Female smokers have the highest alcohol craving in a residential alcoholism treatment cohort

doi:10.1016/j.drugalcdep.2015.02.016

Drug and Alcohol Dependence

Volume 150, 1 May 2015, Pages 179-182

https://doi.org/10.1016/j.drugalcdep.2015.02.016 Get rights and content

Highlights

•
Alcohol craving is a relevant clinical variable associated with subsequent alcohol relapse.
•
Smoking alcoholic women have higher alcohol craving than smoking alcoholic men and nonsmoking alcoholics of both sexes.
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Smoking status by gender and smoking cessation treatment were not associated with alcohol relapse at 12-month follow-up.
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After controlling for confounders, only the Penn Alcohol Craving Scale at admission was associated with alcohol abstinence at 12-month follow-up.

Abstract

Background

Cigarette smoking among female and male alcoholics has not been extensively studied as a factor related to intensity of alcohol craving during residential treatment and corresponding sobriety length.

Methods

This retrospective cohort study assessed self-reported sobriety outcomes in patients with alcohol dependence at 3-month intervals over 12 months after completion of a 30-day residential treatment program. Demographic and clinical variables were collected including smoking status, alcohol craving utilizing the Penn Alcohol Craving Scale (PACS), and alcohol relapse. Statistical analyses included Chi-square, ANOVA, Tukey's test, Kaplan–Meier plots and Cox proportional hazards models as appropriate.

Results

Of the 761 alcohol-dependent study subjects, 355 (47%) were current smokers. Alcohol craving intensity was higher in smoking females compared to nonsmoking females (p = 0.0096), smoking males (p < 0.0001), and nonsmoking males (p < 0.0001). Smoking status-by-sex interaction was not associated with post-treatment relapse. After controlling for other variables, higher PACS scores at admission were associated with higher probability of relapse (p = 0.0003).

Conclusions

In this study, female alcoholic smokers experienced the highest level of alcohol craving in an alcohol treatment setting. Interestingly, this did not translate into higher rates of post-treatment relapse. Further research is warranted to explore the neurobiological basis for sex differences in this highly prevalent comorbidity.

Introduction

The prevalence of tobacco dependence among adults with alcohol dependence is much higher than in the general population. Grant et al. (2004) found that the prevalence of tobacco dependence was threefold higher (45%) among those with DSM-IV alcohol dependence compared with 13% of the general population sample. Multiple studies among inpatient and outpatient clinical populations have observed even higher tobacco dependence prevalence rates of 60–92% among alcohol-dependent patients (Batel et al., 1995, Bien and Burge, 1990, Burling and Ziff, 1988, Kalman, 1998, Kalman et al., 2005, Sobell et al., 2002).

Cigarette smoking among alcoholics has not been extensively studied as a factor related to intensity of alcohol craving during residential treatment. However, higher alcohol craving has been associated with higher rates of post-treatment relapse to alcohol use (Bottlender and Soyka, 2004, Oslin et al., 2009, Schmidt et al., 2011, Schneekloth et al., 2012). It also has been shown that substance use, including tobacco (Cooney et al., 2007), may positively reinforce the urge to drink alcohol. Therefore, it is possible that smoking during treatment may be associated with increased craving and higher probability of post-treatment relapse.

Sex differences in those who drink and smoke have been well studied in the general population, but there is limited evidence regarding these sex effects among alcoholics. One study (Bobo et al., 1996) reviewed three previous investigations of sex effects on tobacco use and smoking cessation during alcoholism treatment (males: n = 503, females: n = 357). Similar rates of tobacco use, dependence severity, and smoking cessation were found between males and females.

To investigate the impact of alcohol craving, smoking while in treatment, and pharmacological smoking cessation therapy (SCT) at discharge on post-treatment relapse among female and male alcoholics, we tested association of these factors with treatment outcomes during the first 12 months after completion of a 30-day residential alcoholism treatment program. Our hypothesis was that alcoholics who smoke would have higher alcohol craving and shorter durations of abstinence than nonsmoking alcoholics. We also examined potential sex-related effects on these associations.

Section snippets

Study design

This study was conducted in compliance with established ethical standards and approved by the Institutional Review Board of the Mayo Clinic Rochester. We conducted a retrospective cohort study among patients admitted to the Mayo Clinic Intensive Addiction Program between November 10, 2005, and July 18, 2013. A small proportion of our sample (37–41%) overlaps with prior reports (Boykoff et al., 2010, Schneekloth et al., 2012), but these investigated different research questions and hypotheses.

Patients

Demographic and clinical variables

The study included 761 alcohol-dependent subjects who completed the PACS at admission. The mean (SD) age was 46.3 (13.6) years (range: 18–85), 487 (64%) were males, and 656 (86%) were of European American descent. A total of 434 (57%) patients had a depressive disorder (major depressive disorder, dysthymia, depression NOS, or substance-induced mood disorders), which was the most frequent comorbidity. Only 142 (19%) patients had alcohol dependence disorder as a single diagnosis without comorbid

Discussion

We hypothesized that smoking alcoholic adults would report higher alcohol craving than nonsmoking alcoholics. Our findings support this hypothesis in women, but not in men. This finding has clinical relevance due to the high prevalence of smoking among treatment-seeking alcoholics, whose risk of relapse may be impacted by their smoking status.

Lisha et al. (2013) found that alcoholic smokers experience more alcohol craving when smoking and greater nicotine craving when drinking. Another study (

Role of funding source

None of the funding sources had any role in study design, collection, analysis, or interpretation of data.

Contributors

We declare that all authors have materially participated in the research and/or article preparation, and we have all approved the final article.

Conflict of interest

Dr Frye declares a potential conflict of interest in grant support (Assurex, Janssen Research and Development, Mayo Foundation, Myriad, National Institute of Alcohol Abuse and Alcoholism (NIAAA), National Institute of Mental Health (NIMH), Pfizer); consultancy (Janssen Research & Development, LLC, Mitsubishi Tanabe Pharma Corporation, Myriad, Sunovion, Supernus Pharmaceuticals, Teva Pharmaceuticals); and CME/Travel Support from CME Outfitters Inc. However, the grants listed did not support the

Acknowledgements

Presented in part at the Annual Meeting of the American Psychiatric Association, New York, May 2014, and the World Congress of Psychiatry of the World Psychiatric Association, Madrid, September 2014.

Funded by Mayo Foundation, Mayo Clinic Samuel C. Johnson Genomics of Addiction Program.

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Short communicationFemale smokers have the highest alcohol craving in a residential alcoholism treatment cohort

Highlights

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Study design

Patients

Demographic and clinical variables

Discussion

Role of funding source

Contributors

Conflict of interest

Acknowledgements

Addict. Behav.

Drug Alcohol Depend.

A retrospective study of gender differences in depressive symptoms and risk of relapse in patients with alcohol dependence

Am. J. Addict.

Relationship between alcohol and tobacco dependencies among alcoholics who smoke

Addiction

Smoking and drinking: a review of the literature

Int. J. Addict.

Nicotine dependence and intentions to quit smoking in three samples of male and female recovering alcoholics and problem drinkers

Subst. Use Misuse

Impact of craving on alcohol relapse during, and 12 months following, outpatient treatment

Alcohol Alcohol.

Gender differences in the relationship between depressive symptoms and cravings in alcoholism

Am. J. Addict.

Alcohol and tobacco cessation in alcohol-dependent smokers: analysis of real-time reports

Psychol. Addict. Behav.

Short communication
Female smokers have the highest alcohol craving in a residential alcoholism treatment cohort