Risk factors for treatment failure in smokers: Relationship to alcohol use and to lifetime history of an alcohol use disorder

Abstract

Little is known about the impact of alcohol involvement on smoking cessation relapse or possible mechanisms for these associations. We addressed these issues using data from a randomized clinical trial of 2 types of framed messages (gain vs. loss) in conjunction with open label sustained-release (SR) bupropion (Toll et al., 2007) (N = 249). Participants were categorized according to whether or not they were diagnosed with a lifetime alcohol use disorder (AUD; i.e., current or past alcohol abuse or past alcohol dependence) and according to 3 levels of alcohol use: abstinence, moderate or hazardous use. Alcohol use categories were established for drinking at baseline, during the 6-week treatment period and through 12 weeks post-quit. There were few significant differences by baseline alcohol use level or AUD history for a series of predictors of smoking cessation failure (e.g., depressive symptoms). During treatment and follow-up, the probability of any smoking on heavy drinking days was significantly higher than the probability of smoking on moderate drinking or abstinent days. AUD history did not predict smoking cessation relapse in any analysis, nor were any alcohol use × AUD history interactions significant. Moderate alcohol users and to a lesser extent, abstainers from alcohol at baseline were less likely than hazardous drinkers to have relapsed at 12 weeks post-quit. Based on these findings, it appears that risk of any smoking and of relapse was associated primarily with heavy drinking days and a hazardous pattern of use respectively, rather than with moderate drinking.

Association between smoking and alcohol‐related behaviours: a time–series analysis of population trends in England

“…The failure to find a clear association between attempts to stop smoking and attempts to reduce alcohol consumption goes against individual‐level findings in the literature 13, 14, 15. This may be because of low statistical power, with the samples in this analysis limited to smokers and high‐risk drinkers which comprises less than one‐fifth of the sample.…”

“…Attempts to quit smoking are less successful among those with alcohol use disorder 13, 14, 15 and episodes of alcohol consumption during a smoking cessation attempt are associated with a greater risk of relapse to smoking 16. Several mechanisms may contribute to the association between alcohol and tobacco use, including genes involved in regulating neurotransmitters, cross‐tolerance and cross‐sensitization to both drugs, conditioning mechanisms in which cravings for alcohol or nicotine are elicited by similar environmental cues, and common psychological and social factors (e.g.…”

Individual and Combined Effects of Multiple High-Risk Triggers on Postcessation Smoking Urge and Lapse

“…Smokers attempting to quit report higher craving for cigarettes (Delfino, Jamner, & Whalen, 2001;Piasecki, McCarthy, Fiore, & Baker, 2008;Piasecki et al, 2011) and are significantly more likely to lapse after they consume alcohol (Brandon et al, 1990;Kahler et al, 2010;Leeman et al, 2008;Shiffman et al, 1996b;van Zundert et al, 2012). Furthermore, smokers who drink more after they quit smoking are significantly less likely than those who drink less to maintain long-term smoking abstinence (Hyland et al, 2004;McClure, Wetter, deMoor, Cinciripini, & Gritz, 2002).…”

“…Unfortunately, almost all unaided quitters (95%) resume regular smoking (Hughes, Keely, & Naud, 2006), and relapse is frequently preceded by isolated incidents of cigarette smoking known as lapses (Kenford et al, 1994). Three specific high-risk triggers-alcohol consumption (Brandon, Tiffany, Obremski, & Baker, 1990;Kahler, Spillane, & Metrik, 2010;Leeman et al, 2008;Shiffman, Paty, Gnys, Kassel, & Hickcox, 1996b;van Zundert, Kuntsche, & Engels, 2012), presence of others smoking (Shiffman, 1982;Shiffman et al, 1996b;Solomon et al, 2007), and negative affect (Kenford et al, 2002;Niaura et al, 2001;Shiffman et al, 1996b)-have consistently been identified as critical postcessation precipitants of lapse/relapse. However, exceedingly few data have addressed how these triggers combine to impact cessation outcomes.…”

Facets of the NEO-PI-R and smoking cessation

“…According to previous research (e.g., Benowitz et al, 2002), studies about smokers from clinical population should include multiple assessments (baseline, post-treatment and follow-ups), and biochemical verification to avoid an overestimation of the absolute abstinence rate. The aim of the present study was to analyze the influence of 30 specific facets of the Five-Factor Model of personality on the short and long-term outcomes of a smoking cessation treatment.…”