Behavioral Economic Demand for Alcohol and Cigarettes in Heavy Drinking Smokers: Evidence of Asymmetric Cross-commodity Reinforcing Value

Abstract

Introduction Previous studies have highlighted a strong bidirectional relationship between cigarette and alcohol consumption. To advance our understanding of this relationship the present study uses a behavioral economic approach in a community sample (N = 383) of nontreatment seeking heavy drinking smokers. Aims and Methods The aims were to examine same-substance and cross-substance relationships between alcohol and cigarette use, and latent factors of demand. A community sample of nontreatment seeking heavy drinking smokers completed an in-person assessment battery including measures of alcohol and tobacco use as well as the Cigarette Purchase Task and the Alcohol Purchase Task. Latent factors of demand were derived from these hypothetical purchase tasks. Results Results revealed a positive correlation between paired alcohol and cigarette demand indices (eg, correlation between alcohol intensity and cigarette intensity) (rs = 0.18–0.46, p ≤ .003). Over and above alcohol factors, cigarette use variables (eg, Fagerström Test for Nicotine Dependence and cigarettes per smoking day) significantly predicted an additional 4.5% (p < .01) of the variance in Persistence values but not Amplitude values for alcohol. Over and above cigarette factors, alcohol use variables predicted cigarette Persistence values (ΔR2 = .013, p = .05), however, did not predict Amplitude values. Conclusions These results advance our understanding of the overlap between cigarette and alcohol by demonstrating that involvement with one substance was associated with demand for the other substance. This asymmetric profile—from smoking to alcohol demand, but not vice versa—suggests that it is not simply tapping into a generally higher reward sensitivity and warrants further investigation. Implications To our knowledge, no study to date has examined alcohol and cigarette demand, via hypothetical purchase tasks, in a clinical sample of heavy drinking smokers. This study demonstrates that behavioral economic indices may be sensitive to cross-substance relationships and specifically that such relationships are asymmetrically stronger for smoking variables affecting alcohol demand, not the other way around.

Behavioral Economic Assessment of Alcohol and Cigarette Demand in Smokers With Alcohol Use Disorder

“…The positive correlations between alcohol and cigarette demand indices suggest that those who had higher demand for alcohol tended to have higher demand for cigarettes too. This co-demand pattern is consistent with a recent study ( 22 ) which revealed the same positive correlations among a similar sample of heavy drinking smokers (but who were not seeking treatment). Moreover, by conducting hierarchical multiple regression analyses, their study found that smoking had a positive impact on the alcohol demand, but not the other way around ( 22 ).…”

“…Although our participants reported lower intensity of alcohol than that of cigarettes, this difference in intensity may reflect the inherent difference in characteristics between alcohol and cigarettes, such as packaging and consumption patterns specific to the products. The relative difference in intensity between alcohol and cigarettes demand, as well as their relative difference in baseline consumption patterns (i.e., less alcohol consumption measured in daily SDU than cigarette consumption measured in cigarettes per day) is consistent with previous research using a similar sample—heavy drinking smokers ( 22 ).…”

“…Similarly, all of our participants had a diagnosis of AUD, while only about 50% who were dependent or abusing alcohol in the study by Amlung et al ( 21 ). Additionally, our participants were also heavy smokers and importantly, several studies found that smoking resulted in higher demand for alcohol than nonsmoking ( 13 , 21 , 22 ). Thus, smoking may have resulted in a higher and more uniform alcohol use demand, masking a possible linear relationship between dependence and demand.…”

“…The other possible reason might be differences between study populations. Unlike previous studies (21,22), our participants were treatment seeking, and thus their motivation of quitting/reducing drinking and smoking may have changed how they responded in these purchase tasks. Besides the difference of motivations, our participants were more dependent on alcohol than the undergraduate samples tested previously (40)-the average AUDIT score in our sample was almost twice that of theirs.…”

“…Extending these results from university settings to communities, Amlung et al ( 21 ) provided further evidence of increased demand for alcohol among smokers compared to nonsmokers. Recently, in a larger community sample ( n = 383) of nontreatment seeking heavy drinking smokers, Green et al ( 22 ) found that alcohol and cigarette demand indices were positively correlated and more importantly, they found that compared to alcohol-related dependence measures, smoking-related measures accounted for more variance in alcohol demand's Persistence factor, suggesting that smoking may play a reinforcing role in increasing alcohol demand among nontreatment seeking heavy drinking sample.…”