Smoking Drinkers: Treat Both Dx

By Frieden, Joyce | Clinical Psychiatry News, April 2004 | Go to article overview

Smoking Drinkers: Treat Both Dx


Frieden, Joyce, Clinical Psychiatry News


SCOTTSDALE, ARIZ. -- Dr. Richard Hurt is sick of watching his alcoholism patients die.

But it's not the alcoholism they're dying from, said Dr. Hurt, director of the Nicotine Dependence Center at the Mayo Clinic, in Rochester, Minn. "Smoking causes significant morbidity and mortality in alcoholics," he said at the annual meeting of the Society for Research on Nicotine and Tobacco. "And quite frankly, I'm tired of seeing people recovering from their alcoholism but dying from their tobacco dependency."

One study of 845 patients who had received treatment for alcoholism found that they died at a much higher rate than would normally be expected, given matched controls for age and gender, he continued. "So what did they die from? Tobacco-caused deaths accounted for 51%, and alcohol-caused deaths, 34%. If I have a disease entity in my treatment unit and it's caused half of the mortality and I don't do something about it, that's not really best practices, I would submit."

Many people do not think that alcoholics can be treated for tobacco dependence and alcoholism simultaneously, but that's not the case, Dr. Hurt said, noting that he and his colleagues did a study of just such a program 10 years ago, in an addiction treatment unit that allowed smoking in a separate "smoking room." At the end of 1 year, 12% of those treated for both addictions had stopped smoking.

"None of the controls had stopped smoking, except for the four who died, and two of those died of tobacco-caused diseases," he said. "They stopped smoking forever."

During the study, "we had a cocaine addict who was in that unit, who said, 'You know, I don't drink very much, but I like to have a glass of wine with dinner sometimes. You've got a smoking room where people go to smoke; could you give me a bottle of wine for dinner tonight?' They looked at him like he was nuts," said Dr. Hurt, who is an internist. "He said, 'I'm not nuts; I just want a glass of wine. I'm not an alcoholic; I'm just a cocaine addict.' And they didn't get it."

Some clinicians are reluctant to treat alcoholics for smoking cessation because they think they are more addicted than other smokers. Dr. Hurt said. But a 1999 study that his group did using nicotine patch therapy on patients who were nonalcoholics, recovering alcoholics with a past history of alcoholism, or current alcoholics found that at the end of six months the nonalcoholics had the best smoking cessation rates--as expected--but the current alcoholics came in second.

The federal government and private foundations should put more emphasis on smoking cessation when they administer grants for substance abuse treatment, Dr. Hurt said. "I'd make it a requirement: If you're going to talk about substance dependence treatment, and you don't have tobacco in this [proposal], that grant is dead on arrival. …

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