Dual Challenges: How Risky Drinking Impairs Smoking Cessation Efforts

By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
Staff Research and Content Writer

© Copyright – SUD RECOVERY CENTERS – A Division of Genesis Behavioral Services, Inc.,
Milwaukee, Wisconsin – April 2024 – All rights reserved.

Tobacco has long been considered one of the most challenging substances to quit. Quitting is even more complicated when someone uses other substances concurrently, such as alcohol or illicit drugs. A new study found a dose-response relationship between risky drinking and smoking cessation— the riskier someone’s drinking was, the less likely they were to be able to quit smoking.

What is the relationship between smoking and drinking?

 It is common for people who smoke also to drink alcohol. According to the American Lung Association, those who smoke are 15% more likely to drink alcohol, nearly twice as likely to binge drink, and three times as likely to engage in heavy alcohol use than non-smokers. Moreover, individuals diagnosed with alcohol use disorders smoke at rates between 34% and 80%, compared to 14% in the general population.

While mechanisms remain unclear, research suggests that alcohol increases the pleasurable effects of nicotine. Nicotine, in turn, enhances the intoxicating effects of alcohol. Alcohol and tobacco are also usually linked behaviourally, with tobacco use increasing during situations where heavy drinking is present (e.g., at bars and nightclubs).


Unfortunately, the co-use of alcohol and tobacco also magnifies the health harms. Those who both smoke and drink tend to have worse health compared to those who only use one of those substances. In addition to the harms associated with each substance, there are multiplicative health risks correlated with tobacco and alcohol use. Concurrent use can lead to a higher risk of early death, in particular from pulmonary, cardiovascular, liver, and pancreatic diseases and several forms of cancer.


How does alcohol use affect smoking behavior?

Alcohol use can increase the intensity of nicotine cravings, making it more difficult to quit smoking. People who use both tobacco and alcohol often experience higher rates of nicotine addiction. They also have less motivation to quit smoking and are more likely to relapse if they quit.

So far, though, little is known about how someone’s level of risky drinking affects their attempts to quit smoking.

Photo by Diego Indriago on Pexels

What are the implications?


These findings suggest that people engaging in risky alcohol use while receiving treatment for tobacco use disorders are less likely to quit smoking than non- and light drinkers. Thus, addressing alcohol use in people with hazardous drinking or alcohol use disorder who smoke may be effective in helping them quit tobacco successfully.


Current guidelines for smoking cessation recognize that alcohol use disorder is a barrier to tobacco cessation (US Clinical Practice Guidelines, CAN-ADAPTT). However, neither US nor Canadian guidelines recommend combining alcohol reduction strategies with tobacco cessation interventions. Thus, the researchers suggest that alcohol reduction interventions be integrated into smoking cessation treatment programming for those exhibiting heavy or risky drinking behavior.



Key Points

  • Drinking alcohol can make it more challenging to quit smoking.
  • People who engage in hazardous drinking or who have moderate to severe alcohol use disorder are less likely to quit smoking than those who do not drink.
  • Incorporating alcohol reduction interventions into smoking cessation treatment can help those with risky drinking problems quit smoking successfully.





American Lung Association. (n.d.). Behavioral health & tobacco use. Retrieved June 14, 2024, from https://www.lung.org/quit-smoking/smoking-facts/impact-of-tobacco-use/behavioral-health-tobacco-use

Wong, B. K. C., Veldhuizen, S., Minian, N., Zawertailo, L., & Selby, P. (2024). The effects of alcohol use on smoking cessation treatment with nicotine replacement therapy: An observational study. Addictive Behaviors, 155.

Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff (2008). A clinical practice guideline for treating tobacco use and dependence: 2008 update. A US Public Health Service report. American journal of preventive medicine35(2), 158–176. https://doi.org/10.1016/j.amepre.2008.04.009