Tobacco and Public Health - TCSC Indonesia

Treatment issues and co-dependence
Effective smoking cessation programs will be necessary to reduce the global burden of
tobacco-related disease. Does alcohol play a role in determining the success of smoking
intervention programs? The evidence strongly suggests that drinking reduces the
already low success rate in smoking intervention programs. This is especially so for
heavy drinkers, and less so for light or moderate drinkers. Binge drinking, loosely
defined as consuming at least five or more drinks on one or more occasions in the previous
month, reduces the probability of success by as much as 50% (Murray et al. 1995;
Dawson 2000). The reason might be that binge drinkers are more likely to have a
genetic defect leading to a more serious addiction problem to both alcohol and tobacco
than moderate drinkers (see above).
Prevention of alcohol and tobacco-related diseases is even more important than
treatment, especially in adolescents and young adults. There is solid evidence that the
use of both substances begins at an early age, implying that efforts to promote a
healthy lifestyle must begin early in life (Burke et al. 1988).
Summary
Both tobacco and alcohol contribute greatly to the global burden of disease. In the
United States, an estimated 20% of the population has had recent exposure to both
drugs, but at high levels of consumption of either substance, dual exposure is common,
perhaps because of genetic susceptibility to addictive agents. At the biologic level, alcohol,
although not a carcinogen, could enhance carcinogenicity of substances such as
N-nitrosoamines contained within tobacco smoke, implying that exposure to both drugs
will have a greater deleterious effect than exposure to either single agent. Malignancies
of the mouth, throat, larynx, and esophagus where there is direct exposure to tobacco
smoke and to alcohol are known to be related to exposure to both agents.
Of the several non-malignant diseases associated with dual exposure to these two
substances, cardiac disease is clearly the most important: both heavy drinking and
heavy smoking increase the risk of heart disease.
Smoking and alcohol consumption adversely effect pregnancy; regrettably, even
though the deleterious impact of these substances on the fetus is well documented,
exposure rates are still high.
Effective smoking cessation programs will be required to reduce the frequency of
smoking-related disease. Unfortunately, smoking cessation programs are less effective
in heavy drinkers; effective treatment of these individuals will require specially
designed intensive therapeutic protocols.
References
ALBERT B. LOWENFELS AND PATRICK MAISONNEUVE 653
1994. Medical-care expenditures attributable to cigarette smoking—United States, 1993. MMWR
Morb Mortal Wkly Rep, 43, 469–72.
National Household Survey on Drug Abuse: Main Findings (1997). National Clearinghouse for
Alcohol and Drug Information. 1997. 2-26-2002. Ref Type: Electronic Citation.