Comorbid Cigarette and Alcohol Addiction

Journal of Addictive Diseases

ISSN: 1055-0887 (Print) 1545-0848 (Online) Journal homepage: http://www.tandfonline.com/loi/wjad20

Comorbid Cigarette and Alcohol Addiction Norman S. Miller MD & Mark S. Gold MD To cite this article: Norman S. Miller MD & Mark S. Gold MD (1998) Comorbid Cigarette and Alcohol Addiction, Journal of Addictive Diseases, 17:1, 55-66, DOI: 10.1300/J069v17n01_06 To link to this article: http://dx.doi.org/10.1300/J069v17n01_06

Published online: 12 Oct 2008.

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Comorbid Cigarette and Alcohol Addiction: Epidemiology and Treatment Norman S. Miller, MD Mark S. Gold, MD SUMMARY. The close association of nicotine addiction and alcoholism is well established. As many as 80% of alcoholics smoke, and 30% of smokers are alcoholics. The mortality from cigarette smoking and alcoholism individually is very high, as an estimated 400,000 deaths from tobacco and 100,000 deaths from alcoholism are reported annually. Cigarettes and alcohol interact to cause certain cancers, e.g., head and neck. Only recently has attention been focused on the role of tobacco in abstinent alcoholics. An important study found high rates of mortality from tobacco in abstinent alcoholics in recovery. However, the mortality rates from alcoholism were high and predominant. Of great importance is that studies show that abstinence from alcohol essentially eliminates the premature deaths or increased mortality rates from active alcoholism. Similar studies showing a reduction in mortality from abstinence in nicotine addiction have not been forthcoming. The importance of treating nicotine addiction, however, is clear to reduce the high mortality rates from tobacco smoking in active or abstinent alcoholics. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: [email protected]] Norman S. Miller is Chief, Division of Addictions Programs, and Associate Professor of Psychiatry and Neurology, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL. Mark S. Gold is Professor, Departments of Neuroscience, Psychiatry, Community Health & Family Medicine, University of Florida Brain Institute, Gainesville, FL. Address correspondence to: Norman S. Miller, University of Illinois at Chicago, Department of Psychiatry, 912 South Wood Street, Chicago, IL 60612. [Haworth co-indexing entry note]: ‘‘Comorbid Cigarette and Alcohol Addiction: Epidemiology and Treatment.’’ Miller, Norman S., and Mark S. Gold. Co-published simultaneously in Journal of Addictive Diseases (The Haworth Medical Press, an imprint of The Haworth Press, Inc.) Vol. 17, No. 1, 1998, pp. 55-66; and: Smoking and Illicit Drug Use (ed: Mark S. Gold, and Barry Stimmel) The Haworth Medical Press, an imprint of The Haworth Press, Inc., 1998, pp. 55-66. Single or multiple copies of this article are available for a fee from The Haworth Document Delivery Service [1-800-342-9678, 9:00 a.m. - 5:00 p.m. (EST). E-mail address: [email protected]].

E 1998 by The Haworth Press, Inc. All rights reserved.

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SMOKING AND ILLICIT DRUG USE

EPIDEMIOLOGY OF TOBACCO AND ALCOHOL That nicotine and alcohol addictions are chronic, fatal diseases is known from clinical experience and diverse studies. As an example, a recent survey of the actual causes of death in the United States between 1977 and 1993 categorized deaths according to the following ‘‘external (nongenetic) factors’’: tobacco (estimated 400,000 deaths), diet and activity patterns (300,000), alcohol (100,000), microbial agents (90,000), toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit drug use (20,000) (Table 1). The study overlooked the known genetic contributions of addictive illnesses, namely, nicotine addiction and alcoholism, by attributing these conditions to roles of external factors.1 As an illustration, in 1990 the number of deaths due to other causes, largely genetic, and external factors, were heart disease (720,000), cancer (505,000), cerebrovascular disease (144,000), accidents (92,000), chronic obstructive pulmonary disease (87,000), pneumonia and influenza (80,000) TABLE 1. Actual Causes of Death in the United States in 1990 (Reprinted from JAMA 270(18):2207-2212, 1993) Cause

Estimated Number*

% of Total Deaths

Tobacco

400,000

19

Diet/activity patterns

300,000

14

Alcohol

100,000

5

Microbial agents

90,000

4

Toxic agents

60,000

3

Firearms

35,000

2

Sexual behavior

30,000

1

Motor vehicles

25,000

1

Illicit use of drugs

20,000