Nikotinabhängigkeit als komorbide Störung bei Alkoholabhängigkeit - Epidemiologie, Ätiologie und Therapie

Zusammenfassung

Alkohol- und Nikotinabhängigkeit sind hoch miteinander assoziiert. Bei dieser zweifachen Abhängigkeit ist die Intensität der jeweiligen einzelnen Abhängigkeit hoch und der Verlauf ungünstiger als bei isolierter Abhängigkeit. Dies betrifft auch die Folgen der Abhängigkeiten für die körperliche Gesundheit und die kognitive Funktionstüchtigkeit. Mögliche biologische Ursachen dieser häufigen Komorbidität sind die additive belohnende Wirkung der Substanzen bei gemeinsamem Konsum, pharmakologische Interaktionen der Substanzen mit Einfluss auf Rezeptoraktivierung und Metabolisation mit Kompensation unangenehmer Alkoholnebenwirkungen durch Nikotinkonsum sowie eine gemeinsame genetische Disposition für beide Abhängigkeiten. Aus psychologischer Perspektive handelt es sich bei der Assoziation der beiden Konsumhandlungen um ein erlerntes Verhalten. Die Befürchtung, nikotinabhängige Alkoholabhängige seien an einer Nikotinentwöhnung nicht interessiert und ohnehin von einer Behandlung beider Abhängigkeiten generell überfordert, ist nicht empirisch gesichert. Allerdings sind die Erfolgsraten einer Nikotinentwöhnung bei dieser Gruppe geringer als bei Nikotinabhängigen ohne Alkoholprobleme. Bei den entsprechenden Untersuchungen wurden allerdings die üblichen therapeutischen Strategien zur Nikotinentwöhnung angewendet. Speziell auf Patienten mit Doppelabhängigkeit zugeschnittene Strategien sind wünschenswert.

Abstract

There is a high association between alcohol and nicotine dependence. Compared to one particular dependence, associated nicotine and alcohol dependence are more severe and the course is more unfavourable for each dependence. This also applies to the sequels of dependence regarding physical health and cognitive functions. Possible biological causes for this high comorbidity are 1) an additive rewarding effect by combined consumption, 2) substance interaction with an impact on receptor activation and metabolism which results in reduction of adverse acute alcohol effects, and 3) a combined genetic disposition for both addictions. From a psychological point of view the association of both acts of use is learned. There is no evidence for the commonly presumed fundamental lack of interest, motivation, and ability for smoking cessation in alcohol dependent patients. The outcome of smoking cessation programs, however, is less successful compared to smokers without alcohol problems. Respective studies have used the common therapeutic strategies for nicotine addiction. Specifically adapted strategies for patients with a dual dependence are required.

Nikotinabhängigkeit - Alkoholabhängigkeit - Therapie - Komorbidität - Ätiologie

Nicotine dependence - alcohol dependence - therapy - comorbidity - aetiology

Literatur

• 1 Peto R, Lopez A D, Boreham J, Thun M, Heath Jr C. Mortality from tobacco in developed countries: indirect estimation from national vital statistics.  Lancet. 1992;  339 1268-1278
• 2 WHO .The World Health Report 2002. Reducing Risks, Promoting Health Life. Geneva: WHO, World Health Organisation 2003
• 3 Peto R, Lopez A D, Boreham J, Thun M, Heath Jr C, Doll R. Mortality from smoking worldwide.  Br Med Bull. 1996;  52 12-21
• 4 Hughes J R. Treatment of nicotine dependence. Is more better?.  JAMA. 1995;  274 1390-1391
• 5 Bien T H, Burge R. Smoking and drinking: a review of the literature.  Int J Addict. 1990;  25 1429-1454
• 6 DiFranza J R, Guerrera M P. Alcoholism and smoking.  J Stud Alcohol. 1990;  51 130-135
• 7 Gulliver S B, Rohsenow D J, Colby S M, Dey A N, Abrams D B, Niaura R S, Monti P M. Interrelationship of smoking and alcohol dependence, use and urges to use.  J Stud Alcohol. 1995;  56 202-206
• 8 Johnson K A, Jennison K M. The drinking-smoking syndrome and social context.  Int J Addict. 1992;  27 749-792
• 9 Grant B F, Hasin D S, Chou S P, Stinson F S, Dawson D A. Nicotine dependence and psychiatric disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions.  Arch Gen Psychiatry. 2004;  61 1107-1115
• 10 Leonard S, Adler L E, Benhammou K, Berger R, Breese C R, Drebing C, Gault J, Lee M J, Logel J, Olincy A, Ross R G, Stevens K, Sullivan B, Vianzon R, Virnich D E, Waldo M, Walton K, Freedman R. Smoking and mental illness.  Pharmacol Biochem Behav. 2001;  70 561-570
• 11 Hurt R D, Patten C A. Treatment of tobacco dependence in alcoholics.  Recent Dev Alcohol. 2003;  16 335-359
• 12 Pomerleau C S. Co-factors for smoking and evolutionary psychobiology.  Addiction. 1997;  92 397-408
• 13 Romberger D J, Grant K. Alcohol consumption and smoking status: the role of smoking cessation.  Biomed Pharmacother. 2004;  58 77-83
• 14 Batel P, Pessione F, Maitre C, Rueff B. Relationship between alcohol and tobacco dependencies among alcoholics who smoke.  Addiction. 1995;  90 977-980
• 15 John U, Meyer C, Rumpf H J, Hapke U. Probabilities of alcohol high-risk drinking, abuse or dependence estimated on grounds of tobacco smoking and nicotine dependence.  Addiction. 2003;  98 805-814
• 16 York J L, Hirsch J A. Drinking patterns and health status in smoking and nonsmoking alcoholics.  Alcohol Clin Exp Res. 1995;  19 666-673
• 17 Daeppen J B, Smith T L, Danko G P, Gordon L, Landi N A, Nurnberger Jr J I, Bucholz K K, Raimo E, Schuckit M A. Clinical correlates of cigarette smoking and nicotine dependence in alcohol-dependent men and women. The Collaborative Study Group on the Genetics of Alcoholism.  Alcohol Alcohol. 2000;  35 171-175
• 18 Toneatto A, Sobell L C, Sobell M B, Kozlowski L T. Effect of cigarette smoking on alcohol treatment outcome.  J Subst Abuse. 1995;  7 245-252
• 19 Hertling I, Ramskogler K, Dvorak A, Klingler A, Saletu-Zyhlarz G, Schoberberger R, Walter H, Kunze M, Lesch O M. Craving and other characteristics of the comorbidity of alcohol and nicotine dependence.  Eur Psychiatry. 2005;  20 442-450
• 20 Marks J L, Hill E M, Pomerleau C S, Mudd S A, Blow F C. Nicotine dependence and withdrawal in alcoholic and nonalcoholic ever-smokers.  J Subst Abuse Treat. 1997;  14 521-527
• 21 Hughes J R. Clinical implications of the association between smoking and alcoholism. In: Fertig J, Fuller R, eds (Hrsg.). Alcohol and Tobacco: From Basic Science to Policy. Rockville, MD: National Institute on Alcoholism and Alcohol Abuse 1996: 171-185
• 22 Currie S R, Hodgins D C, Guebaly N El, Campbell W. Influence of depression and gender on smoking expectancies and temptations in alcoholics in early recovery.  J Subst Abuse. 2001;  13 443-458
• 23 Hurt R D, Offord K P, Croghan I T, Gomez-Dahl L, Kottke T E, Morse R M, Melton III L J. Mortality following inpatient addictions treatment. Role of tobacco use in a community-based cohort.  JAMA. 1996;  275 1097-1103
• 24 Miller N S, Gold M S. Comorbid cigarette and alcohol addiction: epidemiology and treatment.  J Addict Dis. 1998;  17 55-66
• 25 Peto R, Lopez A D, Boreham J, Thun M, Heath Jr C, Doll R. Mortality from smoking worldwide.  Br Med Bull. 1996;  52 12-21
• 26 Vaillant G E, Schnurr P P, Baron J A, Gerber P D. A prospective study of the effects of cigarette smoking and alcohol abuse on mortality.  J Gen Intern Med. 1991;  6 299-304
• 27 Blot W J, McLaughlin J K, Winn D M, Austin D F, Greenberg R S, Preston-Martin S, Bernstein L, Schoenberg J B, Stemhagen A, Fraumeni Jr J F. Smoking and drinking in relation to oral and pharyngeal cancer.  Cancer Res. 1988;  48 3282-3287
• 28 Hawkins B T, Brown R C, Davis T P. Smoking and ischemic stroke: a role for nicotine?.  Trends Pharmacol Sci. 2002;  23 78-82
• 29 Bolego C, Poli A, Paoletti R. Smoking and gender.  Cardiovasc Res. 2002;  53 568-576
• 30 Meyerhoff D J, Tizabi Y, Staley J K, Durazzo T C, Glass J M, Nixon S J. Smoking comorbidity in alcoholism: neurobiological and neurocognitive consequences.  Alcohol Clin Exp Res. 2006;  30 253-264
• 31 Brody A L, Mandelkern M A, Jarvik M E, Lee G S, Smith E C, Huang J C, Bota R G, Bartzokis G, London E D. Differences between smokers and nonsmokers in regional gray matter volumes and densities.  Biol Psychiatry. 2004;  55 77-84
• 32 Hayee A, Haque A, Anwarullah A K, Rabbani M G. Smoking enhances age related brain atrophy - a quantitative study with computed tomography.  Bangladesh Med Res Counc Bull. 2003;  29 118-124
• 33 Durazzo T C, Gazdzinski S, Banys P, Meyerhoff D J. Cigarette smoking exacerbates chronic alcohol-induced brain damage: a preliminary metabolite imaging study.  Alcohol Clin Exp Res. 2004;  28 1849-1860
• 34 Gazdzinski S, Durazzo T C, Studholme C, Song E, Banys P, Meyerhoff D J. Quantitative brain MRI in alcohol dependence: preliminary evidence for effects of concurrent chronic cigarette smoking on regional brain volumes.  Alcohol Clin Exp Res. 2005;  29 1484-1495
• 35 Durazzo T C, Gazdzinski S, Rothlind J C, Banys P, Meyerhoff D J. Brain metabolite concentrations and neurocognition during short-term recovery from alcohol dependence: Preliminary evidence of the effects of concurrent chronic cigarette smoking.  Alcohol Clin Exp Res. 2006;  30 539-551
• 36 Ceballos N A, Tivis R, Lawton-Craddock A, Nixond S J. Nicotine and cognitive efficiency in alcoholics and illicit stimulant abusers: implications of smoking cessation for substance users in treatment.  Subst Use Misuse. 2006;  41 265-281
• 37 Ernst M, Heishman S J, Spurgeon L, London E D. Smoking history and nicotine effects on cognitive performance.  Neuropsychopharmacology. 2001;  25 313-319
• 38 Hill R D. Residual effects of cigarette smoking on cognitive performance in normal aging.  Psychol Aging. 1989;  4 251-254
• 39 Kalmijn S, Boxtel M P van, Verschuren M W, Jolles J, Launer L J. Cigarette smoking and alcohol consumption in relation to cognitive performance in middle age.  Am J Epidemiol. 2002;  156 936-944
• 40 Glass J M, Adams K M, Nigg J T, Wong M M, Puttler L I, Buu A, Jester J M, Fitzgerald H E, Zucker R A. Smoking is associated with neurocognitive deficits in alcoholism.  Drug Alcohol Depend. 2006;  82 119-126
• 41 Pierce R C, Kumaresan V. The mesolimbic dopamine system: the final common pathway for the reinforcing effect of drugs of abuse?.  Neurosci Biobehav Rev. 2006;  30 215-238
• 42 Balfour D J. 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
• 43 Balfour D J, Wright A E, Benwell M E, Birrell C E. The putative role of extra-synaptic mesolimbic dopamine in the neurobiology of nicotine dependence.  Behav Brain Res. 2000;  113 73-83
• 44 Koob G F, Roberts A J, Schulteis G, Parsons L H, Heyser C J, Hyytia P, Merlo-Pich E, Weiss F. Neurocircuitry targets in ethanol reward and dependence.  Alcohol Clin Exp Res. 1998;  22 3-9
• 45 Phillips T J, Shen E H. Neurochemical bases of locomotion and ethanol stimulant effects.  Int Rev Neurobiol. 1996;  39 243-282
• 46 Tizabi Y, Copeland Jr R L, Louis V A, Taylor R E. Effects of combined systemic alcohol and central nicotine administration into ventral tegmental area on dopamine release in the nucleus accumbens.  Alcohol Clin Exp Res. 2002;  26 394-399
• 47 Ericson M, Blomqvist O, Engel J A, Soderpalm B. Voluntary ethanol intake in the rat and the associated accumbal dopamine overflow are blocked by ventral tegmental mecamylamine.  Eur J Pharmacol. 1998;  358 189-196
• 48 Blomqvist O, Hernandez-Avila C A, Kirk J Van, Rose J E, Kranzler H R. Mecamylamine modifies the pharmacokinetics and reinforcing effects of alcohol.  Alcohol Clin Exp Res. 2002;  26 326-331
• 49 Young E M, Mahler S, Chi H, Wit H de. Mecamylamine and ethanol preference in healthy volunteers.  Alcohol Clin Exp Res. 2005;  29 58-65
• 50 Soderpalm B, Ericson M, Olausson P, Blomqvist O, Engel J A. Nicotinic mechanisms involved in the dopamine activating and reinforcing properties of ethanol.  Behav Brain Res. 2000;  113 85-96
• 51 Rose J E, Brauer L H, Behm F M, Cramblett M, Calkins K, Lawhon D. Potentiation of nicotine reward by alcohol.  Alcohol Clin Exp Res. 2002;  26 1930-1931
• 52 Hughes J R, Rose G L, Callas P W. Nicotine is more reinforcing in smokers with a past history of alcoholism than in smokers without this history.  Alcohol Clin Exp Res. 2000;  24 1633-1638
• 53 Campbell V C, Taylor R E, Tizabi Y. Antinociceptive effects of alcohol and nicotine: involvement of the opioid system.  Brain Res. 2006;  1097 71-77
• 54 Howard L A, Ahluwalia J S, Lin S K, Sellers E M, Tyndale R F. CYP2E1*1D regulatory polymorphism: association with alcohol and nicotine dependence.  Pharmacogenetics. 2003;  13 321-328
• 55 Howard L A, Miksys S, Hoffmann E, Mash D, Tyndale R F. Brain CYP2E1 is induced by nicotine and ethanol in rat and is higher in smokers and alcoholics.  Br J Pharmacol. 2003;  138 1376-1386
• 56 Narahashi T, Soderpalm B, Ericson M, Olausson P, Engel J A, Zhang X, Nordberg A, Marszalec W, Aistrup G L, Schmidt L G, Kalouti U, Smolka A M, Hedlund L. Mechanisms of alcohol-nicotine interactions: alcoholics versus smokers.  Alcohol Clin Exp Res. 2001;  25 152S-156S
• 57 Larsson A, Engel J A. Neurochemical and behavioral studies on ethanol and nicotine interactions.  Neurosci Biobehav Rev. 2004;  27 713-720
• 58 Tizabi Y, Manaye K F, Smoot D T, Taylor R E. Nicotine inhibits ethanol-induced toxicity in cultured cerebral cortical cells.  Neurotox Res. 2004;  6 311-316
• 59 Tizabi Y, Manaye K F, Taylor R E. Nicotine blocks ethanol-induced apoptosis in primary cultures of rat cerebral cortical and cerebellar granule cells.  Neurotox Res. 2005;  7 319-322
• 60 Collins A C, Wilkins L H, Slobe B S, Cao J Z, Bullock A E. Long-term ethanol and nicotine treatment elicit tolerance to ethanol.  Alcohol Clin Exp Res. 1996;  20 990-999
• 61 Howard L A, Ahluwalia J S, Lin S K, Sellers E M, Tyndale R F. CYP2E1*1D regulatory polymorphism: association with alcohol and nicotine dependence.  Pharmacogenetics. 2003;  13 321-328
• 62 Lopez M F, White N M, Randall C L. Alcohol tolerance and nicotine cross-tolerance in adolescent mice.  Addict Biol. 2001;  6 119-127
• 63 Madden P A, Heath A C, Starmer G A, Whitfield J B, Martin N G. Alcohol sensitivity and smoking history in men and women.  Alcohol Clin Exp Res. 1995;  19 1111-1120
• 64 Dar M S, Bowman E R, Li C. Intracerebellar nicotinic-cholinergic participation in the cerebellar adenosinergic modulation of ethanol-induced motor incoordination in mice.  Brain Res. 1994;  644 117-127
• 65 Staley J K, Gottschalk C, Petrakis I L, Gueorguieva R, O'Malley S, Baldwin R, Jatlow P, Verhoeff N P, Perry E, Weinzimmer D, Frohlich E, Ruff E, Dyck C H van, Seibyl J P, Innis R B, Krystal J H. 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
• 66 Howard L A, Ahluwalia J S, Lin S K, Sellers E M, Tyndale R F. CYP2E1*1D regulatory polymorphism: association with alcohol and nicotine dependence.  Pharmacogenetics. 2003;  13 321-328
• 67 Howard L A, Miksys S, Hoffmann E, Mash D, Tyndale R F. Brain CYP2E1 is induced by nicotine and ethanol in rat and is higher in smokers and alcoholics.  Br J Pharmacol. 2003;  138 1376-1386
• 68 Dani J A, Harris R A. Nicotine addiction and comorbidity with alcohol abuse and mental illness.  Nat Neurosci. 2005;  8 1465-1470
• 69 Li X C, Karadsheh M S, Jenkins P M, Stitzel J A. Genetic correlation between the free-choice oral consumption of nicotine and alcohol in C57BL/6JxC3H/HeJ F2 intercross mice.  Behav Brain Res. 2005;  157 79-90
• 70 True W R, Xian H, Scherrer J F, Madden P A, Bucholz K K, Heath A C, Eisen S A, Lyons M J, Goldberg J, Tsuang M. Common genetic vulnerability for nicotine and alcohol dependence in men.  Arch Gen Psychiatry. 1999;  56 655-661
• 71 Madden P A, Heath A C. Shared genetic vulnerability in alcohol and cigarette use and dependence.  Alcohol Clin Exp Res. 2002;  26 1919-1921
• 72 Palfai T P, Monti P M, Ostafin B, Hutchison K. Effects of nicotine deprivation on alcohol-related information processing and drinking behaviour.  J Abnrom Psychol. 2000 Feb;  109 (1) 96-105
• 73 Colby S M, Rohsenow D J, Monti P M, Gwaltney C J, Gulliver S B, Abrams D B, Niaura R S, Siroa A D. Effects of tobacco deprivation on alcohol cue reactivity and drinking among young adults.  Addict Behav. 2004 Jul;  29 (5) 879-892
• 74 Cooney J L, Cooney N L, Pilkey D T, Kranzler H R, Oncken C A. Effects of nicotine deprivation on urges to drink and smoke in alcoholic smokers.  Addiction. 2003 Jul;  98 (7) 913-921
• 75 DiFranza J R, Guerrera M P. Alcoholism and smoking.  J Stud Alcohol. 1990;  51 130-135
• 76 Hertling I, Ramskogler K, Dvorak A, Klingler A, Saletu-Zyhlarz G, Schoberberger R, Walter H, Kunze M, Lesch O M. Craving and other characteristics of the comorbidity of alcohol and nicotine dependence.  Eur Psychiatry. 2005;  20 442-450
• 77 Covey L S, Glassman A H, Stetner F, Becker J. Effect of history of alcoholism or major depression on smoking cessation.  Am J Psychiatry. 1993;  150 1546-1547
• 78 Abrams D B, Niaura R, Brown R A, Emmons K M, Goldstein M G, Monti P M. The Tobacco Dependence Treatment Handbook. A Guide To Best Practices. New York: The Guiford Press 2003
• 79 Hurt R D. Pharmacotherapy for alcoholic smokers.  Alcohol Clin Exp Res. 2002;  26 1939-1941
• 80 Hughes J R, Kalman D. Do smokers with alcohol problems have more difficulty quitting?.  Drug Alcohol Depend. 2006;  82 91-102
• 81 Bowman J A, Walsh R A. Smoking intervention within alcohol and other drug treatment services: a selective review with suggestions for practical management.  Drug Alcohol Rev. 2003;  22 73-82
• 82 Sussman S. Smoking cessation among persons in recovery.  Subst Use Misuse. 2002;  37 1275-1298
• 83 Bobo J K, Gilchrist L D. Urging the alcoholic client to quit smoking cigarettes.  Addictive Behaviors. 1983;  8 297-305
• 84 Gulliver S B, Rohsenow D J, Colby S M, Dey A N, Abrams D B, Niaura R S, Monti P M. Interrelationship of smoking and alcohol dependence, use and urges to use.  J Stud Alcohol. 1995;  56 202-206
• 85 Colby S M, Rohsenow D J, Monti P M, Gwaltney C J, Gulliver S B, Abrams D B, Niaura R S, Sirota A D. Effects of tobacco deprivation on alcohol cue reactivity and drinking among young adults.  Addict Behav. 2004;  29 879-892
• 86 Joseph A, Lexau B, Willenbring M, Nugent S, Nelson D. Factors associated with readiness to stop smoking among patients in treatment for alcohol use disorder.  Am J Addict. 2004;  13 405-417
• 87 Kandel D, Chen K, Warner L A, Kessler R C, Grant B. Prevalence and demographic correlates of symptoms of last year dependence on alcohol, nicotine, marijuana and cocaine in the U.S. population.  Drug Alcohol Depend. 1997;  44 11-29
• 88 Bobo J K, McIlvain H E, Gilchrist L D, Bowman A. Nicotine dependence and intentions to quit smoking in three samples of male and female recovering alcoholics and problem drinkers.  Subst Use Misuse. 1996;  31 17-33
• 89 Ellingstad T P, Sobell L C, Sobell M B, Cleland P A, Agrawal S. Alcohol abusers who want to quit smoking: implications for clinical treatment.  Drug Alcohol Depend. 1999;  54 259-265
• 90 Sobell M B, Sobell L C, Kozlowski L T. Dual recoveries from alcohol and smoking problems. In: Fertig JB, Allen JP, eds (Hrsg.). Alcohol and Tobacco: From basic Science to Clinical Practice. Bethesda, M.D.: National Institutes of Health 1995: 207-224
• 91 Hurt R D, Eberman K M, Croghan I T, Offord K P, Davis Jr L J, Morse R M, Palmen M A, Bruce B K. Nicotine dependence treatment during inpatient treatment for other addictions: a prospective intervention trial.  Alcohol Clin Exp Res. 1994;  18 867-872
• 92 Bobo J K, McIlvain H E, Lando H A, Walker R D, Leed-Kelly A. Effect of smoking cessation counseling on recovery from alcoholism: findings from a randomized community intervention trial.  Addiction. 1998;  93 877-887
• 93 Friend K B, Pagano M E. Changes in cigarette consumption and drinking outcomes: findings from Project MATCH.  J Subst Abuse Treat. 2005;  29 221-229
• 94 Hughes J R, Callas P W. Past alcohol problems do not predict worse smoking cessation outcomes.  Drug Alcohol Depend. 2003;  71 269-273
• 95 Hughes J R, Kalman D. Do smokers with alcohol problems have more difficulty quitting?.  Drug Alcohol Depend. 2006;  82 91-102
• 96 Olbrich R, Troeger S, Nikitopoulos J, Mann K, Diehl A. Successful smoking reduction during inpatient alcohol detoxification: a controlled clinical trial.  European Archives of Psychiatry and Clinical Neurosciences submitted. 2007; 
• 97 Fiore M C, Bailey W C, Cohen S J, Dorfman S F, Goldstein M G, Gritz E R, Heyman R B, Jaen C R, Kottke T E, Lando H A, Mecklenburg R E, Mullen P D, Nett L M, Robinson L, Stitzer M L, Tommasello A C, Villejo L, Wewers M E. Treating Tobacco Use and Dependence. Clinical Practice Guideline. U.S. Department of Health and Human Services, Public Health Service 2000
• 98 Kalman D, Hayes K, Colby S M, Eaton C A, Rohsenow D J, Monti P M. Concurrent versus delayed smoking cessation treatment for persons in early alcohol recovery. A pilot study.  J Subst Abuse Treat. 2001;  20 233-238
• 99 Saxon A J, Baer J S, Davis T M, Sloan K L, Malte C A, Fitzgibbons K, Kivlahan D R. Smoking cessation treatment among dually diagnosed individuals: preliminary evaluation of different pharmacotherapies.  Nicotine Tob Res. 2003;  5 589-596
• 100 Hughes J R, Novy P, Hatsukami D K, Jensen J, Callas P W. Efficacy of nicotine patch in smokers with a history of alcoholism.  Alcohol Clin Exp Res. 2003;  27 946-954
• 101 Hurt R D, Dale L C, Offord K P, Croghan I T, Hays J T, Gomez-Dahl L. Nicotine patch therapy for smoking cessation in recovering alcoholics.  Addiction. 1995;  90 1541-1546
• 102 Hurt R D, Dale L C, Offord K P, Croghan I T, Hays J T, Gomez-Dahl L. Nicotine patch therapy for smoking cessation in recovering alcoholics.  Addiction. 1995;  90 1541-1546
• 103 Hurt R D. Pharmacotherapy for alcoholic smokers.  Alcohol Clin Exp Res. 2002;  26 1939-1941
• 104 Ascher J A, Cole J O, Colin J N, Feighner J P, Ferris R M, Fibiger H C, Golden R N, Martin P, Potter W Z, Richelson E. Bupropion: a review of its mechanism of antidepressant activity.  J Clin Psychiatry. 1995;  56 395-401
• 105 Slemmer J E, Martin B R, Damaj M I. Bupropion is a nicotinic antagonist.  J Pharmacol Exp Ther. 2000;  295 321-327
• 106 Fryer J D, Lukas R J. Noncompetitive functional inhibition at diverse, human nicotinic acetylcholine receptor subtypes by bupropion, phencyclidine, and ibogaine.  J Pharmacol Exp Ther. 1999;  288 88-92
• 107 Hayford K E, Patten C A, Rummans T A, Schroeder D R, Offord K P, Croghan I T, Glover E D, Sachs D P, Hurt R D. Efficacy of bupropion for smoking cessation in smokers with a former history of major depression or alcoholism.  Br J Psychiatry. 1999;  174 173-178
• 108 Jorenby D E, Leischow S J, Nides M A, Rennard S I, Johnston J A, Hughes A R, Smith S S, Muramoto M L, Daughton D M, Doan K, Fiore M C, Baker T B. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation.  N Engl J Med. 1999;  340 685-691
• 109 Hays J T, Hurt R D, Rigotti N A, Niaura R, Gonzales D, Durcan M J, Sachs D P, Wolter T D, Buist A S, Johnston J A, White J D. Sustained-release bupropion for pharmacologic relapse prevention after smoking cessation. a randomized, controlled trial.  Ann Intern Med. 2001;  135 423-433
• 110 Johnson B A. Uses of topiramate in the treatment of alcohol dependence.  Expert Rev Neurother. 2004;  4 751-758
• 111 Cohen C, Kodas E, Griebel G. CB1 receptor antagonists for the treatment of nicotine addiction.  Pharmacol Biochem Behav. 2005;  81 387-395
• 112 Diehl A, Nakovics H, Croissant B, Smolka M N, Batra A, Mann K. Galantamine reduces smoking in alcohol-dependent patients: a randomized, placebo-controlled trial.  Int J Clin Pharmacol Ther. 2006;  44 614-622
• 113 Byars J A, Frost-Pineda K, Jacobs W S, Gold M S. Naltrexone Augments the Effects of Nicotine Replacement Therapy in Female Smokers.  J Addict Dis. 2005;  24 49-60
• 114 Stead L F, Lancaster T. Group behaviour therapy programmes for smoking cessation.  Cochrane Database Syst Rev. 2005;  CD001007
• 115 Bobo J K, McIlvain H E, Lando H A, Walker R D, Leed-Kelly A. Effect of smoking cessation counseling on recovery from alcoholism: findings from a randomized community intervention trial.  Addiction. 1998;  93 877-887
• 116 Joseph A M, Nichol K L, Willenbring M L, Korn J E, Lysaght L S. Beneficial effects of treatment of nicotine dependence during an inpatient substance abuse treatment program.  JAMA. 1990;  263 3043-3046
• 117 Burling T A, Marshall G D, Seidner A L. Smoking cessation for substance abuse inpatients.  J Subst Abuse. 1991;  3 269-276
• 118 Miller W R, Rollnick S. Motivational Interviewing: Preparing people to change addictive behaviour. New York: Guilford Press 1991
• 119 Rohsenow D J, Monti P M, Colby S M, Martin R A. Brief interventions for smoking cessation in alcoholic smokers.  Alcohol Clin Exp Res. 2002;  26 1950-1951
• 120 Martin J E, Calfas K J, Patten C A, Polarek M, Hofstetter C R, Noto J, Beach D. Prospective evaluation of three smoking interventions in 205 recovering alcoholics: one-year results of Project SCRAP-Tobacco.  J Consult Clin Psychol. 1997;  65 190-194
• 121 Murray R P, Cribbie R A, Istvan J A, Barnes G E. Longitudinal analysis of the relationship between changes in smoking and changes in drinking in a community sample: the Winnipeg Health and Drinking Survey.  Health Psychol. 2002;  21 237-243
• 122 McIlvain H E, Bobo J K, Leed-Kelly A, Sitorius M A. Practical steps to smoking cessation for recovering alcoholics.  Am Fam Physician. 1998;  57 1869-1882
• 123 Romberger D J, Grant K. Alcohol consumption and smoking status: the role of smoking cessation.  Biomed Pharmacother. 2004;  58 77-83
• 124 Jimenez-Ruiz C, Solano S, Viteri S A, Ferrero M B, Torrecilla M, Mezquita M H. Harm reduction - a treatment approach for resistant smokers with tobacco-related symptoms.  Respiration. 2002;  69 452-455
• 125 Wennike P, Danielsson T, Landfeldt B, Westin A, Tonnesen P. Smoking reduction promotes smoking cessation: results from a double blind, randomized, placebo-controlled trial of nicotine gum with 2-year follow-up.  Addiction. 2003;  98 1395-1402
• 126 Batra A, Klingler K, Landfeldt B, Friederich H M, Westin A, Danielsson T. Smoking reduction treatment with 4-mg nicotine gum: a double-blind, randomized, placebo-controlled study.  Clin Pharmacol Ther. 2005;  78 689-696