Understanding Tobacco's Relationship to Other Drugs

While population level data do not exist, several studies indicate that the prevalence of tobacco use among people receiving treatment or in recovery is dramatically higher than  the general U.S. adult population rate of 20.9 percent (CDC, 2006):

• 90% among alcoholic inpatients in the U.S. (Bien & Burge, 1990)  
  
• 83% among urban methadone maintenance patients in the Northeastern U.S. (Richter et al., 2001)
  
• 77% among methadone maintenance patients in the Midwestern U.S (Nahvi et al., 2006)
  
• 71-93 among alcoholic outpatients (Istvan & Matarazzo, 1984)
  
• 85-90% among substance abusing inpatients (Burling & Ziff , 1988)
  

The 2005 National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration, 2006) found:

• Among persons aged 12 or older, 20.2 percent of past month cigarette smokers reported current use of an illicit drug compared with 4.1 percent of persons who were not current cigarette smokers.
  
• Past month alcohol use was reported by 67.6 percent of current cigarette smokers compared with 46.6 percent of those who did not use cigarettes in the past month.
  
• The association also was found with binge drinking (43.8 percent of current cigarette users vs. 15.7 percent of current nonusers) and heavy drinking (16.1 vs. 3.5 percent, respectively).

Batel et al.(1995) and John et al. (2003) have found corelations between severity of tobacco dependence and severity of other chemical dependencies.

There are several theories to explain high levels of concurrent tobacco use (co-ocurring tobacco dependence) among people with other chemical dependencies:

• Shared Characteristics: Alcohol, tobacco and other drugs appeal to persons with similar personality characteristics (sensation seeking and impulsivity) and co-ocurring depression (Little, 2000).
  
• Reinforcing Effects: Tobacco may enhance the effects of alcohol (Little, 2000) and cocaine (Wiseman & McMillan, 1998)
  
• Shared Brain Pathways: Tobacco affects the same neural pathway - the mesolimbic dopamine system - as alcohol, opiates, cocaine, and marijuana (Pierce & Kumaresan, 2006) 
  
•  Modulating Effects:  Tobacco may reduce cocaine-induced paranoia (Wiseman & McMillan, 1998).

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