Dear Alice,

I have been a smoker for about 8 years and smoke about a pack per day. I am also an alcoholic and now drink about 7 to 10 beers a day, and have been for the past 2.5 years. Last night I decided to quit drinking beer every day and today I am already shaky, nervous, and can't concentrate. I want to quit smoking also so I can join the army. Is it dangerous to quit both at once? Would it be too much stress on my body and mind? And also, would having just one beer a day for the next couple days help with the withdrawal symptoms?

—Aria

Dear Aria,

Congratulations on making the decision to quit smoking and work to overcome your alcohol addiction. Admitting to problems with substance abuse is often difficult, so it's great that you're being honest with yourself and are reaching out for advice. While you're likely to experience withdrawal symptoms, there's no evidence to suggest that it's harmful to quit using tobacco and alcohol at the same time. Although many treatment programs for alcohol addiction don't include help with tobacco use (and vice versa), research shows that quitting both at the same time may make an individual more likely to stay sober long-term. Talking with a health care provider might help you quit both substances safely, while giving you the tools and support to stay substance-free in the long run.

You're not alone in battling two addictions at once. Over 80 percent of people with an alcohol addiction smoke, and smokers are three times more likely to be addicted to alcohol compared to non-smokers. Researchers have noted that people who are trying to quit smoking often relapse when they drink alcohol. Additionally, according to one study, it appears that the interaction between nicotine and alcohol might make it more difficult to quit either substance.

As you've experienced, those who live with alcohol addiction and reduce their intake may experience withdrawal symptoms such as nausea, sweating, and shaking. Once your body has become addicted to alcohol, it can pose significant health risks to quit suddenly. In some cases, people who are addicted to alcohol who stop drinking abruptly may develop delirium tremens (DTs), which is a form of withdrawal that causes severe mental and neurological problems. Symptoms can include:

  • Agitation or irritability
  • Decreased attention span
  • Restlessness or excitement
  • Feelings of fear
  • Sensitivity to light, sound, and touch
  • Confusion, disorientation, or delirium
  • Body tremors
  • Hallucinations
  • Seizures

If you experience any of these symptoms, seek immediate medical attention. Delirium tremens is most common among those with a history of withdrawal symptoms who drink over seven pints of beer or one pint of liquor or spirits each day. According to the drinking habits you described, you may be at risk for DTs by trying to stop drinking on your own. If you want to read more about alcohol withdrawal, be sure to check out Alcohol withdrawal symptoms?.

Unlike alcohol, quitting smoking poses no severe health risks. In fact, there are immediate health benefits. Within hours after your last use, your heart rate and the carbon monoxide in the bloodstream returns to their usual levels. However, you're likely to experience some withdrawal symptoms, including:

  • Strong cravings
  • Anxiety
  • Irritability
  • Difficulty concentrating
  • Depressed mood
  • Frustration or anger
  • Increased hunger
  • Insomnia
  • Constipation or diarrhea

For more information about smoking withdrawal, be sure to review Smoking withdrawal symptoms and how to quit. Although you may experience withdrawal symptoms when you stop alcohol use and smoking, research hasn't found it to be harmful to do both simultaneously. One study found that those who participated in smoking cessation treatment at the same time as their alcohol use treatment were 25 percent more likely to be abstinent from alcohol moving forward. Why might this be the case? This is tied to the GABAA receptors (within the central nervous system), which control desire and cravings for alcohol and nicotine. Because tobacco can block these receptors, continuing to smoke while experiencing alcohol withdrawal can lead to increased alcohol cravings and higher risk of relapse.

Despite your commitment, you may find that it's very difficult to quit drinking and smoking on your own, and doing so on your own may pose risks to your health. You're more likely to be able to stop drinking and smoking, and remain substance-free in the long term, if you seek support from family, friends, and health professionals. An intensive treatment program might help you address the physical and emotional challenges of addiction and quitting. Most studies on quitting smoking agree that having social support and using nicotine replacement options could dramatically increase your chances of succeeding. Studies have also found that social support can help those trying to recover from alcohol addiction. If possible, it may be helpful for you to find a treatment program that addresses both alcohol use and smoking.

It may seem like an immense challenge to confront dual problems with alcohol and smoking, but you've already passed the first hurdle by making a commitment to quit both. By gathering support and seeking treatment, you'll likely feel more confident confronting the next challenges of trying improving your health and joining the army. In the meantime, feel free to read up on other questions related to seeking help in the Helping & Getting Help category in the Go Ask Alice! Alcohol & Other Drugs archives. 

Take care,

Alice!

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