Medications that help smokers quit appear to have another benefit: reducing heavy drinking.
Researchers in the United States and Russia have found that a variety of therapies to reduce the craving for nicotine ― including prescription and over-the-counter medications ― cut smoking and drinking levels in tandem. People who stopped smoking entirely reduced their drinking the most.
Heavy smoking and heavy drinking often go hand in hand, according to first author Hilary Tindle, MD, MPH, an internal medicine physician and the founding director of the Vanderbilt Center for Tobacco, Addiction and Lifestyle at Vanderbilt University Medical Center, Nashville, Tennessee.
“If one smoking medication could help with smoking and alcohol, that’s a major win. That’s one fewer medication that a person has to take,” Tindle told Medscape Medical News. The study was published online August 5 in JAMA Network Open.
The use of nicotine cessation therapies that target particular neurons has been shown to reduce heavy drinking in rats, suggesting a possible neuronal link between drinking and smoking, Tindle said. In addition, she said, many of the cues that induce heavy smoking encourage heavy drinking, too. Such cues vary from person to person but could include watching others smoke and drink at a bar or smelling cigarette smoke or alcohol. As a result, a therapy that addresses one problem may provide psychological ballast for tackling the other, Tindle said.
Each of the 400 participants in the new study (263 men; average age, 39 years) has HIV and lives in St. Petersburg, Russia. Prior to enrollment, participants smoked a mean of 21 cigarettes per day and experienced nine heavy drinking days per month, on average. A heavy drinking day was defined as having five or more drinks per day for men and four or more daily drinks for women.
Researchers randomly divided the participants into four groups. One group received the smoking cessation drug varenicline (Chantix) and a placebo form of a nicotine-containing mouth spray; another received placebo varenicline and active mouth spray; the third received the smoking cessation drug cytisine and placebo mouth spray; the fourth received placebo cytisine and active mouth spray.
The primary outcome was reduction in days of heavy drinking within the prior 30 days, compared to baseline, after 3 months. Across all groups, regardless of the approach to smoking cessation, heavy drinking dropped to an average of approximately two times in 30 days compared to nine times before the study began. No significant differences emerged for any of the approaches, according to the researchers.
Smoking levels dropped, too, for up to 12 months, sometimes to the point of abstinence, according to the researchers. By 3 months, 84 of 400 participants (21%) had stopped drinking altogether, which the researchers biochemically verified. Self-reports showed that this level of alcohol abstinence was maintained at 6 and 12 months.
The researchers say they expected that varenicline and cytisine would reduce heavy drinking days and would help people quit drinking more than nicotine replacement.
“We were pretty surprised to see that there was no difference in how well any of these meds helped people reduce their alcohol,” Tindle said. The mouth spray used in the study is not available over the counter in the United States, but Tindle said nonprescription nicotine replacements are understood to be effective and are available in lozenge, patch, or spray form.
Post hoc analyses of the study results showed a potential virtuous circle: People who quit smoking altogether appeared to reduce their drinking more significantly than those who slowed but did not fully stop their smoking.
“It adds to the evidence base that there’s benefit to smoking cessation medications. There’s real value in helping people quit smoking,” said Stephanie O’Malley, PhD, the Elizabeth Mears and House Jameson Professor of Psychiatry at Yale University School of Medicine, New Haven, Connecticut, who has studied varenicline for alcohol use disorder.
Tindle noted that cytisine is available in Russia but not in the United States. One reason her group conducted the trial in St. Petersburg was to study an additional option for smoking cessation, she said. Another benefit of this location, Tindle added, is that the Russian researchers had built relationships with people with HIV, a group often overlooked in addiction research.
“There are many individuals with a range of comorbidities who smoke, probably at a higher rate than the general population,” O’Malley said. “Individuals with comorbidities are often not recruited into clinical trials, so I think it’s a really important study from that perspective.”
Tindle has helped develop phase 3 trials of cytisine in the United States. O’Malley reported no relevant financial relationships.
JAMA Netw Open. Published online August 5, 2022. Full text
Marcus A. Banks, MA, is a journalist based in New York City who covers health news with a focus on new cancer research. His work appears in Medscape, Cancer Today, The Scientist, Gastroenterology and Endoscopy News, Slate, TCTMD, and Spectrum.
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