ALCOHOL AND TOBACCO (Alcohol Alert #71)

Alcohol and tobacco are among the top causes of preventable deaths in the United States (1). Moreover, these substances often are used together: Studies have found that people who smoke are much more likely to drink, and people who drink are much more likely to smoke (2). Dependence on alcohol and tobacco also is correlated: People who are dependent on alcohol are three times more likely then those in the general population to be smokers, and people who are dependent on tobacco are four times more likely than the general population to be dependent on alcohol (3).

The link between alcohol and tobacco has important implications for those in the alcohol treatment field. Many alcoholics smoke, putting them at high risk for tobacco-related complications including multiple cancers, lung disease, and heart disease (i.e., cardiovascular disease) (4). In fact, statistics suggest that more alcoholics die of tobacco-related illness than die of alcohol-related problems (5). Also, questions remain as
to the best way to treat these co-occurring addictions; some programs target alcoholism first and then address tobacco addiction, whereas others emphasize abstinence from drinking and smoking simultaneously. Effective treatment hinges on a better understanding of how these substances—and their addictions—interact.

Tobacco Use by Physicians in a Physician Health Program, Implications for Treatment and Monitoring (American Journal on Addictions,18:2,103 – 108)

The use of tobacco by physicians with substance abuse histories is drastically understudied. A chart review of 1319 physicians enrolled in a physician health program found tobacco use highest for those referred for substance abuse problems (58.1%). Among a subset of currently monitored substance abusers, all those who relapsed during monitoring were using tobacco and had more difficulty maintaining sobriety following initial treatment (p = 0.0137) than non tobacco users. Because tobacco was a risk factor for relapse, reasons why physician health programs should address its use and treatment facilities should establish tobacco-free environments to provide optimum learning and recovery are explored.

Secondhand smoke exposure and mental health among children and adolescents (Arch Pediatr Adolesc Med. 2011; 165(4):332-8 (ISSN: 1538-3628)

The US Surgeon General has concluded that there is no risk-free level of secondhand smoke (SHS) exposure and estimated that approximately 66% of children aged 3 to 11 years are exposed to SHS. It is well established that SHS exposure causes adverse physical health conditions (eg, respiratory and cardiovascular), and there is increasing evidence suggesting that it may also adversely affect mental health. Cross-sectional studies show a positive association between SHS exposure and anxiety or depression among adults, and results of a 2010 prospective analysis of a large cohort of adults conducted over more than 6 years suggest that SHS exposure may predict the onset of poor mental health. The effects of SHS exposure on the mental health of children and adolescents are still unclear.

Because many mental disorders have an onset in youth at a time when SHS exposure is high, it is critical to consider how SHS may be affecting the mental health of children and adolescents so that appropriate preventive measures can be implemented. Despite evidence of an association, the mechanism by which SHS exposure may promote or exacerbate poor mental health is unclear. Secondhand smoke may be a proxy for stressful living conditions, and stress has been associated with poor mental health. In response to stress, the hypothalamic-pituitary-adrenal axis and immune, metabolic, autonomic, and cardiovascular systems respond to keep the environment of the body in homeostasis. This balance can be measured by examining allostatic load, which represents the wear and tear of the body’s response to prolonged psychological stress and is associated with the onset of physical and mental conditions. Although chronic physical conditions usually manifest in adulthood, there is evidence that prolonged exposure to stress may have an effect on the response of the body to stress and result in poor health even among children. Other hypotheses suggest a link between smoking and poor mental health through nicotine and dopamine pathways. Smokers who have susceptibility genes to low intrasynaptic dopamine levels have greater smoking-induced dopa-mine release, which has been associated with higher risk for mental disorders. Secondhand smoke may also affect respiratory conditions, such as asthma, which has been positively associated with mental disorders. Because youth exposure to SHS may come from the mother, another important confounder to consider is maternal smoking during pregnancy, which has been associated with greater risk for mental disorders.