Guest expert Caroline Kahiu reflects on tobacco smoking and alcohol use being so strongly paired behaviours, affecting millions of people worldwide.
A her crisp article, she outlines how alcohol and tobacco use are ocurring together, what the harm is and Caroline explores the case for better prevention efforts that tackle both issues together. Such efforts would reaffirm people’s human right to health and the highest standard of living.

A few days ago, I was having a conversation with a friend as to why he smokes cigarettes.

His response was: “I do not have to smoke but I smoke when I am drinking alcohol.” This got me thinking. Is tobacco use an accessory to alcohol use?

The co-use of tobacco and alcohol is common. Drinking alcohol and tobacco use together is a socially normative behavior in bars, hotels and clubs. Alcohol and nicotine have been known to go hand in hand and they are highly paired behaviors especially in a social context. One of the adverse effects of alcohol use is sleepiness. Nicotine being a stimulant cancels the sedative effects of alcohol that is classified as a depressant. 

Drinking alcohol and tobacco use together is a socially normative behavior in bars, hotels and clubs.”

Caroline Kahiu

Various studies show the adverse effects of tobacco use and alcohol use respectively, but when combined risk of harm is even heigthened. For instance, tobacco and alcohol use combine to elevate cancer risk; smoking and alcohol use also mean double-trouble for the human brain; and when alcohol and tobacco use are combined, the liver is harmed even more.

Further, alcohol consumption is typically – although not uniformly – found to be associated with smoking cessation failures in prospective community studies.  

For instance, a large investigation into co-occurring alcohol and tobacco use and disorders of the National Epidemiologic Survey on Alcohol and Related Conditions in the United States found:

… rates of tobacco use, daily tobacco use, and nicotine dependence increased with increasing levels of alcohol consumption and the presence of an AUD [alcohol use disorder].

These findings have important implications for the development of prevention and intervention approaches. 

Daniel E. Falk, Ph.D.; Hsiao-ye Yi, Ph.D.; and Susanne Hiller-Sturmhöfel, Ph.D.

Today, the single greatest opportunity for averting non-communicable diseases is prevention. Simply put, prevention is avoiding or delaying initiation into substance use. This includes evidence-based strategies such as implementation and enforcement of tobacco and alcohol control measures and conducting targeted awareness campaigns. 

Evidence-based alcohol and tobacco prevention strategies reaffirm the right of all people to the highest standards of health.”

Caroline Kahiu

Specifically, tobacco control and cessation efforts that are in place include the global annual commemoration of the World No Tobacco Day in May. The commemoration gives us an opportunity to take stock of how far we have come and make future commitments envisaging everyday as a No Tobacco Day. On the flip side, alcohol control strategies such as SAFER by the World Health Organisation target to prevent and reduce human suffering and pain caused by the the products and practices of the alcohol industry.

To support a move towards a more coordinated non-communicable disease approach it is important to conceptualize changes to policy on tobacco and alcohol as affecting a single interlinked system. This can include but is not limited to acknowledging that there is a relationship between tobacco and alcohol use amongst the consumers. We know, for instance, that tobacco cessation efforts are undermined by alcohol availability and consumption. And we know that smoking cessation facilitates alcohol use cessation among tobacco and alcohol co-users

I agree with Kristina Sperkova’s statement, President of Movendi International:

In communities around the world, we see an urgent need for action to prevent and reduce alcohol harm. Investing in the alcohol policy best buys as packaged in SAFER is scientifically sound and economically smart, generating considerable returns on investment.”

Kristina Sperkova, International President, Movendi International

To add to her voice, this will go perfectly hand-in-hand with implementation of the World Health Organisation Framework Convention on Tobacco Control (WHO-FCTC).

Implementation of such evidence-based alcohol and tobacco prevention strategies reaffirms the right of all people to the highest standards of health and asserts the importance of demand reduction strategies as well as supply suppression issues.