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The Impact of Alcohol Use on Smoking Cessation

Tips for treating tobacco use in patients with alcohol use disorder

April is National Alcohol Awareness Month, a time to raise awareness about the deadly public health issue of alcohol use disorder, which claims the lives of more than 140,000 people in the U.S. each year. According to a 2021 national survey, 29.5 million people ages 12 and older had alcohol use disorder. People with alcohol use disorder smoke at more than twice the rate of the national average, and those with severe alcohol use disorder smoke at rates above 52%.

Many studies have documented the strong association between alcohol and cigarette use. Those with heavy alcohol use tend to also be heavy smokers, and regular tobacco users have a 2.7 greater risk of also abusing alcohol compared to their nonsmoking counterparts. Concurrent use of alcohol and tobacco products also increases the risk of several diseases, such as head and neck cancers and liver disease. One group disproportionately impacted by this issue is non-Hispanic Black individuals with alcohol use disorder, whose smoking rates have not declined like the rates of other racial and ethnic groups.

One reason why smoking rates are higher among those with alcohol use disorder is that this group is not routinely encouraged to quit smoking while undergoing treatment for their alcohol use. According to the Centers for Disease Control and Prevention, only one-third of substance use disorder treatment centers report having smoke-free campuses. However, research over the last decade has shown that quitting smoking actually improves alcohol sobriety.

With these findings in mind, it is important that tobacco cessation and treatment be offered as a standard of care for patients with alcohol use disorder.

A few evidence-based tips for treating tobacco use in patients with alcohol use disorder:

  • Use varenicline when possible because it is a safe and effective treatment in patients with alcohol use disorder and may help decrease alcohol consumption.

  • Avoid bupropion if the patient has alcohol withdrawal seizures or is at increased risk for seizures, as this medication lowers the seizure threshold.

  • Talk to patients about their alcohol use and explain that cutting back or quitting alcohol use completely will help them quit smoking, decrease their smoking urges, and help prevent smoking relapse once quit.

For more evidence-based information on treating tobacco use in specific populations, check out one of our upcoming TTS Comprehensive Tobacco Treatment Specialist trainings. Learn more at

About The Author

Rachael Joyner is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certificate in Tobacco Treatment Practice and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.

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