An Epidemiologic Analysis of Co-Occurring Alcohol and Tobacco Use and Disorders: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions

Article excerpt

The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) sought to determine the prevalence of drinking, smoking, and associated disorders in the general population. This survey, which includes a large representative sample of the adult population of the United States, found that drinking rates were highest among young adults and declined with increasing age. Rates of smoking and co-use of alcohol and tobacco were highest among the youngest respondents and declined thereafter. Similar patterns existed for the presence of alcohol use disorders (AUDs), nicotine dependence, and comorbidity between AUDs and nicotine dependence. Among ethnic/racial groups evaluated, Whites were most likely to drink and Native Americans/Alaskan Natives were most likely to smoke and to have an AUD, nicotine dependence, or comorbid AUD and nicotine dependence. Finally, the rates of tobacco use, daily tobacco use, and nicotine dependence increased with increasing levels of alcohol consumption and the presence of an AUD. These findings have important implications for the development of prevention and intervention approaches. KEY WORDS: Age differences; epidemiology; alcohol and other drug use disorders (AODD); racial differences; tobacco; nicotine; comorbidity; ethnic differences; gender differences

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Numerous studies have demonstrated that excessive alcohol consumption and tobacco use are independently associated with a plethora of health-related, social, and economic adverse consequences for the consumers of these legal substances as well as for society at large (Centers for Disease Control and Prevention [CDC] 2004, 2005a). Some of these detrimental effects can be exacerbated in people who use and abuse both substances. For example, the risk of certain cancers is greater for people who drink and smoke than for people who use only one of these substances (National Institute on Alcohol Abuse and Alcoholism [NIAAA] 1998a). To prevent the harmful interaction of alcohol and tobacco use and ameliorate its impact on the individual and society, it is important to understand the mechanisms contributing to the use and abuse of both substances. Many studies into these mechanisms have identified brain molecules, such as neurotransmitters and nicotinic receptors, that interact with alcohol and/or nicotine and which mediate the effects of these substances on the brain. Similar analyses also have identified mechanisms that mediate sensitivity to alcohol and/or nicotine, as well as the rewarding properties of the two drugs. (For more information on these mechanisms, see the articles by Funk and colleagues, Davis and de Fiebre, and Grucza and Bierut in this issue.)

Another large area of research is concerned with how the use of or dependence on one of these substances affects the treatment outcome for dependence on the other substance. For example, studies have begun to address the following questions: Are alcohol-dependent patients who are also nicotine dependent less likely to have successful alcoholism treatment outcomes than those patients who are not nicotine dependent? Should both dependencies be treated at the same time or consecutively? And are special treatment approaches needed for patients who are dependent on both rather than just one substance? This research already has yielded valuable insights. (For more information, see the articles by Foulds and colleagues, Gulliver and colleagues, Ziedonis and colleagues, and Kodl and colleagues in this issue.)

Although all of these avenues of research are of the utmost importance, it is equally critical to obtain a solid understanding of the scope of the problem. Thus, it is important to know the rates of alcohol and tobacco use and co-use in the general population and whether certain demographic subgroups are particularly at risk of using both alcohol and tobacco or being dependent on both substances. Studies of this nature are rare in the literature. …

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