Smoking and treatment outcome for alcoholics: Effects on coping skills, urge to drink, and drinking rates

The interrelationship between alcohol and tobacco addiction is beginning to receive more attention because it has conceptual and practical significance for understanding and treating addictive disorders. This investigation focuses on the effects of smoking on risk for relapse after alcoholism treatment. The relationships between smoking and: (1) alcohol consumption rate and dependence at pretreatment, (2) reactions to coping with alcohol high-risk-for-relapse role plays, and (3) alcohol treatment outcome were investigated. These relationships were studied first in a sample of male VA alcoholics (n=45) and then replicated and extended in a different sample from a private hospital (n=53 females, 110 males). Smoking and drinking rate, and smoking and alcohol dependence, were significantly correlated at pretreatment. Smokers with greater dependence on cigarettes (i.e., higher Fagerstrom Tolerance Questionnaire scores; shorter latency to smoking first cigarette of the day) experienced significantly greater urge to drink, urge to smoke, difficulty, and anxiety in role plays of alcohol high-risk situations, independent of their pretreatment drinking rate or alcohol dependence. Smoking dependence did not predict mean number of drinks per day or frequency of drinking days during 6-month follow-up. In the private hospital sample, among alcoholics who drank at all during follow-up, the more dependent smokers drank more alcohol on drinking days than did the less dependent smokers. Implications for theory and treatment of addictive disorders are discussed.