Substance Abuse and Mental Health Co-Morbidity

December 8, 2008: The Role of Nicotine Addiction in Tobacco Use

Richard Hurt, M.D., Director, Nicotine Dependence Center, Professor of Medicine, Mayo Clinic College of Medicine

Key messages:

• Alcoholics who smoke constitute 26% of all smokers and therefore treating tobacco dependence in substance abusers is a priority for eliminating health disparities
• Regular smoking usually precedes the development of alcoholism, and there is a ten-fold higher prevalence of alcoholism among heavy smokers compared to nonsmokers.
• Tobacco-caused diseases are the leading cause of death among people with alcohol addictions and therefore it is imperative to treat this tobacco dependence simultaneously. Dr. Hurt has determined through research that by treating these two addictions at the same time—while difficult—there is no apparent negative effect on abstinence from alcohol or other drugs. In fact, Prochaska found that tobacco dependence interventions provided during addictions treatment increased long-term alcohol and/or drug abstinence.
• While the prevalence of illicit drug use has gone down among members of the armed services, the prevalence of tobacco use is higher than among the general population. A recent study published in JAMA found that smoking prevalence increased in deployed troops with combat (19%) but decreased in deployed with no combat (16%) and non-deployed (15%).
• Smoking prevalence in those with PTSD is 2–3 times higher than in the general population. Smokers with PTSD also smoke more cigarettes per day and are more tobacco dependent than smokers without PTSD.
• A 2008 survey of tobacco use prevalence in U.S. soldiers in Iraq found that—
  • 64% of marines and sailors used tobacco
  • 24% use both cigarettes and smokeless tobacco
  • 40% use cigarettes OR smokeless tobacco
  • 75% of those surveyed reported that they wanted to quit
• Successful recovery from alcohol or drug dependence but dying from tobacco dependence should no longer be accepted in medical practice.

Following the roundtable presentations, there was an opportunity for comments and questions from ICSH members.

The meeting adjourned for lunch at 12 noon and reconvened at 1:15 pm.

Dr. Terry Pechacek, Ph.D., Associate Director for Science with the CDC's Office on Smoking and Health introduced the first afternoon speaker.