Pills, patches, gums, nasal sprays and lozenges used to help smokers kick the habit can also help heavy drinkers cut back on alcohol, a new study suggests.
The finding follows several months spent working with 400 smokers with HIV who were also heavy drinkers.
Researchers determined that both the prescription smoking cessation medication varenicline (Chantix) and standard over-the-counter and prescription nicotine replacement therapies (NRT) — including patches, gums, lozenges, inhalers and nasal sprays — were highly effective at helping patients quit smoking and curtail drinking at the same time.
So too was another prescription medication called cytosine, which is similar in chemical makeup to Chantix. Though it is not approved for use in the United States, it is in wide use across Eastern Europe, including in Russia where the study was conducted.
The findings among smokers with “risky drinking” habits were dramatic, according to lead researcher Dr. Hilary Tindle, founding director of the Vanderbilt Center for Tobacco, Addiction and Lifestyle in Nashville.
“We found that people reduced their alcohol intake and quit smoking at about the same rate, regardless of which medication they were assigned to,” she said.
Three months into treatment, 21% of participants had stopped drinking altogether. Six months out, between 15% and 19% had stopped smoking, the study found.
Tindle acknowledged that the apparent success as an alcohol treatment of therapies designed to target nicotine receptors in the brain is somewhat surprising. She noted that while NRT has been around since the 1980s, it has never been prescribed for alcohol cessation.
Yet, Tindle said, the findings “also make sense.” That’s because human and animal studies suggest that breaking one habit may help a person break another one and smoking cessation techniques appear to reduce brain-based alcohol cravings.
The findings were reported Aug. 5 in JAMA Network Open. Besides Vanderbilt, the study was conducted by researchers from Boston University, Boston Medical Center and First Pavlov State Medical University in St. Petersburg, Russia.
Tindle noted that the Russian team had a long history of working with HIV patients, and were eager to work with American researchers to explore new ways to help them reduce both alcohol and tobacco use.
The 400 study participants were all Russian and living with HIV — 60% of them having undetectable levels of the virus due to ongoing antiviral treatment. Many were struggling with substance abuse and mental health issues.
All smoked at least five cigarettes a day, although average use exceeded a pack a day.
All also met the U.S. National Institutes of Health’s definition for a “risky drinker,” meaning someone who drinks heavily on at least five days each month. The institute defines heavy drinking as five drinks or more for men, and four or more for women, daily.
Between 2017 and 2020, participants were randomly divided into three treatment groups: one was given Chantix; another, cytosine; and the third received NRT. (Patients did not know which therapy they were given.)
They were tracked for up to one year.
Not only had one-fifth of participants stopped drinking and smoking at three and six months respectively, alcohol abstinence was roughly twice as high (at three, six and 12 months) among those who stopped smoking versus those who continued to do so.
Throughout the year, participants who stopped smoking also saw their alcohol intake plummet, even if they continued to drink.
“The number of heavy drinking days was roughly half in those who quit smoking versus those who continued to smoke,” Tindle said.
She is convinced that the findings would “absolutely” apply to a general population, meaning those who do not also struggle with HIV or other health concerns.
But, Tindle added, more research would be needed to see whether smoking cessation tools could help heavy drinkers cut back or quit even if they are not also current smokers.
George Koob, director of the U.S. National Institute on Alcohol Abuse and Alcoholism in Bethesda, Md., reviewed the findings.
“It is not at all surprising that these smoking cessation treatments would also work on drinking,” he said.
For one thing, alcohol and tobacco use often go hand in hand. And, Koob said, previous studies in both people and animals pointed to the positive impact that smoking cessation therapies can have on drinking behavior.
Patricia Aussem, associate vice president of consumer clinical content development with the Partnership to End Addiction in New York City, was also not surprised by the positive impact smoking cessation tools appear to have on drinking.
“Alcohol and nicotine share some of the same receptors in the brain that are responsible for cravings and consumption,” she pointed out.
But Aussem emphasized that a number of medications are already specifically approved to address alcohol cessation, and she cautioned that turning to smoking cessation therapies to address drinking issues may not always be smooth sailing.
As an example, she cited Chantix. The U.S. Food and Drug Administration warns it may raise the risk for increased intoxication and/or aggressive behavior and amnesia among drinkers.
“While more medication options in the toolbox for alcohol use disorders would be a plus, more research is needed,” Aussem concluded.
The U.S. National Institute on Alcohol Abuse and Alcoholism has more about alcohol treatment.
SOURCES: Hilary Tindle, MD, MPH, professor, medicine, Vanderbilt University, and founding director, ViTAL: Vanderbilt Center for Tobacco, Addiction and Lifestyle Nashville; George Koob, PhD, director, U.S. National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md.; Patricia Aussem, LPC, associate vice president, consumer clinical content development, Partnership to End Addiction, New York City; JAMA Network Open, Aug. 5, 2022
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