarette use and alcohol use. 52 Adolescents who reported e-cigarette use had 3.5 times the odds of initiating alcohol use 6 months later, compared with those who have never used e-cigarettes. This association was found to be stronger in boys than in girls. Further, alcohol users had 3.2 times the odds of initiating subsequent e-cigarette use 6 months later. 52

Overall, these studies provide evidence that depending on dose and type of nicotine-containing product, nicotine appears to increase alcohol reinforcement in men but not women. There is a lack of experimental studies of e-cigarette use and further research is required to examine these effects in adolescents.

Alcohol Effects on Nicotine Reinforcement

Alcohol dependency is positively correlated with the number of combustible cigarettes smoked per session. 53 , 54 Differing doses of alcohol significantly increased cigarette smoking in participants with alcohol dependency compared with those without; however, in nonalcohol-dependent participants, differing alcohol doses had no significant effect on smoking behavior. 54 There were, however, individual differences in the non-dependent group, such that smoking decreased in two participants, increased in two participants, and remained unchanged in a fifth. 54 In comparison, in men with opioid use disorder, drinking alcohol significantly increased the amount and rate of smoking in most, but not in all participants, 55 further demonstrating individual differences in those with other co-occurring substance use disorders.

In moderate-to-heavy smokers who drank alcohol regularly, participants smoked more tobacco cigarettes in the first hour after 0.4 or 0.8 mg/kg alcohol than participants who consumed 0.2 mg/kg alcohol or placebo. 56 Similarly, low doses of alcohol increased cigarette use in daily smokers who were heavy drinkers. After consuming a priming alcoholic drink, participants were less able to resist a first cigarette, initiated smoking sooner, and smoked more cigarettes compared with a placebo beverage. 57

Sex differences also emerge in the effect of alcohol on cigarette smoking. Alcohol increased men’s smoking behaviors compared with placebo, including number of puffs, number of cigarettes, and duration of smoking; however, women’s behavior did not differ between alcohol and placebo conditions. 34 Thus, further consideration for sex differences is required in studying the cross-tolerance of nicotine and alcohol reinforcement.

Although studies generally find that nicotine in both combustible tobacco cigarettes and e-cigarettes increases alcohol reinforcement, and to a lesser extent the converse, further research is required to examine sex differences, adolescent use, and e-cigarette use in controlled laboratory settings, with special consideration for the effects of alcohol on nicotine reinforcement in nontobacco products.

Commonly, patients that have both nicotine and alcohol use disorders have worse treatment outcomes when compared with those with only one. 11 This is likely due to the interactions between alcohol and nicotine cues that contribute to relapse of either, known as the cross-substance cue reactivity theory. 58 These interactions fall into two main overlapping categories: (1) increased craving of one substance following the consumption of the other 19 ; and (2) nonpharmacological alcohol cross-cue provoked urge to use nicotine and vice versa. 20

Nicotine Effects on Alcohol Relapse

Laboratory studies investigating nicotine’s (alone and from tobacco containing cigarettes) effects on alcohol craving have been mixed. In participants who drink alcohol and smoke cigarettes with a broad range of use patterns, alcohol craving increased significantly after smoking a cigarette in heavier drinkers but decreased in light drinkers; though the combination of both low-dose (men: 0.3 g/kg; women: 0.27 g/kg) alcohol and cigarette smoking resulted in greater cravings for alcohol than either alone regardless of drinking patterns. 36 Among a group of occasional smokers, no effect of cigarette smoking was observed on alcohol craving, suggesting that consistent co-use may be required for sufficient cue conditioning. 44 Similarly, cigarette smoking did not evoke a desire to drink in young male and female daily smokers who drank moderate amounts of alcohol. 46 Especially relevant to this review, ad-lib vaping has been found to increase craving for alcohol in light drinkers who vape. 59

Of course, visual smoking cues are also an important factor for relapse, and there is strong evidence that cross-cue conditioning occurs in dual users—though most research to date has focused on the effects of alcohol cues on smoking behavior. Smokers with alcohol use disorder display strong cravings for alcohol when exposed to smoking-related images. 60 Additionally, nicotine withdrawal may increase alcohol craving in response to smoking cues, though results are inconsistent. This effect was only seen in a group of daily smoking hazardous drinkers (those that scored 8 or above on the Alcohol Use Disorders Identification Test) following 6 hours of nicotine deprivation 61 but not in either alcohol-dependent heavy smokers 62 or moderate-to-heavy smoking young adult drinkers 63 at 34 or 5 hours of nicotine deprivation, respectively. 62 , 63

Pretreatment with a transdermal patch containing nicotine alone (21 mg nicotine) increased craving to drink among socially drinking daily smoking men. 25 This finding is important as it divorces visual smoking cues as a factor influencing alcohol craving; thus, nicotine’s subjective effects alone may be enough to act as a conditioned cue for alcohol craving. 64 Interestingly, the same dose of nicotine in women showed no effect on alcohol craving, 65 again highlighting the need to examine sex differences as they relate to dosing regimens and metabolism as well as age.

Alcohol Effects on Nicotine Relapse

Alcohol consumption is strongly associated with smoking relapse. 66 There is extensive laboratory evidence that alcohol increases craving for cigarettes across a variety of use patterns. Following fixed doses of alcohol in laboratory settings, increased urge to smoke has been observed in heavy social drinking light smokers, 67 , 68 heavy social drinking daily smokers, 57 heavy drinking heavy smokers, 25 , 69 young adult heavy social drinking light smokers, 34 occasional drinking daily smokers, 70 nicotine-dependent and non-dependent smokers, 71 and moderate drinking daily and nondaily smokers. 72 No effect of alcohol on the urge to smoke in heavy drinking heavy smokers was found; however, it is suggested that this may be due to subjects being 15 hours smoking abstinent, and therefore, a ceiling effect on cigarette craving was responsible for the finding. 73 Notably, increased craving for cigarettes in heavy drinking light smokers was also found following intravenous alcohol administration; thus, alcohol’s subjective effects may increase craving for cigarettes without any drinking-related cue. 74 An ecological momentary assessment study of daily smokers found that alcohol use predicted smoking and was associated with more frequent reporting of urge to smoke. 40

Unlike with reward, there does not appear to be a relationship between craving and the biphasic effects of alcohol, as cigarette craving evoked by alcohol is maintained throughout the blood alcohol curve. 67 , 68 , 74 , 75 There may also be an effect of gender, with women reporting stronger smoking cravings following alcohol consumption than men, 34 , 75 and women, but not men, having increased urges to smoke following a placebo drink, suggesting that women participants’ urge to smoke may be more cue driven than men. 73 However, there are again inconsistent reports, with both men and women showing increased craving following a placebo beverage. 39 , 71 Notably, alcohol cues have been consistently shown to increase urge to smoke. Among daily smoking alcohol-dependent men, the smell of alcohol promoted the urge to smoke. 58 , 76 Both alcohol- and nonalcohol-dependent daily smokers exhibited substantial increases in urge to smoke following presentations of alcohol-related images, with alcohol-dependent smokers showing equivalent alcohol cue potentiated cravings to those elicited by smoking-related cues. 60

Both alcohol and nicotine consumption, and exposure to their associated cues, increase cravings for each other, though this effect is especially pronounced for alcohol consumption and alcohol cue exposure on urge to smoke. Although, to our knowledge, no studies have evaluated these effects on e-cigarette relapse or vaping’s effect on alcohol relapse, most studies investigating smoking’s effect on alcohol relapse used denicotinized cigarettes as controls. Thus, the primary differences seen were likely mediated by nicotine, though there could be a nicotine and nonnicotine tobacco constituent interaction as well. Overall findings are consistent with epidemiological observations that the use of e-cigarettes is associated with problematic alcohol use in adult, 48 , 51 , 77 young adult, 49 , 78 and adolescent populations. 79 For summaries of all vaping and alcohol co-use findings, see Supplementary Table 1 .

It is difficult to categorize e-cigarettes in existing nicotine use classifications as not only do they differ greatly from current nicotine replacement therapies and tobacco products, but they are also a remarkably broad category of products themselves, making it challenging to establish any consistent conclusions regarding their properties. E-cigarettes vary in many ways, including flavor, nicotine concentration, nicotine type (ie, salt or base), device voltage, primary vehicle constituents and their ratios, and form factor. This variation results in a mixed literature that often neglects to differentiate amongst, or even explicitly state, these properties. Here, we discuss why many of these properties make e-cigarettes a unique category of nicotine products that requires further studies to understand how they affect behavior alone, and in combination with other drugs of abuse, including alcohol. We also point out areas that may overlap (summarized in Figure 1 ) such that some inferences may be made from previously conducted research on alcohol and nicotine co-use.

Properties of tobacco cigarettes, e-cigarettes, NRTs, and their overlapping relationships. For the purposes of this review, e-cigarettes are not considered a NRT. Though the FDA is working to ban menthol in cigarettes, mentholated cigarettes are still currently available; thus, for now all nicotine products have flavors in common. Depending on whether e-cigarettes contain nicotine salt or base, they may be more likely to overlap with cigarettes or NRTs. There is significant overlap between each nicotine product allowing for some understanding of e-cigarette properties to be gleaned from past literature. Past findings, therefore, have validity for directing future clinical and preclinical studies observing the effects of e-cigarettes directly.

Nicotine Type and Concentration

Nicotine’s ability to enter the body depends highly on pH, with higher pH increasing absorption across tissues and being required for efficient absorption through buccal and dermal membranes. 80 For inhalation, however, lower pH results in increased palatability allowing for easier initiation of use and the potential for higher nicotine concentrations; thus, there exists a balancing act for “ideal” ratios of nicotine salt (low pH form) to nicotine base (high pH form) that has created a long history of tobacco companies searching for the perfect combination to evoke the greatest level of consumption. 81 The first generation of e-cigarette liquids (e-liquids) were almost entirely nicotine base, like that of nicotine replacement therapies such as nicotine patches, gums, lozenges, inhalers, and nasal sprays; however, recent e-liquids that are commonly used in pod and disposable devices are now primarily salt based, with a ratio of base to salt of ~0.1, the same ratio used in most cigarettes. 80 , 81

Newer e-liquids also have significantly higher nicotine concentrations, as the more physiological pH of nicotine salt reduces alkaline activated pulmonary protective mechanisms resulting in increased palatability. 82 This is likely why the most popular nicotine base e-liquid concentration is 18 mg/mL, whereas nicotine salt e-liquid is most commonly 59 mg/mL. 83 Thus, there are two separate populations that have often been placed under the umbrella of “e-cigarette users” that are using very different products. These products differ significantly in their pharmacokinetics, with nicotine salt-based e-liquids having near identical pharmacokinetics to that of tobacco cigarettes and nicotine base having a lower blood plasma maximum concentration ( C max ) and time to maximum concentration ( T max ) compared with both. 83 It should be noted, however, that these results were found in adults, which corresponds well with findings showing consistent salivary cotinine, a primary metabolite of nicotine, levels in adults who use JUUL e-cigarettes or smoke tobacco cigarettes 84 ; but, it is not consistent with adolescent urinary cotinine levels that suggest that adolescents who use nicotine salt-based products are being exposed to significantly more nicotine than their tobacco cigarette-smoking counterparts; thus, adolescents are a unique population whose e-cigarette use should be studied independently. 85 , 86 Overall, there is very little consistency across e-cigarettes product to product. Even when simply considering e-cigarettes that primarily use nicotine base, studies cannot agree as to whether they result in greater, equal, or lower nicotine plasma in the blood compared with tobacco cigarettes, likely owing to the differential e-cigarette puff topography by concentration and device voltage. 87 Compared with e-cigarettes and tobacco cigarettes, nicotine replacement therapies, which were designed to be smoking cessation aids, have much slower absorption rates and produce more gradual increases in blood nicotine resulting in lower abuse liability. 88

Nonnicotine Constituents

There are many unique factors apart from nicotine chemistry that differentiate e-cigarettes from tobacco products and nicotine replacement therapies. Though the FDA has banned most flavored cartridge-based e-cigarettes, flavored e-liquids that can be used to refill these devices, as well as menthol cartridges, are still available. 89 There are over 15 000 flavorants available for use in e-liquids, many of which have known pharmacological interactions with nicotine and nicotinic acetylcholine receptors (for review, see ref. 90 ); and, given alcohol’s interaction at nicotinic acetylcholine receptors, it is not unlikely that there are additional complex relationships among alcohol, nicotine, and these flavorants. 16 Flavors such as menthol also alter nicotine metabolism and act as a highly reinforcing sensory cue to smoke (for review, see ref. 91 ), leading the FDA to recently announce a ban on menthol in cigarettes. 92 Therefore, except for limited flavorants in nicotine gum and lozenges, the reinforcement potential of flavors and the novelty of trying new flavors is now exclusive to e-cigarettes.

Like flavors, e-liquids uniquely contain propylene glycol and/or vegetable glycerin that, when vaporized, carry nicotine and flavorants to the mouth, throat, and lungs. The ratio of these constituents in an e-liquid has been shown to affect puff topography and nicotine delivery in experienced users. 93 Because both propylene glycol and alcohol are primarily metabolized by alcohol dehydrogenase in the liver (which becomes saturated at low alcohol concentrations), there are likely metabolic interactions between these substances. 94 For instance, ethanol is known to competitively inhibit propylene glycol metabolism. 95 Additionally, a recent paper validating a rat model of nicotine self-administration found similar responding for nicotine and vehicle vapor (50:50 propylene glycol/vegetable glycerin); the authors suggested that the vehicle itself may have some rewarding properties. 96 This finding could additionally explain why many individuals regularly vape nicotine-free e-liquid. 97

Tobacco cigarettes, too, are distinct in terms of nonnicotine constituents. Cigarettes have over 7000 nonnicotine constituents, most of which have not been studied, and several of which have been shown to have potentiating effects on nicotine reinforcement—some even being reinforcing themselves. 98 , 99 Further, cigarettes contain monoamine oxidase inhibitor constituents, which may also potentiate nicotine reinforcement. 100

Because it is difficult to find consistency in the properties of e-cigarettes, and many properties of other nicotine routes are not shared with e-cigarettes, inferences made from other forms of nicotine exposure (ie, tobacco, nicotine replacement therapies) will only be applicable to a subsection of the properties of a particular type of device/e-liquid. Thus, not only is there need for studies investigating the effects of e-cigarettes on co-use with alcohol, but there is need for studies on each type of e-cigarette/liquid on alcohol co-use to fully understand the addiction-related outcomes of nicotine and alcohol interactions. There is also a need for preclinical research to disambiguate the causal mechanistic underpinnings of nicotine and nonnicotine constituents in their role in co-use. By revisiting this clinical literature using the lens of emerging routes of nicotine administration and its rapid growth amongst more vulnerable populations, preclinical research can then be guided by the existing gaps in knowledge in human studies.

A Contributorship Form detailing each author’s specific involvement with this content, as well as any supplementary data, are available online at https://academic.oup.com/ntr .

Funding related to the review topic include Canadian Institutes of Health Research Catalyst Grant 442011 awarded to JYK and US National Institute of Drug Abuse DA045740 awarded to JEM. JAF was supported by Canadian Institutes of Health Research Vanier Canadian Graduate Scholarship during the preparation of the manuscript.

None declared.

JAF, CJN, JEM, and JYK conceptualized the paper. JAF and CJN wrote initial drafts. JEM and JYK provided manuscript revisions and finalized the manuscript for submission; all authors have given feedback on the final manuscript and approved its submission.

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How Smoking and Drinking Affect the Body

Dr Chia Stanley

Cardiologist

Most people are aware that smoking and heavy drinking are unhealthy habits, but not many realise just how much harm they can cause.

Dr Stanley Chia , cardiologist at Mount Elizabeth Hospitals, explains the effects of smoking and drinking on our health.

Growing up, many children may view drinking and smoking as privileges of adults and therefore 'cool' activities to engage in. Media portrayal of smoking and alcohol use has certainly helped to perpetuate the appeal of these social habits. The importance of public awareness about the dangers of heavy smoking and drinking has never been greater.

The danger of smoking

Cigarettes contain more than 4,000 chemical compounds and 400 toxic chemicals that include tar, carbon monoxide, DDT, arsenic and formaldehyde. The nicotine in cigarettes, in particular, makes them highly addictive. There are so many diseases caused by smoking that it's hard to decide where to begin.

Any amount and type of smoking is bad for your health. Besides being a notorious risk factor for lung cancer , coronary artery disease , heart attack and stroke , smoking can damage almost any organ in our body, leading to leukaemia and cancers of the kidney, pancreas, bladder, throat, mouth and uterus. It can damage the airways and air sacs of our lungs to cause chronic bronchitis and breathing difficulties. It can also raise our blood pressure and cholesterol levels, reduce bone density in women and increase the risk of infertility, preterm delivery, stillbirth and sudden infant death syndrome.

The danger of heavy drinking: How much alcohol is too much?

Most people like to have a drink or two, be it beer, wine or spirits. Light drinking is acceptable and may even be beneficial for the heart. Heavy and binge drinking, on the other hand, can lead to serious medical problems.

Drinking 7 or more drinks per week is considered excessive drinking for women, while 15 drinks or more per week is deemed to be excessive for men.

A healthy limit for drinking is usually no more than 2 drinks (3 units of alcohol) a day for men and 1 drink (2 units) a day for women. Binge drinking means having 5 or more drinks for men and 4 or more drinks for women on one occasion.

Certain groups of people should not drink alcohol at all. These include young people under the age of 18, pregnant women, people with certain health conditions, patients on medication that will interact with alcohol, recovering alcoholics, and people who intend to drive or do activities that require attention and coordination.

Heavy drinking can lead to many serious health conditions. Binge drinking can cause immediate problems such as acute intoxication, nausea and vomiting, blurred vision, impaired judgment and alcohol poisoning.

In the long term, heavy alcohol consumption can cause high blood pressure, gastric problems, liver cirrhosis, liver cancer, pancreatitis, memory impairment, alcohol dependence and various psychological conditions. Excessive alcohol drinking can also result in accidental injuries and even death. Pregnant women who drink heavily can harm their babies.

Effects of smoking and drinking on the heart

Both tobacco and alcohol can affect the heart. While the deleterious effect of smoking on the risk of cardiovascular disease is well-recognised and straightforward (the risk of heart disease increases with the amount of smoking), the impact of drinking is more complex.

Some evidence suggests that moderate drinking (3 – 14 drinks a week) may be associated with a lower risk of heart attack, while heavier drinking may well increase the risk of heart attack, heart failure, stroke and high blood pressure.

As smoking is also common among alcohol drinkers, and smokers and drinkers frequently share similar behavioural and lifestyle patterns, it is currently unclear whether it is the combined or independent effects of smoking and alcohol that greatly raises cardiovascular risk.

Nonetheless, the health problems associated with excessive smoking and drinking are extensive. Public health efforts to minimise the dangers of both smoking and drinking may significantly improve the well-being of society.

Benefits of kicking the habit

It is important to realise that quitting smoking can improve your quality of life – physically, emotionally and financially. It can help you and those around you breathe better and live longer.

People who stop smoking generally have an improved sense of smell and taste, feel less stressed and become more energetic. They will usually have younger looking skin and improved fertility. Their loved ones will be healthier as passive smoking is reduced.

For people who drink too much, alcohol tolerance can lead to false reassurance that they are drinking within limits, since they do not feel drunk. Health benefits of reducing alcohol intake include weight loss, a reduced risk of many forms of cancer, less anxiety, clearer skin, no hangovers and better self-esteem.

Withdrawal symptoms of smoking

While you're trying to quit smoking, you will experience some withdrawal symptoms. These symptoms are usually the worst in the first week and then gradually improve. Common physical symptoms to expect include:

• Appetite increase. You will feel hungry more often as the effects of chemicals from cigarettes are no longer present.
• Nicotine cravings. Each craving will only last about 15 – 20 minutes but it will happen often and throughout the quitting process.
• Cough. This may last for a few weeks as your respiratory system cleans itself.
• Mild headaches and dizziness. These are often the first withdrawal symptoms to appear but they also resolve quickly.
• Tiredness. In the absence of nicotine, which is a stimulant, you will likely feel tired, restless, and might have insomnia.
• Constipation. This may occur in the first month of quitting.
• Mental and emotional symptoms. These include anxiety, depression, irritability, and mental fog.

How to quit: Smoking cessation

Smoking cessation means abstaining from cigarettes and/or other tobacco products for at least 6 months, but preferably for a year. This can be a challenging attempt as the nicotine in tobacco is addictive and cause dependence. You will experience several unpleasant short-term effects and withdrawal symptoms as you embark on this effort. Nevertheless, smokers can and do quit smoking for good.

Smokers who quit smoking with support are more likely to succeed than those who do it on their own. Hence, it is helpful for those trying to stop to consult a health professional on engage a smoking cessation programme.

For regular, very heavy drinkers, stopping alcohol consumption abruptly can be dangerous. They should therefore consult their doctors to manage the withdrawal symptoms.

Always remember that our health is important to us and our families, and we should take care to safeguard it.

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Cigarette and Alcohol Consumption Essay

Over time, advertisements on smoking and alcoholism have been carefully crafted to entice consumers. For instance, the three videos, Vintage Lucky Strike Cigarette Commercial, Channing Tatum in Mountain Dew Best Commercial Ever , and Thank You for Smoking , are advertising the consumption of alcohol and cigarettes attractively. These substances pose tremendous challenges to an individual’s health, family, and attitude towards people.

Alcohol and smoking have changed the way people act, and this reflects the behaviors of all characters in the three videos. According to Vintage Lucky Strike Cigarette Commercial , smoking raises irritability and anxiety as evident among the characters. Moreover, the habit is costly to maintain as an addicted individual should purchase cigarettes daily. Thank You for Smoking also shows that nicotine, in cigarettes affects recognition as to some extent, the characters take a while before recognizing people. Channing Tatum in Mountain Dew Best Commercial Ever portrays the driver and his friends risking their lives by excessive consumption of alcohol. Their acts, for example, when Tatum forgets a soda he bought, reveal that the substance impairs memory. Indeed, alcohol and cigarette consumption pose behavioral, biological, and psychological impacts, which necessitate cessation.

The clips on smoking also reveal that the behavior is harmful to a child’s development. In Thank You for Smoking, a father’s addiction to cigarettes has caused negative psychological impacts on his child, and one of the children says, “do not ruin my childhood.” Some children perceive that cigarettes can kill following their parents’ behaviors. As such, long-term consumption of this substance leads to loss of body weight, which is evident from all the characters who appear to have unhealthy body weights. Therefore, alcohol and cigarette consumption are life-threatening, apart from causing rejection from family members.

Conclusively, alcohol and cigarette consumption is accompanied by tremendous challenges. They drain users financially because they should maintain the habit daily due to addiction. The substances also have immense implications on the behavior and cognition of an individual. Additionally, users tend to lose weight and become irritable with time. Smokers and alcoholics also face rejection from their family members, apart from being forgetful. Indeed, none of these substances are good for human consumption and the user pays enormous prices, which include the challenges mentioned earlier. There is a choice to quit alcohol and cigarette consumption to live a healthy life and raise a safe generation.

Works Cited

“Channing Tatum in Mountain Dew Best Commercial Ever.” YouTube, uploaded by Katyan Anuj, 2009. Web.

“Thank You for Smoking.” YouTube , uploaded by Foxhomeent, 2011. Web.

“Vintage Lucky Strike Cigarette Commercial.” YouTube , uploaded by Seansvoivce, 2010. Web.

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IvyPanda. (2022, September 8). Cigarette and Alcohol Consumption. https://ivypanda.com/essays/cigarette-and-alcohol-consumption/

"Cigarette and Alcohol Consumption." IvyPanda , 8 Sept. 2022, ivypanda.com/essays/cigarette-and-alcohol-consumption/.

IvyPanda . (2022) 'Cigarette and Alcohol Consumption'. 8 September.

IvyPanda . 2022. "Cigarette and Alcohol Consumption." September 8, 2022. https://ivypanda.com/essays/cigarette-and-alcohol-consumption/.

1. IvyPanda . "Cigarette and Alcohol Consumption." September 8, 2022. https://ivypanda.com/essays/cigarette-and-alcohol-consumption/.

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IvyPanda . "Cigarette and Alcohol Consumption." September 8, 2022. https://ivypanda.com/essays/cigarette-and-alcohol-consumption/.

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Essay on Smoking

500 words essay on  smoking.

One of the most common problems we are facing in today’s world which is killing people is smoking. A lot of people pick up this habit because of stress , personal issues and more. In fact, some even begin showing it off. When someone smokes a cigarette, they not only hurt themselves but everyone around them. It has many ill-effects on the human body which we will go through in the essay on smoking.

Ill-Effects of Smoking

Tobacco can have a disastrous impact on our health. Nonetheless, people consume it daily for a long period of time till it’s too late. Nearly one billion people in the whole world smoke. It is a shocking figure as that 1 billion puts millions of people at risk along with themselves.

Cigarettes have a major impact on the lungs. Around a third of all cancer cases happen due to smoking. For instance, it can affect breathing and causes shortness of breath and coughing. Further, it also increases the risk of respiratory tract infection which ultimately reduces the quality of life.

In addition to these serious health consequences, smoking impacts the well-being of a person as well. It alters the sense of smell and taste. Further, it also reduces the ability to perform physical exercises.

It also hampers your physical appearances like giving yellow teeth and aged skin. You also get a greater risk of depression or anxiety . Smoking also affects our relationship with our family, friends and colleagues.

Most importantly, it is also an expensive habit. In other words, it entails heavy financial costs. Even though some people don’t have money to get by, they waste it on cigarettes because of their addiction.

How to Quit Smoking?

There are many ways through which one can quit smoking. The first one is preparing for the day when you will quit. It is not easy to quit a habit abruptly, so set a date to give yourself time to prepare mentally.

Further, you can also use NRTs for your nicotine dependence. They can reduce your craving and withdrawal symptoms. NRTs like skin patches, chewing gums, lozenges, nasal spray and inhalers can help greatly.

Moreover, you can also consider non-nicotine medications. They require a prescription so it is essential to talk to your doctor to get access to it. Most importantly, seek behavioural support. To tackle your dependence on nicotine, it is essential to get counselling services, self-materials or more to get through this phase.

One can also try alternative therapies if they want to try them. There is no harm in trying as long as you are determined to quit smoking. For instance, filters, smoking deterrents, e-cigarettes, acupuncture, cold laser therapy, yoga and more can work for some people.

Always remember that you cannot quit smoking instantly as it will be bad for you as well. Try cutting down on it and then slowly and steadily give it up altogether.

Get the huge list of more than 500 Essay Topics and Ideas

Conclusion of the Essay on Smoking

Thus, if anyone is a slave to cigarettes, it is essential for them to understand that it is never too late to stop smoking. With the help and a good action plan, anyone can quit it for good. Moreover, the benefits will be evident within a few days of quitting.

FAQ of Essay on Smoking

Question 1: What are the effects of smoking?

Answer 1: Smoking has major effects like cancer, heart disease, stroke, lung diseases, diabetes, and more. It also increases the risk for tuberculosis, certain eye diseases, and problems with the immune system .

Question 2: Why should we avoid smoking?

Answer 2: We must avoid smoking as it can lengthen your life expectancy. Moreover, by not smoking, you decrease your risk of disease which includes lung cancer, throat cancer, heart disease, high blood pressure, and more.

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

The Issue of Smoking and Alcohol Drinking Among Adolescents

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Published: Feb 8, 2022

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Persuasive Essay Guide

Persuasive Essay About Smoking

Persuasive Essay About Smoking - Making a Powerful Argument with Examples

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Are you wondering how to write your next persuasive essay about smoking?

Smoking has been one of the most controversial topics in our society for years. It is associated with many health risks and can be seen as a danger to both individuals and communities.

Writing an effective persuasive essay about smoking can help sway public opinion. It can also encourage people to make healthier choices and stop smoking. 

But where do you begin?

In this blog, we’ll provide some examples to get you started. So read on to get inspired!

• 1. What You Need To Know About Persuasive Essay
• 2. Persuasive Essay Examples About Smoking
• 3. Argumentative Essay About Smoking Examples
• 4. Tips for Writing a Persuasive Essay About Smoking

What You Need To Know About Persuasive Essay

A persuasive essay is a type of writing that aims to convince its readers to take a certain stance or action. It often uses logical arguments and evidence to back up its argument in order to persuade readers.

It also utilizes rhetorical techniques such as ethos, pathos, and logos to make the argument more convincing. In other words, persuasive essays use facts and evidence as well as emotion to make their points.

A persuasive essay about smoking would use these techniques to convince its readers about any point about smoking. Check out an example below:

Simple persuasive essay about smoking

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Persuasive Essay Examples About Smoking

Smoking is one of the leading causes of preventable death in the world. It leads to adverse health effects, including lung cancer, heart disease, and damage to the respiratory tract. However, the number of people who smoke cigarettes has been on the rise globally.

A lot has been written on topics related to the effects of smoking. Reading essays about it can help you get an idea of what makes a good persuasive essay.

Here are some sample persuasive essays about smoking that you can use as inspiration for your own writing:

Persuasive speech on smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

Persuasive Essay About Smoking Introduction

Persuasive Essay About Stop Smoking

Short Persuasive Essay About Smoking

Stop Smoking Persuasive Speech

Check out some more persuasive essay examples on various other topics.

Argumentative Essay About Smoking Examples

An argumentative essay is a type of essay that uses facts and logical arguments to back up a point. It is similar to a persuasive essay but differs in that it utilizes more evidence than emotion.

If you’re looking to write an argumentative essay about smoking, here are some examples to get you started on the arguments of why you should not smoke.

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

Argumentative essay about smoking introduction

Check out the video below to find useful arguments against smoking:

Tips for Writing a Persuasive Essay About Smoking

You have read some examples of persuasive and argumentative essays about smoking. Now here are some tips that will help you craft a powerful essay on this topic.

Choose a Specific Angle

Select a particular perspective on the issue that you can use to form your argument. When talking about smoking, you can focus on any aspect such as the health risks, economic costs, or environmental impact.

Think about how you want to approach the topic. For instance, you could write about why smoking should be banned. 

Check out the list of persuasive essay topics to help you while you are thinking of an angle to choose!

Research the Facts

Before writing your essay, make sure to research the facts about smoking. This will give you reliable information to use in your arguments and evidence for why people should avoid smoking.

You can find and use credible data and information from reputable sources such as government websites, health organizations, and scientific studies. 

For instance, you should gather facts about health issues and negative effects of tobacco if arguing against smoking. Moreover, you should use and cite sources carefully.

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Make an Outline

The next step is to create an outline for your essay. This will help you organize your thoughts and make sure that all the points in your essay flow together logically.

Your outline should include the introduction, body paragraphs, and conclusion. This will help ensure that your essay has a clear structure and argument.

Use Persuasive Language

When writing your essay, make sure to use persuasive language such as “it is necessary” or “people must be aware”. This will help you convey your message more effectively and emphasize the importance of your point.

Also, don’t forget to use rhetorical devices such as ethos, pathos, and logos to make your arguments more convincing. That is, you should incorporate emotion, personal experience, and logic into your arguments.

Introduce Opposing Arguments

Another important tip when writing a persuasive essay on smoking is to introduce opposing arguments. It will show that you are aware of the counterarguments and can provide evidence to refute them. This will help you strengthen your argument.

By doing this, your essay will come off as more balanced and objective, making it more convincing.

Finish Strong

Finally, make sure to finish your essay with a powerful conclusion. This will help you leave a lasting impression on your readers and reinforce the main points of your argument. You can end by summarizing the key points or giving some advice to the reader.

A powerful conclusion could either include food for thought or a call to action. So be sure to use persuasive language and make your conclusion strong.

To conclude,

By following these tips, you can write an effective and persuasive essay on smoking. Remember to research the facts, make an outline, and use persuasive language.

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SMOKING CIGARETTES, DRINKING ALCOHOLIC BEVERAGES, AND STUDENTS' ACADEMIC PERFORMANCE IN SCIENCE AND TECHNOLOGY IN A PHILIPPINE NATIONAL HIGH SCHOOL

2021, IOER International Multidisciplinary Research

This research ascertained the relationships between the smoking behavior, alcohol drinking behavior and academic performance of Science and Technology students in Dasmariňas National High School using descriptive-correlational method. Specifically, the study aimed to describe the cigarette smoking behavior and alcohol drinking behavior among high school students; determine the academic performance of the students; determine the significant relationship among academic performance, cigarette smoking behavior, and alcohol drinking behavior; and determine the significant relationship between smoking cigarette and alcohol drinking behavior. Data were gathered using a validated researcher-made test questionnaires and were further analyzed using frequency counts, percentage and chi-square test. More than one-fourth of the respondents who were identified drinkers smoked mostly 1-3 times per week, and the majority were mild drinkers who can consume 1-3 bottles of alcoholic beverages per week. The academic performance of the respondents belonged to the average level. This study reveals that frequency of smoking and drinking alcoholic beverages affects the academic performance of the students. Drinking alcoholic beverages is highly significant to smoking. Results of this study serve as reminders for parents to provide more time to their children in dealing with the habits of smoking cigarettes and drinking alcoholic beverages.

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The relationships between specific quantities and frequencies of alcohol, cigarette, and illicit substance use and substance use (SUD) and other psychiatric disorders were investigated among 1,285 randomly selected children and adolescents, aged 9 to 18, and their parents, from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Logistic regressions indicated that daily cigarette smoking, weekly alcohol consumption, and any illicit substance use in the past year were each independently associated with an elevated likelihood of diagnosis with SUD and other psychiatric disorders (anxiety, mood, or disruptive behavior disorders), controlling for sociodemographic characteristics (age, gender, ethnicity, family income). The associations between the use of specific substances and specific psychiatric disorders varied as a function of gender.

Joshua Eniojukan

The prevalence in the use of alcohol calls for concern especially in the hands of adolescents. This study therefore sought to determine the Prevalence and Patterns of Alcohol Use among Senior Secondary School Students in Abraka, Delta state, Nigeria. This was a cross sectional study among 456 respondents drawn from 4 randomly selected mixed secondary schools in Abraka. The respondents were Senior Secondary School Students who were selected through multi-stage random sampling. Data collected were analysed with SPSS Version 20. Majority (97%) of the respondents were aged 11-20 years; 52% were males; 95% were Christians and 77% lived with both parents. Alcohol use prevalence was 55%; there were more male(35%) than female(20%) drinkers; 66% consumed beer, 86% of them consumed alcoholic wine; 45% began drinking at 11-15 years; 42% drank at ceremonies; 10% drank for pleasure; 22% drank because they feel it was a sociable thing to do; 4% and 2% respectively drink because their parents and friends also drank.71% were currently drinking; Alcoholic wines are most favoured. Alcohol drinking habit was associated with gender but not with religion and class specialization. In conclusion, alcohol use prevalence among senior secondary school students in Abraka was quite high, with most of the students initiating the habit at an early age. The prevalent socio-cultural environment and traditions appeared to be a key factor in this community. There is need, therefore, to develop viable underage preventive programmes on alcohol use for adolescents in this community.

Harshitha Menon

Man on earth ever since had a major role to play in the development of him and the country, slowly was drawn to drink to relax, celebrate and socialize as alcohol is legal and a popular social activity. Alcohol taken in low-risk patterns is called Social drinkers. Many people who drink are not alcoholics. Alcohol in moderation is what keeps social drinkers merely social and not full-blown alcoholics. The precipice of alcoholism is slippery and anybody can slide down, no matter how much they think they will never become one. People who drink heavily is at risk for adverse health consequences (biologically) and the drinker be it social drinker or alcoholic develops guilt (psychologically) if the intake is crossing the regular limit. The encyclopedia of psychology defines Guilt as a cognitive or an emotional experience that occurs when a person believes or realizes accurately or not that he or she has compromised his or her own standards of conduct or has violated a moral standard and bears significant responsibility for that violation. It is closely related to the concept of remorse. Guilt prone, leads to feel low in esteem as they do not perform an expected active and responsible role in the family and ultimately to the society. So the present study attempts to find out whether the social drinkers and alcoholics differ in terms of guilt and self esteem. The sample consists of 100 members of which 50 are social drinkers and the remaining 50 are alcoholics. They are in the age group of 35 to 55 years. Purposive sampling technique is used to select the sample and Expost facto research design is being used. Guilt Questionnaire by Malcolm Miller, and Rosenberg Self Esteem Scale (1965) are used to measure Guilt and self esteem respectively.Independent t test (critical ratio) and Pearson‟s product moment correlation are used to analyse the data.

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Persuasive Essay Writing

Persuasive Essay About Smoking

Craft an Engaging Persuasive Essay About Smoking: Examples & Tips

Published on: Jan 25, 2023

Last updated on: Jan 29, 2024

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Are you stuck on your persuasive essay about smoking? If so, don’t worry – it doesn’t have to be an uphill battle. 

What if we told you that learning to craft a compelling argument to persuade your reader was just a piece of cake? 

In this blog post, we'll provide tips and examples on writing an engaging persuasive essay on the dangers of smoking…all without breaking a sweat! 

So grab a cup of coffee, get comfortable, and let's get started!

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Persuasive Essay-Defined 

A persuasive essay is a form of academic writing that presents an argument in favor of a particular position, opinion, or viewpoint. 

It is usually written to convince the audience to take a certain action or adopt a specific viewpoint. 

The primary purpose of this type of essay is to provide evidence and arguments that support the writer's opinion.

In persuasive writing, the writer will often use facts, logic, and emotion to convince the reader that their stance is correct. 

The writer can persuade the reader to consider or agree with their point of view by presenting a well-researched and logically structured argument. 

The goal of a persuasive essay is not to sway the reader's opinion. It is to rather inform and educate them on a particular topic or issue. 

Check this free downloadable example of a persuasive essay about smoking!

Simple Persuasive essay about smoking

Read our extensive guide on persuasive essays to learn more about crafting a masterpiece every time. 

Persuasive Essay Examples About Smoking 

Are you a student looking for some useful tips to write an effective persuasive essay about the dangers of smoking? 

Look no further! Here are several great examples of persuasive essays that masterfully tackle the subject and persuade readers creatively.

Persuasive speech on the smoking outline

Persuasive essay about smoking should be banned

Persuasive essay about smoking pdf

Persuasive essay about smoking cannot relieve stress

Persuasive essay about smoking in public places

Speech about smoking is dangerous

For more examples about persuasive essays, check out our blog on persuasive essay examples .

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Argumentative Essay About Smoking Examples

Our examples can help you find the points that work best for your style and argument. 

Argumentative essay about smoking introduction

Argumentative essay about smoking pdf

Argumentative essay about smoking in public places

10 Tips for Writing a Persuasive Essay About Smoking 

Here are a few tips and tricks to make your persuasive essay about smoking stand out: 

1. Do Your Research

 Before you start writing, make sure to do thorough research on the topic of smoking and its effects. 

Look for primary and secondary sources that provide valuable information about the issue.

2. Create an Outline

An outline is essential when organizing your thoughts and ideas into a cohesive structure. This can help you organize your arguments and counterarguments.

Read our blog about creating a persuasive essay outline to master your next essay.

Check out this amazing video here!

3. Clearly Define the Issue

 Make sure your writing identifies the problem of smoking and why it should be stopped.

4. Highlight Consequences

 Show readers the possible negative impacts of smoking, like cancer, respiratory issues, and addiction.

5. Identity Solutions 

Provide viable solutions to the problem, such as cessation programs, cigarette alternatives, and lifestyle changes.

6. Be Research-Oriented  

Research facts about smoking and provide sources for those facts that can be used to support your argument.

7. Aim For the Emotions

Use powerful language and vivid imagery to draw readers in and make them feel like you do about smoking.

8. Use Personal Stories 

Share personal stories or anecdotes of people who have successfully quit smoking and those negatively impacted by it.

9. Include an Action Plan

Offer step-by-step instructions on how to quit smoking, and provide resources for assistance effectively.

10. Reference Experts 

Incorporate quotes and opinions from medical professionals, researchers, or other experts in the field.

These tips can help you write an effective persuasive essay about smoking and its negative effects on the body, mind, and society. 

When your next writing assignment has you feeling stuck, don't forget that essay examples about smoking are always available to break through writer's block.

And if you need help getting started, our expert essay writer at CollegeEssay.org is more than happy to assist. 

Just give us your details, and our persuasive essay writer will start working on crafting a masterpiece. 

We provide top-notch essay writing service online to help you get the grades you deserve and boost your career.

Try our AI writing tool today to save time and effort!

Frequently Asked Questions

What would be a good thesis statement for smoking.

A good thesis statement for smoking could be: "Smoking has serious health risks that outweigh any perceived benefits, and its use should be strongly discouraged."

What are good topics for persuasive essays?

Good topics for persuasive essays include the effects of smoking on health, the dangers of second-hand smoke, the economic implications of tobacco taxes, and ways to reduce teenage smoking. 

These topics can be explored differently to provide a unique and engaging argument.

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Cigarette Smoking and the Risk for Alcohol Use Disorders Among Adolescent Drinkers

Background:.

Cigarette smoking and alcohol use disorders are closely linked, but it is not clear whether higher rates of alcohol use disorder (AUD) among smokers are solely attributable to heavier drinking, or alternatively, whether smokers are more vulnerable to alcohol abuse and dependence than non-smokers who drink comparable quantities. We sought to address this issue using data from a nationally representative U.S. sample of adolescents and young adults. Specifically, we analyzed the relationship between cigarette smoking, drinking, and alcohol use disorders.

Data were from the aggregated 2002 through 2004 U.S. National Survey on Drug Use and Health. Participants were randomly selected, household-dwelling adolescents and young adults (ages 12-20) from the non-institutionalized, civilian population of the United States (N=74,836). Measurements included current DSM-IV alcohol abuse or dependence, number of drinks in the past 30-days, and past-year cigarette smoking, defined as having smoked more than 100 cigarettes across the lifetime and having smoked during the past year.

Past-year smokers, (prevalence=16.0%) drank in higher quantities than never-smokers, but were also at elevated risk for AUD when compared to never-smokers who drank equivalent quantities. The effect was observed across age groups, but was more prominent among younger adolescents. After adjusting for drinking quantity and sociodemographic variables, smokers had 4.5-fold higher odds of AUD than never-smokers (95% CI: 3.1-6.6). Youths who reported smoking but did not cross the 100-cigarette threshold were at intermediate risk (OR=2.3, 95% CI: 1.7-3.3). Differences in AUD between smokers and never-smokers were most pronounced at lower levels of drinking.

Conclusions:

The results are consistent with a higher vulnerability to alcohol use disorders among smokers, compared to non-smokers who drink equivalent quantities.

Introduction

Tobacco smoking and excessive alcohol use comprise the first and third most lethal modifiable risk factors affecting health in the United States ( Mokdad et al., 2004 ). Every year, approximately 1.5 million people in the U.S. become daily cigarette smokers and the overwhelming majority of those individuals are adolescents and young adults ( Chen and Kandel, 1995 ; Substance Abuse and Mental Health Services Administration, 2004 ; U. S. Department of Health and Human Services, 1994 ). In addition to the chronic effects that smoking has on morbidity later in life, smoking in adolescence presents a unique set of health-risks, including reduced rates of lung growth and elevated respiratory problems ( Arday et al., 1995 ). Moreover, individuals who smoke early in life are less likely to quit as adults ( Breslau and Peterson, 1996 ). Likewise, alcohol use typically begins in adolescence, and early initiation of alcohol use is a strong predictor of subsequent problems and dependence ( DeWit et al., 2000 ; Grant and Dawson, 1997 ; Prescott and Kendler, 1999 ).

In addition to the direct impact of smoking and excessive drinking on general health outcomes, there is a strong tendency for cigarette smoking and alcohol dependence to co-occur, and both are associated with other drug use disorders ( Dani and Harris, 2005 ; Grant et al., 2004 ; John et al., 2004 ; Kessler et al., 2005 ). Tobacco smoking and alcohol use have long been recognized as early and important steps on the pathway to more serious drug use ( Kandel, 1975 ; Kandel et al., 1992 ; Lai et al., 2000 ; Torabi et al., 1993 ). Because of their legality (for adults) and ready availability, both alcohol and tobacco are seen as gateways to more serious substance use. Cigarette smoking is of special interest because cigarettes were legally available to minors until recently, and are still readily available to minors from the Internet and non-commercial sources ( Castrucci et al., 2002 ; Jensen et al., 2004 ; Ribisl et al., 2003 ). Moreover, evidence from a number of studies indicates that cigarette smoking is a strong predictor of subsequent alcohol use, abuse and dependence ( Biederman et al., 2005 ; Chen et al., 2002 ; Grant, 1998 ; Lewinsohn et al., 1999 ). Prospective ( Lewinsohn et al., 1999 ) and retrospective ( Grant, 1998 ) studies have shown that the age at which smoking starts is a robust predictor of heavy alcohol consumption and alcohol use disorders. In an analysis of retrospective data from a large, nationally representative sample, this association held even when accounting for such factors as age at first drink, duration of alcohol use and family history of alcohol dependence ( Grant, 1998 ).

While the link between smoking and alcoholism is well documented, it is not clear whether smoking is simply related to heavier drinking, resulting in alcohol problems, or whether drinkers who smoke are more vulnerable to alcohol use disorders than those who do not. A great deal of research on the connection between cigarette smoking and alcohol use or alcoholism has focused on psychosocial factors, which presumably lead to higher levels of drinking by resulting in more opportunities and greater inclinations to drink. Such factors include deviant peer group association, and risk-prone personality traits that are known to predict use of alcohol and other drugs ( Dinn et al., 2004 ; Fergusson et al., 2002 ; Kopstein et al., 2001 ; Wills and Cleary, 1999 ). However, these psychosocial factors may not completely account for the association between early smoking and subsequent alcohol and drug problems ( Siqueira and Brook, 2003 ). Some authors have speculated that the pathway from use of alcohol and tobacco to abuse of the same substances, and of illicit drugs, may be facilitated by effects of early-stage drug use on central reward circuitry. Such suggestions are based on observations in animal models that exposure to some drugs alters future behavioral responses to the same or other drugs ( Schenk, 2002 ).

One potential indicator of whether groups of individuals exhibit differential vulnerability to addiction for a given substance is the relationship between use and abuse or dependence. This approach was used by Chen and Kandel to examine the relationship between substance use and dependence for the cases of nicotine and cocaine ( Chen and Kandel, 2002 ; Kandel and Chen, 2000 ;). In the present study, we take an analogous approach to address whether smoking might predict differential susceptibility to alcohol abuse and/or dependence, also known as alcohol use disorder (AUD). We sought to examine the relationship between alcohol consumption and AUD in youths ages 12-20 as a function of cigarette smoking. Higher levels of AUD among smokers who drink at similar levels as their never-smoking counterparts could indicate that smoking among youths is associated specifically with vulnerability to AUD, rather than simply being a predictor of higher rates of drinking.

The National Survey on Drug Use and Health is an ideal source of data to address these questions further because it is the only major U.S. national survey that assesses diagnostic criteria for alcohol use disorder (AUD) among younger adolescents (ages 12-14), in addition to including commonly used measures of alcohol consumption. To our knowledge, none of the existing studies on the associations between smoking and AUD in adolescence utilize nationally representative samples, except those based on retrospective reports from adults. Accordingly, this report will also describe the epidemiology of cigarette smoking and AUD in a large, nationally representative sample of adolescents and young adults.

Survey Description

Data were aggregated from the 2002 through 2004 administrations of the National Survey on Drug Use and Health (NSDUH; Substance Abuse and Mental Health Services Administration, 2003 ; Wright et al., 2002 ). Samples for all three administrations were selected to be representative of the non-institutionalized civilian population of the United States, ages 12 and older, including those residing in group quarters (e.g., college dormitories). Independent, multistage area probability samples were collected each year for all 50 U.S. states and the District of Columbia. The total sample size was 135,910. Prior to public release of the data, sub-sampling was used to protect respondent identity, reducing the combined sample size to 109,309. The survey was conducted anonymously, that is, participants' names were not recorded or linked with their answers. General information was collected in face-to-face interviews administered by trained interviewers while audio computer-assisted self-interview (ACASI) methods were used to collect sensitive information; i.e. responses to substance use modules were not disclosed to the interviewer. Informed consent was obtained from all participants.

Oversampling of youths (ages 12-17) and young adults (ages 18-25) was incorporated into the NSDUH procedures. The present analyses include subjects ages 20 and younger. Age 20 was selected as the upper bound to avoid complications arising from combining legal aged drinkers with underage drinkers in the same analyses. Response rate for the 12-20 year-old age bracket was 80.7% for the 2002-2004 surveys. The subsample size for individuals under age 21 was 75,633; 78 participants were excluded from the analyses because of missing responses to questions needed for smoking categorization.

Cigarette Smoking

Individuals who indicated that they had ever smoked cigarettes were probed about the quantity they had smoked and whether they had ever smoked daily for a period of 30 days or longer. For the present analyses, individuals who had never initiated smoking were classified as never-smokers (n=44,009). Those who had ever smoked, but had smoked 100 or fewer cigarettes in their lifetime were classified as experimenters (n=19,442). Former smokers (individuals who had smoked more than 100 cigarettes in their lives, but reported not smoking at all in the past year) were excluded from the analyses (n=719), as were subjects with incomplete data on necessary variables (n=78). Those who had smoked more than 100 cigarettes in their lives and reported any past-year smoking were classified as smokers (n=11,385). Resulting sample size for the analyses was 74,836. The 100-cigarette threshold is a commonly used cutoff, employed by several major surveys including the National Health Interview Survey (e.g., Wortley et al., 2003 ). Individuals whose tobacco use was limited to pipes, cigars, or smokeless tobacco were counted as never-smokers (n=3,050, or 4.1% of the total sample). The vast majority (85.9%) of non-cigarette tobacco users also smoked cigarettes at some point in their lives. The decision to count the remainder as never-smokers was made as a more conservative alternative to excluding these subjects from the analyses. Analyses contrasted past-year smokers with never-smokers and experimenters.

Alcohol Use

Questions assessing quantity of alcohol use covered the past 30-day time frame. Past-30 day consumption was calculated from responses to questions regarding the number of drinking days during this time frame and the typical amount consumed per drinking day. For some descriptive analyses, categories of drinking quantity were defined based on the distribution among the subset of participants who reported one or more drink in the past month (n=18,290 or 25.3% of the weighted sample). The cutoffs were chosen such that the lowest drinking category (1-8 drinks in the past month) comprised approximately 40% of past-month drinkers, while the remaining three groups (9-20 drinks, 21-50 drinks, more than 50 drinks) each consisted of about 20% of these subjects.

Alcohol Use Disorder

The NSDUH interview included a section of 14 questions that probed symptoms of DSM-IV ( American Psychiatric Association, 2000 ) alcohol abuse and dependence that was administered to past-year drinkers. Each question is asked on a 12-month basis; e.g., “During the past 12 months, did drinking alcohol cause you to do things that repeatedly got you in trouble with the law?” Alcohol-use disorder, defined as the presence of alcohol abuse or dependence in the last 12-months, was coded according to DSM-IV specifications. The level of agreement between alcohol-use disorder diagnoses obtained using the NSDUH interview and clinician-administered interviews is comparable to levels of agreement with clinician diagnoses obtained using state-of-the-art lay-administered structured interviews (BK Jordan, RS Karg, K Batts, CA Wiesen, and JF Epstein; Manuscript submitted for publication, 2005).

Other Variables

Age was categorized into three, 3-year intervals: 12-14 years old, 15-17 years and 18-20 years old. Race combined with ethnicity was grouped into four categories: White, Black, Hispanic, and other; the latter category includes non-Hispanic mixed race individuals. For models incorporating past 30-day quantity of alcohol consumption, the logarithms of the number of drinks was used. The log transformation was a substantially better predictor of AUD than the untransformed variable. Inclusion of polynomial terms did not result in substantive improvements in model fit. Family income was grouped into four categories: <$20,000 per year, $20,000-$50,000 per year, $50,000-$75,000 per year and over $75,000 per year. Population density was defined by whether or not the individual resided in a metropolitan statistical area, or “metropolitan area”, as defined by the U.S. Census Bureau.

Statistical Methods

All statistical analyses were conducted using the SUDAAN statistical software package ( RTI International, 2004 ). Variance estimation utilized a Taylor linearization method appropriate for the multistage design of the survey; sampling weights were utilized for all analyses so that the sample was demographically representative of the 12-20 year old U.S. population according to U.S. census estimates. Two-by-two contingency tables with Chi-square tests were used to analyze associations between categorical variables. Logistic regression models were employed for bivariate and multivariate models of alcohol use disorder.

Sociodemographic Correlates of Youth Smoking

Demographic description of the unweighted and weighted 2002-2004 NSDUH sample is presented in Table 1 . The prevalences of past-year smoking by demographic group are presented in Table 2 . For this sample of youths ages 12-20, the prevalence of past-year smoking was 16.0% (SE=0.2%) -- this includes only individuals who report having smoked more than 100 cigarettes in their life. The vast majority (84%) of past-year smokers reported being daily smokers, defined as ever having smoked daily for a period of 30 days or longer. Hence, the 100-cigarette cut-off appears to be effective at identifying committed smokers in this age range. An additional 26.3% of youths reported trying smoking at some point in their lives (labeled “experimenters”), but had not crossed the 100-cigarette threshold. Males and females reported smoking in approximately equal numbers in the 12-16 year old range, but there were more male smokers than female smokers in the 17-20 year-old range. Only 2.1% (SE=0.1) of 12-14 year-olds reported past-year smoking but prevalence rose rapidly with age: more than one-in-three 19-20 year-olds reported past-year smoking. Smoking was more prevalent in White youths than in racial / ethnic minorities, particularly Black youths. Youths from lower income households were more likely to report past-year smoking, as were those from non-metropolitan areas.

Demographic Composition of 2002-04 NSDUH Samples of Youth 20 and Under.

Prevalence of Smoking 1 by Demographic Group

Past-month Drinking by Smoking Status and Demographics

Past-month drinking quantity was grouped into five categories: No drinking at all, between 1 and 8 drinks, 9 to 20 drinks, 21-50 drinks and 50 or more drinks. Populations of these categories by demographic group are shown in Table 3 . Overall, 25.3% of youths drank in the past month, roughly 10 percent had 8 or fewer drinks, and each of the three heavier drinking categories comprised about 5% of youths. Males and females were nearly equally represented among non-drinkers, though males exhibited a slight trend to drink more heavily. Drinking quantity rose sharply with age, with fewer than 1% of 12-14 year olds drinking more than 20 drinks in the past month, contrasted with 8.3% of 15-17 and more than 20% of 18-20 year olds. White youths were more likely than other racial and ethnic groups to report drinking, while Black youths were the least likely to report drinking. There was a slight trend toward more drinking for youths from the lowest income group, <$20,000 per year, and only trivial differences between youths within a metropolitan statistical area (MSA) and those outside of an MSA. As expected, smoking status was a very strong predictor of drinking behavior. For example, the prevalence of drinking more than 50 drinks in the past 30 days was 19% among smokers, contrasted with 5.7% among experimenters and only 0.6% among never-smokers.

Past-month Drinking Quantity, by Smoking and Demographic Group

Prevalence and Univariate Predictors of Alcohol Use Disorder

Of the full sample, 9.5% (SE=0.2) of youths met criteria for past year alcohol use disorder, which is defined as alcohol abuse or dependence; this includes a 3.6% prevalence of alcohol dependence combined with a 5.9% prevalence of alcohol abuse only. Among the subset of youth who report any past-30 day drinking, 29.0% (SE=0.5) met diagnostic criteria for alcohol use disorder. The left-hand side Table 4 describes the univariate predictors of AUD among past-month drinkers, including smoking status, past-month drinking quantity, and demographic factors. In the univariate logistic models, smoking status is highly predictive of AUD. Compared with never-smokers, smokers had more than 4-fold higher odds of AUD and experimenters had over 2-fold higher odds. Age was inversely associated with AUD; the odds ratio for 12-14 year olds was 0.6, relative to 18-20 year-olds; 15-17 year olds were equivalent to their older counterparts in terms of AUD risk. Black youth were at substantially lower risk than Whites. Males were at 1.4-fold higher risk than females. Youths from households earning less than $20,000 per year were at slightly elevated odds for AUD; there were was no significant difference in AUD risk associated with living in a metropolitan area compared with living in a non-metropolitan area.

Univariate and Multivariate Logistic Regression Models for the Prediction of Alcohol use Disorder among Past-Month Drinkers (N=18,290).

Smoking Status as a Predictor of AUD at Fixed Levels of Drinking

The relationship between drinking quantity and alcohol use disorder in is listed Table 4 as the odds ratio between AUD and the logarithm of the number of drinks consumed in the past-30 days. This relationship is explored in more detail in Figure 1 , which contrasts the prevalence of AUD in smokers with the prevalence in never-smokers in each category of drinking quantity. Separate plots were generated for each of the three age groups -- two cells with fewer than 40 individuals were omitted from the analysis. For all groups, smokers had higher rates of AUD than never-smokers at any given quantity of drinking. Hence, even at low levels of alcohol use, youths who smoke have high rates of alcohol use disorder. For example, among youths who report 1-8 drinks in the past month, 28.4% of 12-14 year-old smokers met criteria for AUD, as well as 22.5% of 15-17 year-old smokers and 19.0% of 18-20 year-old smokers. In contrast, the prevalences of AUD for never-smokers in the same category of drinking quantity were 4.2%, 5.5%, and 4.3% respectively. Experimenters were omitted from the plots for clarity, but generally constituted an intermediate category between never-smokers and smokers.

Prevalence of past-year alcohol use disorder among past-30 day drinkers. Prevalences for never smokers (Open Circles) and smokers (Filled Circles) are plotted as a function of past-month drinking quantity, stratified by age. Cells with fewer than 40 subjects were omitted from the analysis.

Multivariate Regression Model of AUD

The right-hand side of Table 4 summarizes the multivariate logistic regression model of AUD, predicted from demographic variables, smoking status, and past-month drinking quantity. Models were computed for males and females separately, and for the combined sample. In addition to the variables listed above, two-way interactions were tested between drinking quantity (logarithm of number of past-month drinks), smoking status, and age category, as these were the largest predictors in the univariate models. The smoking status by age category interaction did not reach significance, and so was not included in the final model, but the other two interactions were included. Results for all models are shown, though the male and female models exhibited few differences. To facilitate presentation of the results, we will focus on the combined sex model and only refer to single-sex models where important differences were observed.

Smoking status remained a substantial predictor of AUD, even after adjusting for drinking quantity and other variables, consistent with the results shown in Figure 1 . Smokers were at 4.5-fold higher odds for AUD than non-smokers, with experimenters falling between the two groups. Younger age groups, though at lower overall risk for AUD in the univariate models, were at elevated risk after adjusting for drinking quantity, smoking status, and demographic characteristics. Family income was no longer a significant predictor in the multivariate model, and the protective effect observed for Black youth relative to Whites in the bivariate model was not present in the multivariate model. Likewise, males and females were at equal odds for AUD in the multivariate model. The differences associated with race, gender, and family income in the bivariate analyses are likely to be partially or fully attributable to differences in drinking behavior, which are accounted for in the multivariate model.

Age and smoking status both interacted with drinking quantity in the prediction of AUD for the combined gender (overall Wald-χ 2 = 10.5 and 11.2, respectively, both p<0.001) and male-only (Wald-χ 2 =5.7, 7.4, p=0.004 and p<0.001, respectively) models; only the interaction of smoking status with drinking quantity was significant in the female-only model. The interactions were all negative, indicating a lower slope between drinking quantity and AUD for smokers and for younger adolescents. As discussed in more detail below, this is a reflection of the elevated risk for smokers and for younger adolescents at low quantities of drinking (intercepts). In the combined gender model, the interaction odds ratio between drinking quantity and smoking category was 0.5 (95% CI 0.4-0.7) for smokers and 0.7 (95% CI: 0.5-0.9) for experimenters, relative to never-smokers. The interaction odds ratio between drinking quantity and age category was 0.6 (95% CI 0.4-0.8) for 12-14 year olds and 0.7 (95% CI: 0.6-0.8) for 15-17 year olds, relative to 18-20 year olds.

To dissect the contributions of the two significant statistical interactions to overall risk profiles, the probability of AUD was calculated as a function of past-month drinking quantity for smokers and never-smokers, stratified by age. These calculations were based on the odds ratios derived from the regression analyses described above; results are plotted in Figure 2 . For clarity, the experimenter groups were omitted from this plot. At low levels of drinking, smokers are at higher risk than non-smokers and younger adolescents are at higher risk than older individuals. Differences in prevalence between smokers and never-smokers are especially prominent for younger age groups, resulting in very high risk for young smokers, even at low quantities of drinking. Differences between smokers and never-smokers and between younger and older subjects are diminished at higher levels of drinking. Hence, the lower slopes for smokers and younger adolescents in the AUD versus drinking quantity plot are offset by higher levels of AUD at low levels of drinking for these groups.

Probability of Alcohol Use Disorder among past-30 day drinkers, predicted from regression analysis for smokers (black lines) and never-smokers (white lines). Probabilities are also stratified by age group: 12-14 (hashes), 15-17 (circles), and 18-20 (triangles).

Ancillary Analyses

In order to assess the robustness of the results to analytical decisions, we conducted two additional analyses. In the first, the decision made in the original analysis to count non-cigarette smoking tobacco users (i.e., those who only used cigars, pipes, or smokeless tobacco) as never-smokers was evaluated. The final multivariate regression model for the prediction of AUD was recomputed with these users excluded from the analyses (n=3,050 or 4.1% of the original sample). Odds ratio estimates were little changed from those listed Table 4 , and in all cases were within the 95% CI of the original OR; for example, OR estimates were 5.0 for smokers (95% CI: 3.3-7.6) and 2.6 for experimenters (95% CI: 2.6-5.0). In the second analysis, the measure of past-30 day drinking quantity was replaced with past-year drinking frequency; i.e., the number of drinking days in the past year. Though this is a less precise measure because it assesses number of drinking days, but not number of drinks per drinking day, it reflects the time frame over which AUD was assessed. In this analysis, smokers and experimenters were still at elevated risk compared to never-smokers (OR=3.9; 95% CI: 2.4-6.4 and OR=2.6; 95% CI: 1.6-4.3, respectively). Likewise, younger adolescents were at elevated risk (12-14 year old vs. 18-20 year old: OR=2.2; 95% CI: 1.2-4.1; 15-17 year old vs. 18-20 year old: OR=3.1; 95% CI: 2.1-4.6) and drinking frequency exhibited significant, negative interactions with smoking status and age. Hence, the major findings of the analysis were robust to differences in exclusion criteria and choice of quantitative indicator of alcohol use.

Among youth ages 12 to 20, 16% reported past-year smoking. Smokers reported substantially higher quantities of past-month drinking than either experimenters or never-smokers. Among those who reported drinking in the past month, smokers had 4-fold higher odds of past-year AUD, and experimenters had more than two-fold higher odds of past-year AUD. Hence, smokers have higher rates of heavy drinking and AUD than never-smokers. However, these differences were observed at all levels of drinking quantity and across all age categories. After adjusting for demographic variables and drinking quantity, the odds of past-year AUD among smokers remained more than 4-fold higher than those for never-smokers; likewise experimenters remained at more than 2-fold higher odds for AUD than never-smokers. Therefore, the connection between smoking and AUD cannot be attributed solely to heavier drinking among smokers.

Though AUD was a strong function of drinking quantity, this relationship was moderated by age and smoking status. Large differences in AUD prevalence between smokers and never-smokers, and between older and younger subjects, are observed at low levels of drinking. These differences diminish at higher levels of drinking. This results in negative interactions between drinking quantity and age, and between drinking quantity and smoking status. The combination of young age and smoking puts adolescent smokers at especially high risk for AUD, and this additional risk is most pronounced at comparatively low levels of drinking. In other words, among adolescents, young smokers are at substantially higher risk for AUD than their non-smoking counterparts who drink comparable quantities.

The finding of high levels of AUD at low levels of drinking for adolescent smokers is reminiscent of the work of Kandel and Chen, relating smoking quantity to symptoms of nicotine dependence. In particular, they reported that adolescents had higher rates of nicotine dependence than adults at equivalent levels of smoking. Likewise, females exhibited higher rates of nicotine dependence than males at equivalent smoking quantities. These authors hypothesized that different rates of dependence at equivalent levels of use reflected differential sensitivity to nicotine, though they emphasized that this hypothesis requires further testing ( Kandel and Chen, 2000 ). We have taken a complementary approach by examining use of one substance as a risk factor for addiction to another substance at equivalent levels of use of the second substance. Moreover, we have focused on adolescents only, so that a finer-grained examination of age trends within this important period of risk for AUD could be carried out. We reiterate the hypothetical nature of the interpretation of higher levels of dependence at equivalent levels of use as a reflection of heightened sensitivity to the substance (alcohol, in our case).

Assuming that elevated susceptibility to AUD at equivalent quantities of drinking is truly indicative of pharmacological sensitivity to alcohol, it remains to be determined whether adolescent smoking has a causal effect on that sensitivity, or whether it is an indicator of preexisting vulnerability. There may be other unmeasured or unanalyzed variables that mediate this association, including genetic factors. Adolescent smoking may be an indicator of genetic predisposition to AUD, and other unknown factors may contribute to both outcomes. That is, genetic or other factors involved in the initiation of adolescent smoking may also play a role in the development of alcohol abuse and dependence. However, these mechanisms are not mutually exclusive. That is, smoking may be both an indicator of pre-existing vulnerability to AUD and may also have a pharmacological influence on response to alcohol that modulates susceptibility to AUD.

There is abundant evidence from animal studies that nicotine impacts the adolescent central nervous system in such a manner as to increase vulnerability to addiction and that such effects are unique to adolescence ( Adriani and Laviola, 2004 ). For example, in adolescent rat models, nicotine effects on gene expression and brain development are more deleterious than those observed in adults ( Trauth et al., 1999 ). Additionally, adolescent rats exposed to nicotine become sensitized to the behavioral effects of subsequent cocaine exposure, suggesting that nicotine may alter future behavioral response to other drugs, thereby increasing vulnerability to alcohol and other drug use disorders ( Collins and Izenwasser, 2004 ; McMillen et al., 2005 ). Thus, adolescent nicotine exposure in animals results in persistent neurobiological changes that may influence the reinforcing effects of multiple drugs of abuse ( McMillen et al., 2005 ; Trauth et al., 2001 ; Trauth et al., 2000 ). Such observations have led to the proposal that nicotine may act as a “neurochemical gateway” to more serious substance abuse ( Kelley and Rowan, 2004 ). However, it remains to be determined whether the well-documented effects of nicotine exposure on adolescent brain development in animals extend to humans.

Despite our inability to determine a precise mechanism by which the association between adolescent smoking and AUD takes place, these findings add to the large number of documented deleterious health effects associated with smoking, particularly among young people. Additionally, these results suggest that understanding the role of cigarette smoking in the development of alcohol dependence and other addictions could yield substantial public health benefits. If it is found that nicotine influences risk for AUD via direct pharmacological effects on brain development akin to those seen in animal models, a powerful message could be added to adolescent health education programs; namely, that smoking in adolescence poses tangible risks for the brain in addition to other well-known risks for physical health.

Among the limitations of this study is the use of self-reported data for substance use and abuse, which could introduce reporting bias as a confounding variable. The absence of longitudinal data represents an additional limitation; closely spaced longitudinal data on drinking quantity, smoking, and AUD on a representative sample of adolescents would allow for testing of a variety of causal models. However, very large samples would be required conduct analyses similar to those presented here. Accordingly, a major strength of this study is the large sample size, which provided the necessary statistical power to analyze the complex relationship between smoking, drinking quantity, and AUD in adolescence. Additional strengths are the representativeness of the sample and the availably of past-year diagnostic data directly from adolescent participants, rather than reliance on longer-term retrospective data from adults.

Adolescent smokers are more likely to drink and are at substantially elevated risk for alcohol use disorders than their never-smoking counterparts. This association remains even after adjusting for quantity of alcohol use, using either stratification or regression approaches. Moreover, the vulnerability to AUD is especially pronounced among younger smokers. Hence, smoking is not only an indicator of heavier drinking, but is associated with vulnerability to AUD even when accounting for drinking behaviors.

Acknowledgements

The Author's are grateful to Mr. Joe Gfroerer (SAMHSA-OAS), Dr. Tom Przybeck (Washington University), and Dr. Lewis R. Goldberg (Oregon Research Institute) for valuable comments on the manuscript).

Funding: Analysis and manuscript preparation were supported by NIH-K01DA16618 (RAG), NIH-U10AA08401 (LJB), and NIH-P01CA089392 (LJB). The NSDUH was sponsored by the Substance Abuse and Mental Health Services Administration, Office of Applied Studies (SAMHSA-OAS); field work was conducted by RTI, International. NSDUH data was obtained from the Substance Abuse and Mental Health Data Archive through the Inter-university Consortium for Political and Social Research ( http://www.icpsr.umich.edu/SAMHDA ).

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Four unhealthy habits – and how to break them

W hether it’s smoking, vaping , caffeine, alcohol, or late-night snacking , it can be very hard to kick an unhealthy habit. Just ask Adele. The singer previously gave up her 25-a-day cigarette habit, but she just can’t seem to quit caffeine , and has been left with withdrawal symptoms including migraines and “the shakes”. 

“I decided this week to stop drinking coffee,” she told her audience in Las Vegas. “It was harder than giving up cigarettes, harder than when you want to stop drinking… I had a splitting headache for two days because I cut it out. My head was pounding. It was like there was a drill inside my head. It was a lot.”

Research shows it takes 66 days to form a habit and, once it’s set, it can prove very difficult to break. Your vice of choice – whether it’s a flat white, a cigarette or a packet of biscuits – prompts the release of dopamine, the neurotransmitter responsible for feelings of pleasure and reward, and it can seem impossible to cut it out.

“The only way I can cut down on something is to impose an arbitrary rule on myself,” says one colleague of mine, who has valiantly cut out 4pm biscuits and other sweet treats in the office. “I invented a rule that I wouldn’t have sugary snacks from Monday to Friday. And going cold turkey during the week actually means I crave sugar less when Saturday comes, as I’ve broken the addictive cycle.”

More than just dogged determination, there are certain tips and tricks that can help you boot a bad habit once and for all. Here’s how.

There’s nothing inherently wrong with a morning coffee, and multiple studies have indicated that moderate caffeine consumption can have health benefits . But while you might not think of it as a drug, caffeine can cause dependency like any other addictive substance – as Adele knows all too well.

“Caffeine addiction is a subtle combination of physical and psychological addiction,” says John Dicey, co-author of the Allen Carr books on how to quit smoking. Caffeine blocks adenosine receptors (which promote sleep), which increases the production of dopamine and other neurotransmitters that play a role in cognitive function, such as noradrenaline and glutamate.

However, you end up needing more to chase down that energy boost. “Stimulants tend to become less effective the more you use them. If you have a coffee every time you’re tired, it eventually stops working… [you’re] becoming even more exhausted, and seemingly even more in need of another fix. Your mind associates taking the drug with feeling better than you did the moment before.” How can you cut down?

There is some anecdotal evidence to suggest that switching to decaffeinated coffee can help, and this is a tactic Adele has employed. “I did have about 25 decaf coffees yesterday, trying to trick my brain into thinking I was drinking coffee,” she said.

As with any bad habit, it is more helpful to replace it with a healthier one, rather than focus on cutting it out. With coffee, this could be decaf, but it could also be a herbal tea or a different soft drink.

You may experience the predictable withdrawal symptoms: headaches, fatigue and irritability, to name a few. But persevere. More important than weathering the physical symptoms is changing your mindset around caffeine withdrawal.

“Whether it’s a drug or a habit that you want to rid yourself of – don’t worry about withdrawal. Those feelings are mostly caused by a sense that you’ve sacrificed something, or given up something precious,” says Dicey. “If you think in terms of having ‘got rid of’ a habit or drug, rather than having ‘given it up’, it makes a huge psychological difference.” Remember, too, he argues, that most of the energy you glean from caffeine is an “illusionary boost… If you really are tired, then your body is asking for sleep and rest, not caffeine.”

It is notoriously hard to give up cigarettes – in one study, which followed 630 smokers who tried to quit, only 22 per cent managed to keep their resolve after two weeks, and just 8 per cent at six months. But as a former 80-a-day smoker, Dicey can advise.

There are different schools of thought, but he argues it is better to go cold turkey than to taper down. “Most people who taper down find it harder to quit… and often end up smoking more. By controlling it, it makes cigarettes seem even more precious,” he says. One study published in Psychological Science found that smokers who tried to control their thoughts of smoking found they thought about it more.

Here’s how you should go about it. With smoking, as with any habit you want to break, “set a date and stick to it”, he says. “Think of the date you plan to change as a big day, something to look forward to rather than dread. You’re planning to make a really positive change that will make you happier, healthier and more in control of your life – it’s something to anticipate with relish rather than fear.”  

The second tip is to avoid trying to quit through willpower alone. Research shows that nicotine-replacement therapies, such as skin patches, chewing gum and nasal sprays, can be effective, especially when combined with support from a stop-smoking service.  

“Most people go about quitting the wrong way… willpower [alone] doesn’t really work,” says Dicey. “Rather than focusing on the downsides – smokers know all the bad stuff and it doesn’t prevent them smoking – the best way to look at it is what are the arguments for smoking? For instance, ‘It makes me feel less stressed.’ Once they’ve understood why they do it, they can begin to understand why smoking doesn’t actually help with those things.” Research shows that the stress and anxiety levels of smokers are actually higher than non-smokers.

A sugary snack habit can be among the most difficult to quit, as sugar itself is pretty hard to avoid. “We’re faced with high-sugar foods everywhere we go and every supermarket is laden with sugary options,” says nutritionist Jenna Hope. As with smoking, simply relying on willpower to break a bad habit is unlikely to work.

One 2008 study published in the journal Appetite found that those who suppressed their thoughts about eating chocolate experienced a behavioural rebound effect and ended up eating significantly more chocolate than those who didn’t.

Sugar isn’t an addictive substance, but it can stimulate the brain’s “reward centre” in a similar way to caffeine and other dependencies, says Hope. It can also contribute to a “blood-sugar rollercoaster”.

Instead of going cold turkey (which, in the case of sugar, is nigh on impossible), she suggests gradually decreasing your overall intake. If you have sugar in tea or coffee, for example, try “halving the amount you’re adding to tea and coffee, and then slowly halve it again and again, until you no longer need sugar in your hot drinks”.

She also recommends “starting the day with a savoury breakfast, such as peanut butter on rye toast, eggs or cottage cheese on crackers with vegetables, as this can help to stabilise your blood-sugar levels”, and swapping one sugary snack per day for a savoury option.

Plenty of us are aware that we could do with cutting down on how much we drink – although if your drinking has become a problem and tipped into alcohol addiction, the advice is to speak to your GP or call the free national alcohol helpline, Drinkline, in confidence.

But if you are primarily a social drinker wanting to break the habit of always saying yes to that second glass of wine on a weeknight, the same bad-habit-breaking principles apply. Replacing an unhealthy habit with a healthier one is key. Follow specific strategies, rather than rely on willpower alone: for example, try implementing a rule of two dry days per week; alternating one alcoholic beverage with a non-alcoholic one at the pub; and taking a 20-minute break between drinks.

Have you managed to break a bad habit? Tell us how in the comments section below 

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Donnelly: No plan to ban sale of alcohol to under-21s despite move on cigarettes

Under plans approved by Cabinet, the legal age for buying cigarettes and other tobacco products will be raised from 18 to 21.

The health minister said there are no plans to ban the sale of alcohol to people under the age of 21, despite a move to raise the minimum age for the purchase of cigarettes.

Under plans approved by Cabinet, the legal age for buying cigarettes and other tobacco products will rise from 18 to 21.

It would make Ireland the first country in the EU to take the measure.

On raising the age for buying alcohol, Stephen Donnelly said there is no advice that it would “necessarily be effective”.

“There’s no consideration of any changes on alcohol whatsoever. It’s never come up. It’s not being considered,” Mr Donnelly said on Tuesday.

“It’s not being considered by anybody. We have no clinical advice that it’s necessary or would necessarily be effective.”

He said that while there is a Government goal that no one in Ireland smokes, there is no such strategy for alcohol.

“There are obviously health implications of excessive drinking and on that Ireland has taken an important global leadership position,” he added.

“We’ve introduced the alcohol labelling to include a cancer warning and to include warnings on alcohol, which I think people really do need to know about.

“We brought in minimum unit pricing. We brought in several measures which I think are important in terms of tackling excessive and harmful drinking.

“But there’s a very different national strategy between alcohol and cigarettes.”

He said plans to increase the legal age of buying cigarettes to 21 should see a reduction in smokers by several percentage points.

Mr Donnelly also defended not including the sale of vapes in its proposed legislation, saying the clinical advice is “not in at this point”.

“We got very clear clinical advice in terms of mandating a minimum age of 18 for the sale of vapes based on cognitive development and impairing cognitive development,” he added.

“Clinical evidence may be emerging but it’s certainly not at the point of increasing from 19 and 20-year-olds but it is something that I think should be should be kept under review.”

The Fianna Fail minister went on to accuse the tobacco industry of “coming and having another go” in downplaying the dangers of vaping, similar to campaigns that were previously run by tobacco companies.

“We have ongoing and emerging evidence of the harms that vaping causes, including damage to the lungs,” he added.

He said the Government is introducing other measures around the advertising and licensing of vapes, and plans to ban the sale of disposable vapes.

“We’re also drafting legislation looking at colours and flavouring. My view, rightly or wrongly, is there has been a very cynical attempt to target young people with vapes,” Mr Donnelly added.

Minister of State Ossian Smyth said he is concerned about the environmental impact of vapes.

“What we’re seeing is in the last couple of years an explosion in use amongst teenagers, and that’s resulting in tens of millions of these vapes ending up in the environment,” he said.

“We’re now going to proceed, myself and the Department of Health, to seek a ban on disposable vapes.”

The Government’s latest move comes 20 years after Ireland became the first country in the world to ban smoking in workplaces, including pubs and restaurants.

Currently, 18% of the population over the age of 15 are smokers.

The new proposal is designed to reduce Ireland’s adult smoking rate to less than 5%.

Smoking and exposure to second-hand smoke kills an estimated 4,500 people a year in Ireland.

The Government said evidence shows that people are at high risk of becoming smokers between the ages of 18 and 21.

It added that raising the minimum purchasing age will make it harder for young people to access tobacco products through direct and proxy buys as well as social sources.

Health officials said smoking causes 13% of all cancers and contributes to many preventable illnesses including respiratory and cardiovascular diseases, eye diseases, diabetes and rheumatoid arthritis.

It is also responsible for 5% of hospital inpatient admissions, while the financial loss caused by smoking is estimated at 10.6 billion euro annually.

Chief Medical Officer Professor Breda Smyth said: “Our smoking rates are still unacceptably high, so I am delighted that we are progressing a strong population protection measure that will help bring us closer to the goal of a tobacco-free Ireland.”

The Bill will provide that the prohibition on tobacco product sales will not apply to those who are currently between the ages of 18 and 20.

The proposed legislation will not impact the minimum legal age of sale of nicotine-inhaling products or vapes.

Since December, the sale of vapes to under-18s has been banned. There is currently no proposal to extend this ban to the age of 21.

The Government said preliminary legal advice suggests Ireland cannot pursue a “smokefree generation” policy as has been suggested in other jurisdictions because of the EU’s single market rules and Tobacco Products Directive.

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