Editorial [ Smoking and Drinking Go Hand in Hand ]

Smoking and drinking often occur simultaneously. When drinking, the urge to smoke increases and vice versa. This is commonly observed in pubs, where the majority of visitors smokes and drinks alcohol. When asking these drinkers, the majority acknowledges that they smoke more cigarettes during the drinking session than they would do on other occasions without alcohol consumption. Fig. 1 illustrates the relationship between alcohol consumption and smoking among 500 Dutch students [1]. The presented data are typically found in surveys on drinking and smoking habits. Students that consume more alcohol also smoke more cigarettes. In addition, the percentage of smokers steadily increases from abstainers to excessive drinking groups. Among alcoholics, 90%also meet the criteria for nicotine dependence [2]. Smokers, especially those who are nicotine dependent, have a higher risk of alcohol dependence [3], and dependency-related problems are more severe in those who smoke more cigarettes [4]. Although many studies have examined the individual effects of nicotine and alcohol on cognitive and psychomotor performance, surprisingly few studies examined the effects of co-administration on human behavior. A study by Michel and Battig [5] showed that in female smokers nicotine accelerated processing speed in a visual information processing task, whereas alcohol significantly slowed processing speed. However, when administering tobacco and alcohol together, no significant difference was found from pre-drug baseline performance. Kerr and colleagues [6] also reported opposite effects of nicotine (improvement) and alcohol (impairment) on tests of memory scanning, tracking, psychomotor performance and choice reaction time tests. Co-use of nicotine and alcohol attenuated these effects and overall performance did not differ greatly from the nondrug condition. These studies support the idea that, when consumed in a moderate fashion, the co-use of tobacco seems to reverse the cognitive effects caused by alcohol consumption. Kouri and colleagues [7] showed that those who smoked before a drinking session wanted to drink more alcohol than those who did not smoke. Also, smoking before the drinking session resulted in higher subjective feelings of intoxication, and alcohol's euphoric effects were reported at lower blood alcohol concentrations. Experiments in which participants were pre-treated with the nicotine receptor antagonist mecamylamine [8, 9] showed the opposite effects. Participants who received mecamylamine were less euphoric during drinking when compared those who consumed alcohol without this treatment. From a different angle, the relationship between smoking and drinking was also established in smokers who were pre-treated with alcohol [10]. Those who consumed alcohol before smoking reported a significantly higher rate of smoking satisfaction than those who did not consume alcohol. In sum, there is much evidence that smoking and drinking reinforce each other and that this is established by enhancing their rewarding effects. In this issue of CURRENT DRUG ABUSE REVIEWS, Schlaepfer and colleagues discuss the substantial scientific evidence of a common genetic vulnerability to alcohol and nicotine addictions. The authors conclude that neuronal nicotinic acetylcholine receptors (nAChRs) genes may have a role in mediating behaviors that are the risk factors for alcohol and nicotine dependence. Also, nAChRs play an important mediating role in the dopaminergic reward system mediating the pleasurable feelings of reward when drinking alcohol and smoking. A review by Dr Scepis discusses various pharmacological and non-pharmacological ways to help adolescent quit smoking. Smoking cessation remains extremely difficult and many smokers fail to stop. Relapse is common even after several times of smoking cessation. A recent meta-analysis on smoking cessation attempts among adolescent current smokers reveiled that their lifetime cessation attempt prevalence was 71% (range 28-84%). More than half had made multiple attempts and the median prevalence of relapse was 92% within 1 year [11]. Many governments and organizations try to convince smokers to quit and inform smokers about the negative health consequences of smoking. Various warning labels including text or pictures on cigarette packages are in use to inform smokers. In this issue of CURRENT DRUG ABUSE REVIEWS, Dr Givel reviews the product design approach of the U.S. Food and Drugs Administration. Future studies should continue to examine the causes and effects of co-use of nicotine and alcohol. New treatments or ways to reduce their use should be developed, taking into account that both addictions are often related. REFERENCES [1] Verster JC. Alcohol hangover frequency, severity and interventions among Dutch college students. Alcoholism: Clin Exp Res 2006; 30 (supplement to #6): 157A. [2] Batel P, Pessione F, Maitre C, Rueff B. Relationship between alcohol and tobacco dependencies among alcoholics who smoke. Addiction 1995; 90: 977-80