Cigarettes More Lethal Than AlcoholAlcoholics should use nicotine gums or patches, say researchers

 By Anne Haddad

 A drink in one hand, a cigarette in the other. Which is more lethal?Experts say the cigarette. Even alcoholic smokers are more likely to die from problems caused by smoking than by drinking, they say.
Though research is just beginning into links between smoking and alcoholism, a new study says smokers with a history of alcoholism may benefit from nicotine gum, patches and other substitutes for smoking. 
"The next step I would find interesting would be to look at the idea of how to tackle both addictions -- sequentially or at the same time? And if you do it sequentially, which one makes the most sense to do first?" asks Gail L. Rose, research associate at the University of Vermont. She was project manager for the study led by Professor of Psychiatry John R. Hughes.
The study, reported in this month's issue of Alcoholism: Clinical and Experimental Research, looked at 20 smokers with a history of alcoholism and 10 smokers who were not alcoholics. All volunteered to abstain from cigarettes for four days.
On each of the first three days, they were given 2-milligram nicotine gum, 4-milligram nicotine gum or placebo gum. They picked up the gum at noon and returned at 6 p.m. with any unused gum.
On the fourth day, they were given a choice of all three gums to chew throughout the day.
The researchers found the subjects who had no history of alcoholism showed no preference for one gum, but the 20 recovering alcoholics chewed more milligrams of nicotine each day, Rose says.
The smokers, none of whom were trying to quit for good, didn't report a preference for any of the gums, yet their behavior showed a distinct preference for the high-nicotine version, Rose says.
"If they tell us how they feel, they feel no different," she says. "But if we look at what they chose, they chose more nicotine. They don't really know why they prefer it. A lot of smokers don't really understand why they smoke, but they feel they have to."
The scientists tried to determine how much they wanted the gum by asking how much they would pay for a piece of gum on a day they couldn't smoke?
Those with a history of alcohol problems were willing to pay more than their counterparts, Rose says.
"That indicates to us how valuable this gum is to them," she says.
Statistics show a strong link between alcoholism and smoking. About 90 percent of alcoholics smoke, compared with 24 percent of the general adult population, according to Rose and figures from the U.S. Centers for Disease Control and Prevention.
The reason for that high rate is unclear, says Kenneth A. Perkins, professor of psychiatry at the University of Pittsburgh's Medical Center. He also studies alcoholism and smoking.
"I caution against thinking there must be some sort of addictive personality. There certainly is no official diagnosis of that type, but clearly if you have one drug dependency, you are certainly at increased risk for another. Not all others, but certain others," Perkins says.
For example, Perkins says while 90 percent of alcoholics are smokers, the percentage of smokers who are alcoholics is nowhere near that high. Rather, he says one drug seems to change how a person reacts to another substance.
Until recently, the alcohol-treatment community has not pushed recovering alcoholics to quit smoking because it might be too stressful and thwart their efforts to stay off alcohol. But recent research indicates that isn't necessarily true, Perkins says. Not only can they quit cigarettes as well as liquor, he says they should especially quit smoking.