The stereotype of the Alcoholics Anonymous attendee dashing out during breaks for a cigarette reflects a sobering reality: Depending on who you ask, 50% to 80% of alcoholics are smokers, compared to only 23% of the general population, and behavioral studies in the past have shown that smoking and drinking can be mutual triggers—think of the "non-smoking" friend who still bums cigarettes when you're out at a bar.
Now, scientists at the San Francisco VA Medical Center have issued preliminary findings that suggest there are neurological links between smoking and drinking, most notably that alcohol-related brain damage repairs more slowly when a former drinker is also a smoker. The research, published in the March issue of Alcoholism: Clinical and Experimental Research, has important implications for the future of treating alcoholism.
Investigators divided their subjects in recovery into two groups: one of non-smokers and one of smokers. They used magnetic resonance and spectroscopic imaging to assess, among other things, levels of brain metabolites, which are biochemical indications of positive brain function. The tests were run initially during the first week after the subject's last drink and then again a month later. Results of another set of tests, measuring cognitive factors like learning, memory, attention and processing speed, are currently under review at the journal Drug and Alcohol Dependence.
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"The alcoholics who continue to actively smoke during their short-term abstinence from alcohol showed significantly less recovery in biochemical markers of cell membrane turn-over as well as neuronal health," said Timothy Durazzo, a scientist at the Medical Center and the lead author of the study. "And in some areas, the differences were extremely pronounced."
Specifically, Durazzo and his team found that metabolite levels in recovering alcoholics that smoked, already depressed from years of chemical abuse, did not improve as rapidly as levels in non-smoking recovering alcoholics. Other brain biochemicals important for cognition reacted in similar ways.
Emphasizing that his findings were preliminary, Durazzo said he is going to attempt to replicate them with a larger set of subjects. If his theory withstands further trials, there will be two repercussions for the treatment of alcoholics: For one, a new understanding of the chemical interactions between alcoholism and smoking addiction could lead to different prescriptions for alcoholics depending on whether or not they smoke.
"Since our study suggests that there are biochemical differences in the smoking recovering alcoholics, we are questioning ourselves whether they might respond differently to pharmacological agents than the nonsmoking alcoholics," said Durazzo.
Secondly and more immediately, cessation of smoking could be incorporated as part of an alcoholic therapy program, a proposal that Durazzo has tried in vain to communicate to his test subjects.
"I bring up the question to my guys because ethically, I have a responsibility to say, 'Hey look, this is preliminary data but it's pretty pronounced; you may want to consider giving up smoking,'" he said. "They look at me, they say, 'Doc, are you smoking crack? Do you expect me to give up my cigarettes when I've already given up a substance that basically, I've been using for 15, 20 years?'"