Why do drinkers smoke and smokers drink?

Posted by DrMendelsohn on 5 October, 2013

Alcohol.jpgWhy does a drink goes so well with a cigarette? Alcohol and nicotine have a strong and complex relationship and interact in the brain and liver. Some of their harmful effects, such as the risk of cancer, are multiplied when the two are used together.

Why do heavy drinkers smoke?

Genetic factors play an important role in whether you smoke or drink. The genes for alcohol and smoking often go together, so some people are genetically prone to both behaviours. (1)

Smoking is more satisfying with a drink and a drink is more satisfying with a cigarette. The reason is that both act in the reward centre of the brain releasing the feel-good hormone, dopamine. When both are used together, the pleasure is additive. (2)

Over time, alcohol and smoking become associated in the brain, so that the use of one (alcohol or smoking) triggers the desire for the other.

How smoking helps drinkers

In spite of its devastating health effects, smoking has some positive effects in drinkers. Smoking slows the absorption of alcohol from the gut, so that blood alcohol levels are lower. (Johnson) Smoking also accelerates the breakdown of alcohol in the liver, so it is removed from the body more quickly. (3)

Nicotine is a stimulant and counteracts some of the side-effects of alcohol.  Drinkers who smoke feel less intoxicated, think more clearly and are less drowsy. (2,4) Withdrawal from alcohol is also less severe in drinkers.

How can heavy drinkers quit smoking?

When quitting smoking, it is a good idea to avoid alcohol for the first couple of weeks if possible, as a drink will often trigger cigarette cravings and is a common cause of relapse to smoking. Heavy drinkers should reduce their alcohol intake.

If you are a heavy drinker, quitting smoking is likely to more difficult and you may need longer and more intensive treatment. It is best to stop smoking and alcohol together if possible, rather than one at a time. (5)

Champix is particularly effective in helping heavy drinkers quit smoking. As well as relieving nicotine cravings and withdrawal symptoms, Champix also reduces the desire to drink and helps to cut down alcohol intake. (6).

Research has also shown that heavy drinkers get more benefit from combination nicotine therapy than from using one product only. (7) This involves using nicotine patches combined with the nicotine mouth spray, lozenges, gum or inhalator.



1) True WR. Common genetic vulnerability for nicotine and alcohol dependence in men. Arch Gen Psychiatry 1999

2) Hurley LL. Positive and negative effects of alcohol and nicotine and their interactions. Neurotox Res. 2012

3) Yue J. Differential induction of ethanol-metabolizing CYP2E1 and nicotine-metabolizing. Eur J Pharmacol 2009

4) Madden P. Alcohol sensitivity and smoking history in men and women. Alcohol Clin Exp Res 1995

5) Prochaska JJ. A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment. J Consult Clin Psych 2004

6) Mitchell J. Varenicline decreases alcohol consumption in heavy-drinking smokers. Psychopharm 2012

7) Cooney NL. Smoking Cessation During Alcohol Treatment. Randomized Trial of Combination Nicotine Patch Plus Nicotine Gum. Addiction 2009


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