Smoking Status May Identify Potential Alcohol Abuse

Smoking status may be used as a clinical indicator of alcohol misuse, according to the abstract of "Smoking Status as a Clinical Indicator for Alcohol Misuse in U.S. Adults," a study published in the April 9 issue of Archives of Internal Medicine.

Researchers examined a sample of 42,374 adults from the National Epidemiological Survey on Alcohol and Related Conditions and discovered that daily, occasional and ex-smokers were more likely than those who had never smoked to also be hazardous drinkers. In addition, daily and occasional smokers were more likely to meet criteria for alcohol abuse diagnoses.

Researchers say this is the first study to link occasional, non-daily smoking with the greatest risk for hazardous drinking and alcohol-related diagnoses. Hazardous drinkers are defined as men who consume five or more drinks a day or 14 or more drinks per week, or women who consume four or more drinks daily or seven or more drinks per week. Individuals who met criteria for either alcohol abuse or dependence were categorized as having an alcohol diagnosis.

The data are important to family physicians because research has shown that most physicians screen for smoking, but many do not inquire about alcohol abuse. "Only 30 percent of individuals who had a primary care visit reported being screened for an alcohol or drug use problem," said principal investigator Sherry McKee, Ph.D., assistant professor of psychiatry at the Yale University School of Medicine, New Haven, Conn., and her co-authors.

Smoking status is routinely questioned during patient encounters and "is more often assessed than alcohol use," said the authors. However, the study's data highlight "the importance of physicians adopting standard alcohol screening questions" during visits. This can be as simple as asking how many times in the past year male patients have had five or more drinks in a day or female patients have had four or more drinks in a day.

Data were gathered from the National Epidemiological Survey on Alcohol and Related Conditions conducted by the National Institute on Alcohol Abuse and Alcoholism between 2001 and 2002. The response rate was 81 percent, and data were weighted to account for oversampling and adjusted to be representative of the U.S. population as reported in the 2000 census.

Twenty-six percent of the sample met criteria for hazardous drinking, and 8.5 percent met criteria for an alcohol diagnosis. Among current smokers, however, those numbers rose to 45 percent at risk for hazardous drinking and nearly 18 percent who met criteria for an alcohol diagnosis.