Tobacco Smoking Reduction or Cessation Associated With Improved Alcohol Use Disorder Treatment Outcomes

In this systematic review, researchers summarized the evidence on the effect of tobacco smoking on the treatment of alcohol use disorder (AUD). Included studies (N=43) were conducted among ≥40 participants (n=10,296) who had AUD with or without tobacco smoking, with no other substance use disorders or co-morbid psychiatric disorders.

  • Among patients receiving cognitive behavioral therapy for AUD (15 studies, 5542 participants), increased or continued tobacco smoking was associated with worse drinking outcomes in 10 studies, and no effect in 4 studies. One study showed a negative association.
  • Among patients receiving AUD pharmacotherapy (15 studies, 2966 participants), smoking was associated with a 1.5–2.3 times higher risk of return to alcohol use in 6 studies. In 6 studies there was no difference in AUD outcomes between people with or without smoking. In one study results were mixed; 3 studies showed a negative association.
  • In summary, 16 of 30 studies on behavioral or pharmacological AUD treatment showed that smoking reduction or cessation was associated with better drinking outcomes (lower rates of return to use, less drinking), whereas 4 studies showed the opposite.
  • For smoking cessation treatment (13 studies, 1849 participants), 7 studies showed a positive effect of treatment on smoking. Only one study showed a reduction of both smoking and drinking, with a significant association between both (odds ratio, 1.6).

Comments: Current evidence suggests that positive AUD treatment outcomes are facilitated by tobacco smoking reduction or cessation. It should be noted that while smoking may trigger alcohol consumption, alcohol use may also promote smoking. Clinicians should inform patients of the potential benefit of reducing smoking for AUD treatment outcomes and offer support for smoking reduction or cessation.

Nicolas Bertholet, MD, MSc

Reference: van Amsterdam J, van den Brink W. Smoking as an outcome moderator in the treatment of alcohol use disorders. Alcohol Alcohol. 2022;agac027.

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