Researchers have determined that recovering alcoholics drink a lot of coffee and smoke a lot of cigarettes.
This “discovery” by scientists with Vanderbilt University is not likely to surprise anyone who has attended an Alcoholics Anonymous meeting, or seen one portrayed in a film or television show. But the specific data collected by the research team at the university’s Addiction Center and the questions that information raises may lead to a better understanding of the biology of addiction and improvements in the way alcoholism is treated.
Caffeine and nicotine have long been staples of addiction-recovery groups such as AA and other 12-step programs, but the Vanderbilt study was one of the first scientific attempts to document the degree to which recovering alcoholics ingest these two substances.
Under the direction of Dr. Peter R. Martin, the director of the Vanderbilt Addiction Center and a professor of psychiatry and pharmacology at the Vanderbilt University School of Medicine, university researchers queried 289 AA attendees in the Nashville, Tenn., area about their consumption of coffee, cigarettes, and alcohol.
The study, which was previewed online in July, is scheduled to be published in the October print edition of the journal Alcoholism: Clinical and Experimental Research. Significant results, as reported in a July 22 article on the ScienceDaily website, include the following:
- 88.5 percent of individuals who were interviewed said they consumed coffee, with about a third reporting that they drink four or more cups per day.
- The most common reasons given for drinking coffee were to feel better and to increase concentration and alertness.
- 56.9 percent of the research subjects said they smoked; 78.7 percent of the smokers said they went through at least half a pack every day; and 60 percent were considered “highly” or “very highly” dependent upon nicotine.
- The most common reason the smokers gave for their habit was that the nicotine helped reduce feelings of anxiety, irritability, and depression.
The results reported by the Vanderbilt researchers indicate that smoking and coffee consumption among AA members is significantly higher than the national averages for both commodities.
According to a 2007 report by the National Coffee Association, 81 percent of Americans drink coffee, with 57 percent reporting that they down at least one cup a day. The American Cancer Society reports that 20.9 percent of American adults smoked cigarettes in 2005, the last year for which data is currently available.
Having scientifically quantified what was already accepted as common knowledge, Martin said the next step was to interpret the data and apply it to existing beliefs and methodologies related to alcoholism rehabilitation and recovery.
“Is this behavior simply a way to bond or connect in AA meetings, analogous to the peace pipe among North American Indians, or do constituents of these natural compounds result in pharmacological actions that affect the brain?” he asked in the ScienceDaily article. “Perhaps most interesting, how do these consummatory behaviors affect the brain and what is their role in recovery?”
For example, Martin said, smokers’ reports that cigarettes helped them ward off anxiety and depression may indicate attempts to avoid situations that could prompt them to once again reach for a bottle. “Many of these negative affective states are described by patients as contributors or triggers to relapse after periods of sobriety,” he said.
Selena Bartlett, a researcher with the University of California, San Francisco, is among those who would likely dissuade recovering alcoholics from attempting to find solace at the end of a lit cigarette. In a July 18 U.S. News & World Report article that addressed the Vanderbilt findings, Bartlett told health reporter Steven Reinberg that a biological reliance on cigarettes may decrease the ability of recovering alcoholics to stay sober:
In animal experiments, Bartlett found that nicotine can cause relapses to alcohol drinking. “But we don’t know how nicotine and alcohol react to keep each other going,” she said.
Nicotine has its own specific system in the brain, and alcohol may interact with that system, Bartlett said. Recovering alcoholics who continue to smoke may be more likely to relapse than nonsmokers, she added.
“My prediction would be that the relapse rate among smokers is higher,” Bartlett said.
Bartlett thinks that nicotine addiction and alcohol addiction need to be treated together. To that end, she is involved in the study using the smoking cessation drug Chantix to see if both alcohol and nicotine addiction can be treated with this single medication.
As scientists such as Bartlett evaluate and debate the ramifications of the Vanderbilt research, the report’s lead author called for continued analysis to determine both the positive and negative effects caffeine and nicotine may be having on recovering alcoholics.
“This is very important indeed in this era of attempting to develop medications that may enhance recovery by diminishing craving and relapse to alcoholism,” he said in a release that was posted on the Vanderbilt website. “In fact, there may be very useful lessons to be derived by the pharmaceutical industry from the observations in this research.”
While Martin, Bartlett, and their scientific colleagues work to understand how new insights into the biological connections between coffee, cigarettes, and alcohol could alter treatment protocols, some legislators and policy makers have already leapt into action.
In New York, a state law that prohibits smoking in all public and private addiction-recovery centers went into effect July 24, 2008. The law was an expansion of a 1990s-era regulation that barred cigarettes from state-run recovery facilities.
Karen Carpenter-Palumbo, the commissioner of the New York Office of Alcoholism and Substance Abuse Services, told Associated Press writer Valerie Bauman that the new law was designed to “really promote an overall recovery plan that involves health and wellness for the optimal chance for recovery.”
Though not an alcoholic, one recovering individual expressed sentiments similar to those that were documented in the Vanderbilt study. Brian Lapsker, who said he has been receiving treatment for PCP addiction for nine months, told Bauman that he feared the smoking ban would add undue hardship to an already difficult recovery process. “I look forward to my every cigarette that I smoke,” he said in an article that appeared two days before the law went into effect. “That’s what gets me through the day, through the stress, through the pressure.”
During a press conference on the day the ban went into effect, Carpenter-Palumbo cited the mortality of cigarettes as reason enough to prohibit their use. According to LoHud.com reporter Cara Matthews, Carpenter-Palumbo said that cigarettes are responsible for more deaths every year than are alcohol, cocaine, heroin, HIV, homicides, and suicides combined.
“If we truly want to improve health, we truly want to enhance people’s recovery from chemical addiction and save lives, we had to go forward with what is the first-in-the-nation bold public health initiative to address the addiction that will likely kill them,” Carpenter-Palumbo said.