Can I quit alcohol and cigarettes at the same time?

Dear Aria,

Congratulations on making the decision to quit smoking and work to overcome your alcohol addiction. Acknowledging challenges with substance use, even just to yourself, is often difficult, so here’s to you for taking the first step towards reaching out for help and achieving your goals. While you're likely to experience withdrawal symptoms given your history with tobacco and alcohol, there's no evidence to suggest that it's harmful to quit using both substances at the same time. In fact, recent research suggests that it may actually be beneficial to quit both at once as it could improve your overall chances of achieving longer-term sobriety!

You're not alone in battling these two addictions. There is a high correlation between cigarette smoking and alcohol dependence. Over 80 percent of people with an alcohol addiction also smoke, and those who smoke are three times more likely to be addicted to alcohol compared to non-smokers. Because many people often smoke and drink in similar situations (for example, at bars or parties), 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 alone, meaning that people who attempt to quit both at the same time have better odds of avoiding relapse. 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. This effect could be explained biologically by the role of GABA 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 alcohol-related relapse.

While the short-term effects of alcohol use disorder can be life-threatening, smoking actually has greater health impacts in the long-term: more people experiencing alcohol addiction die from smoking-related diseases than from alcohol-related diseases. There is also an overlap in health complications prevalent in smoking and alcohol dependent populations, and using both substances together may lead to even greater health risks. Unfortunately, despite the fact that a large majority of patients in treatment for alcohol use disorder are considered heavy smokers or tobacco dependent, many alcohol treatment programs don't include help with tobacco use (and vice versa). In order to quit both substances safely, you may consider seeking guidance from a health care provider or addiction specialist who has experience providing addiction treatment for both substances simultaneously. Additionally, some general tools for both tobacco and alcohol cessation include:

• Write it down: Listing out your reasons to desire a smoke-free and alcohol-free life may help motivate you, especially when the process gets difficult.
• Make a plan to quit: Prepare for this big change beforehand by outlining a plan of when and how you will decrease or eliminate alcohol or tobacco use.
• Find social support: Communicating with friends, family, and specialized support groups in person or online has proven to be beneficial for success.
• Keep a busy calendar: Fill your time with activities to prevent boredom. Going for a walk, watching a movie, or learning a new hobby are great ways to keep yourself occupied and away from drinking or smoking.
• Avoid temptation: Steer clear of people or places that may make you want to smoke or drink. If you can't avoid these obstacles, try making a plan to manage your emotions during these experiences to keep from becoming tempted.
• Track your progress: Apps such as quitSTART are useful in helping to reach your goals and staying motivated.

For people with a history of substance use, it’s common to experience withdrawal symptoms when trying to quit. Common alcohol withdrawal symptoms include nausea, sweating, shaking, and other symptoms; rarer and more life-threatening symptoms include seizures and extremely high heart rate and blood pressure. Unlike alcohol, quitting smoking poses no significant health risks, and in fact offers immediate health benefits. Within hours after quitting tobacco, the heart rate and the carbon monoxide in the bloodstream return to their usual level. However, quitting tobacco may also come with uncomfortable withdrawal symptoms, such as strong cravings, insomnia, and mood changes. In addition to physical symptoms, quitting substances may also be accompanied by changes in mood, including signs of depression. You may consider seeking assistance from a health care provider, mental health professional, or addiction specialist to make a plan to monitor, mitigate, and overcome these withdrawal symptoms.

It may seem like an immense challenge to confront dual problems with alcohol and smoking, but you've already cleared the first hurdle by making a commitment to yourself to quit both. An intensive treatment program might help you address the physical and emotional challenges of addiction and quitting. You may also benefit from a treatment program that addresses both alcohol and tobacco simultaneously. 

Take care,