This story appeared in The Hartford Courant
29 May 2004 ( http://www.ctnow.com/news/health/hc-smokedrink.artmar29,0,7311594.story
)
By GARRET CONDON, Courant
Staff Writer
There is nothing like a cocktail with
a cigarette.
Researchers who study the effects of alcohol and tobacco say that
the two substances go together, but not like love and marriage.
More like esophageal and pancreatic cancer.
Used together, it turns out, alcohol and tobacco are worse than
the sum of their hazards.
"There are ways in which alcohol and tobacco interact to be particularly
deadly," said Dr. Michael Fiore, director of the Center for Tobacco
Research and Intervention at the University of Wisconsin Medical
School in Madison. "For many of the cancers that plague people
who smoke, they also have as a cause alcohol used in excess. When
you link the two of them, they're really bad actors."
The state's smoking ban takes effect in bars as planned on Thursday,
completing a process that began with a prohibition in restaurants
last October. During a brief, failed attempt to preserve some
smoke-filled barrooms, opponents of the law cited the long-standing
right to enjoy a drink and a smoke and warned that a bit of American
culture was under siege.
"To say that you cannot smoke in these places is not right," said
John Woermer, owner of the Old Corner Cafe in Naugatuck, speaking
before the legislature's General Law Committee earlier this month.
The interrelationship between booze and butts is close, indeed.
Psychologist Ned Cooney of the VA Connecticut Healthcare System,
who also is an associate professor of psychiatry at Yale, said
the smoking rate among problem drinkers is 75 percent or 80 percent,
compared with about 25 percent in the population as a whole.
And, he said, "people who are smokers are more likely to drink."
Alcoholism is about 10 to 14 times more prevalent among smokers
than among nonsmokers.
Psychologist Sherry McKee, an assistant professor in the Department
of Psychiatry at Yale University Medical School, says it's no
accident that drinkers smoke. Tobacco companies have long marketed
their products in gin mills, and that effort has only increased
since the 1998 Master Settlement Agreement, which prohibits cigarette
promotions aimed at kids, she said. Also, she observed, some of
the same genes that predict a vulnerability to alcoholism may
predict a predisposition to smoke.
And the pleasures of the two drugs are biochemically linked, Fiore
said.
"We know that both alcohol and tobacco result in the release of
dopamine, and dopamine is the common neurotransmitter for the
experience of pleasure," he said. "They are similar in some of
their actions on the brain."
But if you double your pleasure, you also double your trouble.
Tobacco is infamously bad. Alcohol, on the other hand, lives two
lives. In moderation, it is thought to confer heart-health benefits
to otherwise healthy individuals. In excess, it's dangerous.
Fiore cited esophageal cancer, stomach cancer and pancreatic cancer
as cancers that have both tobacco and heavy alcohol use as risk
factors. (It's not known if the benefits of moderate drinking
are canceled out in smokers.) Cooney said one large study found
that smokers with drinking problems were more likely to die from
smoking-related causes than from drinking-related causes.
Fiore said that each year, about half of the smokers in America
try to quit. Most would-be quitters don't last more than one day,
and only about 5 percent are still off cigarettes a year later.
Those who have a particularly tough time quitting are drinkers,
he said. More than 10,000 smokers have gone to the University
of Wisconsin center in an attempt to quit smoking. Fiore said
that half of those who relapsed did so while drinking.
"There is an incredibly high rate of relapse that is associated
with drinking," he said. Alcohol, he said, lowers inhibitions
- and the self-discipline to avoid smoking is one such inhibition.
In addition, he said, failed quitters say bars and taverns are
filled with "powerful social prompts" to smoke.
Dr. Henry Kranzler, a professor of psychiatry at the University
of Connecticut Health Center, said banning smoking in bars is
likely to reduce the state's smoking rate. "I'd be willing to
bet on it," he said.
He also acknowledged that bar owners may feel some pain. "The
people who smoke in their bars are probably the ones who buy the
most booze," he said.
Of course, a key reason for the ban in Connecticut is to protect
tavern workers from secondhand smoke, which can cause cancer.
This is why Fiore smolders when opponents cite a kind of inalienable
right to a martini and a Marlboro.
"If this was anything but tobacco, we wouldn't even be discussing
it," he said. "Would we tolerate a restaurant owner who says,
`It's my right to sprinkle a little asbestos dust in my environment,
and if my workers don't like it, they don't have to work here?'
We would never dream of talking about it."
Researchers at Yale University and the VA Connecticut Healthcare
System are offering free smoking-cessation treatment and treatment
of both alcohol and tobacco addiction as part of clinical trials.
For smoking treatment alone, call 203-974-7588. For treatment
of both alcoholism and cigarette addiction, call 860-667-6736.
