June 18, 2012

Smoking “Quitlines” Help Alcoholics?

(Ivanhoe Newswire) — Smoking quitlines have been heralded as an effective and inexpensive way to curb smoking addiction.  Now, a new study reveals that they could potentially intervene in alcohol addiction as well.

There have been numerous studies showing the link between drinking and smoking behaviors, but few smoking quitlines actually screen and counsel callers about alcohol abuse. In the first study of its kind, researchers examined the drinking patterns of callers to the New York State Smoker´s Quitline (NYSSQL) and found that a large proportion of smokers consume alcohol in hazardous amounts, and these high-level smokers had more difficulty with smoking cessation compared with moderate drinking smokers.

"Quitlines have a broad reach, serving about a half a million smokers in the US each year, and are able to reach populations of smokers that would otherwise be difficult to provide services to," Christopher Kahler, professor of behavioral and social sciences at the Center for Alcohol and Addiction Studies at Brown University, was quoted as saying. "They are a remarkable success story in taking tested treatment methods, validating them for use in a new format, and disseminating this approach very broadly. Quitlines are available in all 50 states and are common in Europe, Canada, and elsewhere."

The NYSSQL was chosen for this experiment because of its commitment to innovative treatment research, as well as its status as one of the busiest quitlines in the country; in 2010, it received more than 100,000 contacts for assistance.

Benjamin A. Toll, assistant professor of psychiatry at the Yale University School of Medicine and his colleagues used modified guidelines from the National Institute on Alcohol Abuse and Alcoholism to measure the rates of hazardous drinking among 88,479 (53.2% female) callers to the NYSSQL. They also collected data during two routine follow-up interviews and a three-month follow-up interview to compare smoking-cessation rates for callers who met criteria for hazardous drinking compared with moderate drinkers and non-drinkers.

"Our strongest finding was that in a large sample of smokers — almost 90,000 individuals — a relatively high proportion, almost 23 percent, drank at government-defined hazardous drinking levels," Toll was quoted as saying. "This is the first study to assess prevalence of hazardous alcohol use in a quitline population of smokers."
Kahler was quoted as saying, "In other words, this study demonstrated that hazardous drinking occurs in almost one out of four quitline callers and can interfere with efforts to quit smoking. The results provide powerful documentation that there are a large number of heavy drinkers who could be served through the quitline system if assessments and brief alcohol intervention were made a part of the quitline protocols."

The high proportion of smokers that drank hazardous amounts was not surprising, but the reasons for this association are varied.

"There are many potential contributing factors," Kahler was quoted as saying. "First, those who drink heavily may have more disrupted lives and more psychosocial stressors. They are likely to have a higher proportion of smokers in their social networks. Finally, drinking alcohol can lead to cravings to smoke, and high levels of drinking may make it more difficult to inhibit smoking behavior during a quit attempt. Results from prior work I have done suggests that heavy drinkers are generally equally motivated to quit smoking as moderate drinkers."

This study showcases a new way to reach a large number of hazardous drinkers to help them reduce their alcohol consumption.

"Brief alcohol interventions for as short as five minutes have been shown to reduce rates of hazardous drinking,” Toll was quoted as saying. "It would be relatively straightforward for quitlines to add in a counseling module specific to hazardous drinkers. In fact, we just completed data collection for a study testing the effect of adding a brief alcohol intervention to standard NY quitline smoking cessation treatment for hazardous drinking smokers. We expect the results of that study to be forthcoming within the year."

Kahler was quoted as saying, "The standard advice is to recommend that smokers avoid drinking alcohol as much as possible when quitting. However, that advice is not very detailed. Our approach in clinical trials has been to provide information on the association between drinking and smoking relapse, assess drinking patterns and their association with quitting, and assess smokers' willingness to avoid or reduce drinking when quitting. After that, it is important to help smokers set concrete goals for their drinking and to check in on those goals at each session. We have found that even those smokers who make a quit attempt and fail are often able to maintain reductions in drinking."

Source: Alcoholism: Clinical & Experimental Research