Clinical trial aims to help heavy drinkers quit smoking

Quitting smoking is hard. And it’s harder for those who drink alcohol regularly.

Several reasons may explain the strong link between smoking and frequent alcohol use. From a social perspective, cigarettes and alcohol are both legal and readily accessible in the U.S. From the brain’s perspective, nicotine increases the rewarding effects of alcohol, and vice versa. Alcohol also lowers our inhibitions, or our ability to control impulses, making it more difficult to deny “just one cigarette.” In fact, roughly 40% of heavy-drinking smokers say alcohol was a factor in their unsuccessful attempts to quit smoking.

Smokers who are heavy drinkers* face unique challenges in quitting smoking that aren’t really addressed by the current standard of care. Research shows that medication (such as Chantix or Bupropion), nicotine-replacement aids (e.g. patch, gum, lozenge, inhaler), behavioral counseling, or some combination of these can help people become smoke-free. While these treatments may work for some heavy-drinking smokers, most are ineffective for long-term (>6 months) abstinence from smoking. Also, few primary care physicians are trained to provide intensive treatment and counseling to help heavy drinkers quit smoking.

For these people (estimated to be about 6 million people in the U.S.), research suggests that a comprehensive treatment strategy that simultaneously addresses drinking and smoking behaviors may be the best bet, but there is still work to be done. Under the supervision of Andrea King, PhD, at the University of Chicago, I am coordinating a clinical trial that will assess the effectiveness of a three-part smoking cessation intervention in adult, heavy drinking smokers, using Chantix, the nicotine patch, and brief behavioral coaching.

Our goal is to find an effective, targeted treatment plan that primary care physicians can implement in the clinic. We think this combination of medications and behavioral support will help smokers cope with cravings, triggers, and nicotine withdrawal symptoms.

Smokers begin taking Chantix one week before the target quit date to let the drug slowly build up in the brain. Once it reaches steady levels, Chantix helps to ease the quitting process by minimizing withdrawal symptoms and reducing the rewarding effects of cigarettes. Recent research also shows that Chantix can reduce alcohol consumption, particularly among heavy drinkers.

Chantix does not eliminate all cigarette cravings, especially at the beginning stages of a quit attempt when cravings tend to be strongest. The addition of a daily nicotine patch seems to help reduce these “spot cravings.” The patch slowly releases nicotine in the body, maintaining constant levels of nicotine in the brain, which also helps to minimize withdrawal symptoms.

Behavioral coaching also teaches patients additional skills to help quit, such as managing triggers (such as alcohol or sensory cues associated with smoking, like an ashtray or cigarette smoke) and understanding the benefits of quitting. The behavioral portion in our clinical trial is based on the Courage to Quit® program created by Dr. King in collaboration with the Respiratory Health Association of Chicago. This program provides educational material about medications, stress management, and the health and financial gains of being smoke-free. Also, smokers who drink heavily may not be aware of how detrimental their drinking behavior may be to their quit attempt. Even with just 15 minutes of counseling, smokers can learn how to modify their behaviors to avoid relapsing to smoking.

We hope that a three-part program consisting of Chantix, nicotine patch, and behavioral support will be an effective and readily available option for heavy drinking smokers to successfully quit cigarettes. However, like any substance use disorder or addiction, maintaining abstinence can be a lifelong process for many smokers, so it may take a few quit attempts before being successful.

If you are interested in participating in the study described above, please contact Dr. Ashley Vena (avena@uchicago.edu). To learn more about the Courage to Quit® program, please visit http://stopsmoking.uchicago.edu/couragetoquit.html.

* The National Institute on Alcohol Abuse and Alcoholism defines heavy alcohol use as more than 14 standard drinks per week for men and more than 7 standard drinks per week for females.