Latest Research

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

© CopyrightSUD 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 did this study do?

This study assessed the relationship between smoking cessation success and the severity of alcohol use disorders. The researchers were interested in identifying a threshold at which risky drinking inhibits or prevents smoking cessation. This threshold could provide an opportunity to deliver targeted cessation support for risky drinkers looking to quit smoking. This is especially important given the shortage of clinical resources to treat both conditions; a threshold would allow practitioners to identify patients who would most benefit from clinical treatment for their alcohol use and smoking cessation attempts.

This study used the 10-item Alcohol Use Disorders Identification Test (or AUDIT-10 scores) to measure levels of alcohol use in a large sample of people receiving treatment for tobacco use disorder. Participants received nicotine replacement therapy (NRT) to treat their tobacco use but did not receive any treatment for their alcohol use. The participants comprised the largest clinical sample in existence available to assess smoking cessation outcomes among people who use alcohol.

The researchers classified alcohol use into the following categories:
• No alcohol use in the previous year
• Did not meet AUDIT-C criteria (brief alcohol dependence screening)
• Low or lower-risk alcohol consumption (AUDIT-10 score under 8)
• Harmful or hazardous consumption (AUDIT-10 scores of 8–14)
• Moderate to severe alcohol use disorder (AUDIT-10 scores of 15–40)

What were the main findings?

This study found a dose-response relationship between risky drinking and challenges with smoking cessation. Higher alcohol dependence, measured by higher AUDIT scores, decreased someone’s odds of successful smoking cessation.

Both hazardous alcohol users (AUDIT-10 scores of 8-14) and those with moderate to severe alcohol use disorder (AUDIT-10 scores of 15-40) had more trouble quitting smoking compared to those who did not drink alcohol. The authors note that the treatment differences between non-drinkers and heavier drinkers were minor individually but would be clinically significant at a population level. That is to say, slight improvements in cessation outcomes for individuals would have a significant impact on reducing population smoking rates among people who drink alcohol.

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

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.