Nicotine-patch treatment works for smokers with long-term sobriety

  • At least 80 percent of alcoholics smoke.
  • Smokers with past alcoholism are more nicotine dependent than smokers without a history of alcoholism.
  • New research has found that nicotine-patch treatment works as well for smokers with long-term sobriety as it does for smokers without a history of alcoholism.
  • Optimal treatment options for smokers with current alcoholism or recent sobriety remain unclear.

A clear majority of alcoholics smoke. According to the National Institute on Alcohol Abuse and Alcoholism, between 80 and 95 percent of alcoholics smoke cigarettes, which is more than three times higher than among the population as a whole. Research has also shown that smokers with a history of alcoholism are more nicotine dependent than smokers with no such history, and suggests smoking cessation may prompt a relapse to drinking among a small number of smokers with a history of alcoholism. However, findings published in the June issue of Alcoholism: Clinical & Experimental Research indicate that nicotine replacement therapy (NRT) works as well for smokers with long-term sobriety as it does for smokers without a history of alcoholism.

"This study refutes the common perception that smokers with a history of alcoholism have more difficulty quitting smoking and are likely to relapse back to alcoholism," said John R. Hughes, professor of psychiatry at the University of Vermont and lead author of the study. "Our results suggest smokers with this history need to be encouraged to attempt to stop smoking."

Hughes also said that for "for 85 percent of smokers with past alcoholism, quitting smoking is not a problem. Furthermore, as our findings indicate, we found smokers with past but not current alcoholism were able to quit as well and benefited from nicotine-patch treatment to the same degree as smokers without this history."

This study was designed to duplicate and build upon a previous study that examined heavy smokers with no history of alcoholism. Researchers examined 115 heavy smokers with a past history of alcoholism (78 males, 37 females); most had been abstinent from alcohol for more than five years. Study participants were recruited through media advertisements, and from outpatient alcohol treatment sites and Alcoholics Anonymous meetings. Past and present alcohol and drug dependence was assessed using Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition criteria. Participants were randomly assigned to either a 21 mg. nicotine patch (n=61) or a placebo (n=54). Abstinence from smoking, alcohol and other drugs was verified by breath and urine tests.

"These findings are consistent with other studies of smokers with long-term sobriety," said David Kalman, assistant professor of psychiatry at Boston University School of Medicine. "First, quit rates of smokers with and without a history of alcohol dependence are similar. Second, NRT is neither more nor less effective for smokers with or without a history of alcohol dependence. Note that ‘long-term sobriety’ is not precisely defined, but most smokers in these studies have at least a year of sobriety and the median length of sobriety is typically around five years. By contrast, other studies have found that smokers with less than a year of alcohol abstinence have greater difficulty quitting."

Kalman added that a practical implication of the study is that "people in long-term recovery who use the nicotine patch in combination with counseling can and do quit smoking; and they are no less successful than smokers without such a history. Future research should focus on identifying effective treatment approaches with smokers in early recovery," he said. "We should also continue to examine the effect, if any, of trying to quit smoking on sobriety, particularly for people in early sobriety. However, consistent with the preponderance of data, I believe that we should be encouraging all smokers in alcohol recovery – including those with less than a year of sobriety – to consider quitting smoking and that we should certainly not be discouraging them to try to quit on the assumption that it will jeopardize their sobriety."

Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

Articles were written based on the following published research:

John R. Hughes; Pamela Novy; Dorothy K. Hatsukami; Joni Jensen; Peter W. Callas (June 2003). Efficacy of nicotine patch in smokers with a history of alcoholism. Alcoholism: Clinical & Experimental Research, 27(6), 946-955.