Smokers who try to quit 'drink less alcohol', too

“How quitting smoking can be good for your liver: Those who have given up cigarettes ‘drink less alcohol too’,” the Mail Online reports.

The news follows an analysis of two ongoing studies that aimed to investigate whether people who attempt to stop smoking are more likely than other smokers to report lowering their alcohol consumption.

Those who had attempted to quit smoking within the last week had significantly lower scores on an alcohol intake questionnaire compared with non-quitters.

The same people were also more likely to report they were currently trying to reduce how much alcohol they drank. The main effect seemed to come from a reduction in binge drinking.

It is important to be aware that studies like this are unable to rule out the influence of other potential factors.

It could be the case that some people were advised by their doctor to quit smoking while also reducing their alcohol consumption for health reasons, or were simply on a health kick.

Nevertheless, the links between smoking and excessive alcohol consumption and poor health are well established.

Smoking has long been known as a risk for lung cancer and, as we discussed just last week, smoking is directly linked to seven types of cancer.

Quitting smoking and sticking to the recommended alcohol guidelines should significantly reduce your cancer risk.

Where did the story come from?

The study was carried out by researchers from a number of UK universities, including University College London, the University of Sheffield, King’s College London, the University of Bristol, and Newcastle University.

It was funded by the National Institute for Health Research (NIHR) School for Public Health Research (SPHR) and Cancer Research UK.

The study was published in the peer-reviewed journal, BioMed Central (BMC) Public Health. It is available on an open-access basis, so it is free to read online.

Although the tone of the Mail Online headline made it seem like quitting smoking has potential benefits for liver health, this was not proven in this study.

You would need a much longer follow-up period to see if the reduction in alcohol consumption in ex-smokers was a long-term effect. That aside, the main body of the news story provided balanced reporting.

What kind of research was this?

This was a cross-sectional analysis of two ongoing studies: the Smoking Toolkit Study (STS) and the Alcohol Toolkit Study (ATS).

It aimed to investigate whether people who attempt to stop smoking are more likely than other smokers to lower, or at least try to reduce, their alcohol consumption.

Smoking and excessive alcohol consumption are two of the most significant factors that can lead to poor health by triggering chronic diseases such as cancer and heart disease.

The behaviours have a close and complex relationship. As such, they are important public health challenges in the UK.

Research suggests drinking lots of alcohol while also trying to quit smoking makes the quit attempt more likely to fail, one reason being that alcohol can weaken willpower, making a lapse more likely.

As a result, smokers trying to quit are often advised to cut back on alcohol as well, but it is unclear how often they follow this advice.

Cross-sectional studies like this are useful for assessing the relationship between two variables – in this case, quitting smoking and alcohol consumption.

However, the study design cannot confirm the link and say that one has caused the other. 

A longer-term cohort study that followed these people up to see how the two factors changed over time would be one of the best ways to validate these findings and see how they’re related.

What did the research involve?

The researchers used data from household surveys conducted as part of two ongoing studies: the Smoking Toolkit Study (STS) and the Alcohol Toolkit Study (ATS), which collected information on smoking, alcohol consumption and related behaviours in England.

They analysed data from 6,287 participants aged 16 and over who had reported smoking tobacco from March 2014 to September 2015.

All the smokers were also asked if they had made a serious attempt to quit smoking, and were classified according to their responses.

The smokers were further classified as light or heavy drinkers. Alcohol consumption was assessed through the Alcohol Use Disorders Identification Test (AUDIT-C), which asked participants about how often they drank.

Information on various socio-demographic, possibly confounding, factors was also collected, including:

• age
• sex
• socio-economic status
• education level
• ethnicity
• disability

The researchers then looked for links between people who had recently attempted to stop smoking and subsequent changes in their alcohol consumption. The results were stratified by socio-demographic factors.

What were the basic results?

Those who attempted to quit smoking within the last week had significantly lower AUDIT-C alcohol scores than those who had not tried to quit. On average their scores were about -0.66 points lower (95% confidence interval [CI] -0.11 to -1.21). 

There was, however, no significant difference in their typical quantity or frequency of drinking.

But those who had attempted to quit smoking in the last week were less likely to binge drink and less likely to be classified as high-risk drinkers (AUDIT-C score of five or more).

The same people who were trying to quit were also more likely to report that they were currently trying to reduce their alcohol consumption.

These analyses were after adjustment for socio-demographic characteristics, which did not differ between quitters and non-quitters.

How did the researchers interpret the results?

The researchers concluded: “Smokers who report a recent attempt to stop are more likely to report lower-risk alcohol consumption, including less frequent binge drinking, after adjusting for socio-demographic characteristics.

“Among smokers with higher-risk alcohol consumption, those who report a last week attempt to stop are more likely to report also a current attempt to cut down on their drinking.”

Conclusion

This was a cross-sectional analysis of two ongoing studies that aimed to investigate whether people who attempt to stop smoking are more likely than other smokers to lower, or at least try to reduce, their alcohol consumption.

The researchers found those who attempted to quit smoking within the last week did have lower drinking scores on the AUDIT-C survey compared with smokers who weren’t quitting.

The same people were also more likely to report they were currently trying to reduce how much alcohol they drank.

There was no difference in drinking frequency, however – the main effect seemed to be coming from a reduction in binge drinking.

So some participants may have had a drink every day during the week, but still drank less overall in terms of total units consumed.

Despite these results, there are a few points to note:

• This was an observational study, which cannot prove that the quit attempt has directly caused the reduction in alcohol. Although the researchers attempted to control for potential confounders, there could be other factors that influenced changes in alcohol consumption.
• As the authors note, it’s also not possible to rule out reverse causation – that people with lower alcohol consumption were perhaps more likely to attempt to quit smoking.
• The self-reporting nature of the surveys could lead to misreporting as a result of possible social pressures, such as stigma attached to both smoking and high alcohol consumption.
• The study looked at immediate changes in smoking and alcohol consumption (in the last week) but longer-term follow-up would be needed to see if these decisions stuck or whether people reverted to their previous habits.
• People who are trying to quit smoking may be advised to cut back on alcohol by smoking cessation professionals because of the known association between the two. This study does not inform whether individuals have cut back as a result of the advice of professionals or on their own initiative.

As it stands, people are advised to follow current smoking and alcohol public health recommendations.

If you smoke, the single best thing you can do for your health is to quit smoking. Stopping drinking, or at least cutting down, would be an added bonus your body will welcome.  

Links To The Headlines

How quitting smoking can be good for your LIVER: Those who have given up cigarettes ‘drink less alcohol too’. Mail Online, July 22 2016

Links To Science

Brown J, West R, Beard E, et al. Are recent attempts to quit smoking associated with reduced drinking in England? A cross-sectional population survey. BMC Public Health. Published online July 22 2016