Marked Reduction of Heavy Drinking did not Reduce Nicotine Use over 1 Year in a Clinical Sample of Alcohol-Dependent Patients

Introduction

Alcohol abuse and nicotine consumption are highly correlated [1]. Neurobiological theories suggest that both substances are strong reinforcers because of their effect on increased dopamine release in the mesolimbic system [2] [3], and that reinforcing effects are enhanced in the case of combined consumption [2]. Pharmacological interactions between alcohol and nicotine influence both metabolization and receptor activation and thus might play an important role in maintaining the combined use of both substances. For example, a smoking-induced increase of nicotine blood concentration leads to a desensitization of neuronal nicotine cholinergic receptors (nAChR), thus limiting the nicotine effects. Conversely, alcohol increases those nAChR activities which were limited by nicotine [4]. Reduction of unpleasant side effects of one substance by the other may also support combined consumption. Alcohol-induced impairments of motor coordination [5] and GABA_A-mediated alcohol withdrawal symptoms seem to be reduced by nicotine consumption [6]. Such neurobiological mechanisms might explain the frequent concomitant consumption of both substances. It might be assumed that heavily drinking smokers who markedly decrease their alcohol intake will also decrease their nicotine consumption and dependence.

References

• 1 Bien TH, Burge R. Smoking and drinking: a review of the literature.  Int J Addict. 1990;  25 1429-1454
• 2 Balfour DJ. The neurobiology of tobacco dependence: a preclinical perspective on the role of the dopamine projections to the nucleus.  Nicotine Tob Res. 2004;  6 899-912
• 3 Koob GF, Roberts AJ, Schulteis G. et al . Neurocircuitry targets in ethanol reward and dependence.  Alcohol Clin Exp Res. 1998;  22 3-9
• 4 Narahashi T, Soderpalm B, Ericson M. et al . Mechanisms of alcohol-nicotine interactions: alcoholics versus smokers.  Alcohol Clin Exp Res. 2001;  25 152S-156S
• 5 Dar MS, Bowman ER, Li C. Intracerebellar nicotinic-cholinergic participation in the cerebellar adenosinergic modulation of ethanol-induced motor incoordination in mice.  Brain Res. 1994;  644 117-127
• 6 Staley JK, Gottschalk C, Petrakis IL. et al . Cortical gamma-aminobutyric acid type A-benzodiazepine receptors in recovery from alcohol dependence: relationship to features of alcohol dependence and cigarette smoking.  Arch Gen Psychiatry. 2005;  62 877-888
• 7 Wölwer W, Frommann N, Kilgus E. et al . Alkoholabhängigkeit: Evaluation einer Kombinationsbehandlung mit Acamprosat und integrativer Verhaltenstherapie [Alcohol dependence: Evaluation of a combined treatment with acamprosate and integrative behavioural therapy].  Der Nervenarzt. 2006;  77 (S 02) S245
• 8 Heatherton TF, Koziowski LT, Frecker RC. et al . The FTND for nicotine dependence: A revision of the FTND tolerance questionnaire.  Br J Addict. 1991;  86 1119-1127
• 9 Dawson DA, Roomb R. Towards agreement on ways to measure and report drinking patterns and alcohol-related problems in adult general population surveys: the Skarpö Conference overview.  J Subst Abuse. 2000;  12 1-21
• 10 Friend KB, Pagano ME. Changes in cigarette consumption and drinking outcomes: findings from Project MATCH.  J Subst Abuse Treat. 2005;  29 221-229
• 11 Hintz T, Mann K. Long-term behavior in treated alcoholism: Evidence for beneficial carry-over effects of abstinence from smoking on alcohol use and vice versa.  Addict Behav. 2007;  32 3093-3100
• 12 Lesch OM, Walter H. Alkohol und Tabak. Medizinische und soziologische. Aspekte von Gebrauch, Missbrauch und Abhängigkeit.. Wien: Springer Verlag; 2009
• 13 Gilbertson R, Frye RF, Nixon SJ. Nicotine as a factor in stress responsiveness among detoxified alcoholics.  Alcohol Alcohol. 2010;  Nov 2 [Epub ahead of print]
• 14 Anton RF, O’Malley SS, Ciraulo DA. et al . Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial.  JAMA. 2006;  295 2003-2017

Correspondence