The rate at which nicotine is metabolised in heavy drinkers, or more precisely, people who are chronic alcohol abusers, who smoke tobacco, has been investigated to see if there was a change in rate of nicotine metabolism and smoking in alcohol-dependent smokers who stop drinking.
Noah Gubner of the UCSF Center for Tobacco Control Research & Education, Maciej Goniewicz of the Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA, and colleagues elsewhere in the USA and Poland, explain how the rate at which a smoker’s body metabolises the psychoactive compound in tobacco, nicotine, is an important factor in how much a person smokes, their degree of dependence, and the possibility of using nicotine replacement therapy.
Another factor that can influence smoking behaviour, however, is how much alcohol the smoker drinks. Theory suggests that chronic alcohol abuse can accelerate the rate of nicotine metabolism and so smokers who are heavy drinkers often find that they are heavy smokers, chainsmokers, too.
To test this hypothesis, the team recruited 22 Caucasian men randomly selected from a sample of 165 smokers who were enrolled on a seven-week alcohol dependence treatment program in Poland. They tested urine samples from the men, collecting data at three time points: baseline (week 1, after acute alcohol detoxification), week 4, and week 7. Volunteers were regularly and frequently breathalysed to ensure that none were drinking alcohol at any time during the study. The researchers determined the nicotine metabolite ratio, a biomarker for the rate of nicotine metabolism, and total nicotine equivalents, a biomarker for total daily nicotine exposure.
The results were quite self-explanatory at least for this small group of heavydrinking smokers. “We found a large reduction in rate of nicotine metabolism over the seven weeks but no change in smoking,” Gubner told Sciencebase. The data showed a significant decrease in nicotine metabolites in urine over the seven weeks of alcohol abstention. However, there was no change in urine total nicotine equivalents across the three sessions, which indicates that there was no change in daily nicotine intake. Chronic alcohol abuse may increase the rate of nicotine metabolism, which then decreases over time after the volunteers stopped drinking alcohol.
Future research is needed to determine the effects of alcohol abuse on rate of nicotine metabolism could be used to develop improved smoking cessation interventions,” Gubner says. “Research suggests that individuals who have a faster rate of nicotine metabolism have lower smoking cessation rates using nicotine replacement therapy such as the patch. We saw a decrease in rate of nicotine metabolism over 4-7 weeks after alcohol cessation, suggesting alcohol abuse resulted in an increase in the rate of nicotine metabolism. For example, in alcohol dependent individuals who stop drinking, our study suggests that altering either the timing of when to initiate smoking cessation or in the type of smoking cessation intervention could potentially improve outcomes, however, this needs to be tested,” Gubner adds.
I asked Gubner whether alcohol make smokers heavier smokers because they process nicotine faster than other people and so need a more frequent hit? Why didn’t total nicotine intake change if that’s the case?
“This is an interesting point,” he says. “One might expect to see a decrease in smoking and total nicotine intake if rate of nicotine metabolism was decreasing. We did not find this. However, all individuals had a long history of both alcohol and tobacco use, it is possible that changes in smoking and nicotine intake would be observed over a longer period of time,” he told Sciencebase. “The results support the idea that chronic alcohol abuse may increase the rate of nicotine metabolism (observed shortly after alcohol cessation), which then decreases over time after alcohol cessation.”
DOI: 10.1016/j.drugalcdep.2016.04.006