Alcohol and Smoking: Change one at a time, or both together?

Alcohol and smoking

  • Written by Club Soda member and psychologist Helen O’Connor

Does it make it harder to control or stop drinking if you continue to smoke? Is it better to make one lifestyle change at a time, or should I tackle both together?

This blog post looks into this conundrum in more depth and offers some suggestions for people who smoke but are hoping to reduce or stop drinking.

I draw upon my personal experiences as a now-non-smoker and controlled drinker and my professional work as a psychologist in health behaviour change and addictions. I’ll also touch upon some relevant research on alcohol and smoking.

There’s no single right way for anyone to approach making changes in their own life – but I hope that this information and the suggestions for further reflection and action will help you be more successful in your quest for control over those behaviours you want to change.

“It’s complicated” – the relationship between alcohol and smoking

As a psychologist who has worked in drug and alcohol misuse and addiction, smoking cessation, and health behaviour change, I have seen all sorts of relationships between smoking and alcohol:

  • It’s quite rare to meet someone who is dependent on alcohol who doesn’t smoke.

  • Physically dependent alcoholics often smoke more once they stop drinking.

  • People who are trying to quit smoking (or have for some time) frequently blame alcohol for slip-ups or relapses.

  • Some people who stop smoking say they drink more, but

  • Some people who stop smoking say they drink less.

  • And some people who stop drinking say they smoke fewer cigarettes.

That’s a pretty mixed bag of positive and negative consequences of quitting ‘habit one’ on ‘habit two’ (whether habit one is alcohol or cigarettes).

So what’s the best advice for people who smoke and drink, and would like to stop or cut back on alcohol (and maybe one day quit smoking too)? Should we focus on changing one thing at a time, or try to change both at once?

Changing one thing at a time

It can take considerable effort, focus, and self-control to extinguish a habit, especially a habit that is not just behavioural but is also associated with some degree of physical addiction. People are often advised to place all this effort on one habit at a time, to get better outcomes.

There is even some science to back this up. Ego-depletion is the hypothesis that self-control is a limited resource, and like a muscle, it can become fatigued after resisting repeated temptations. Although backed up by hundreds of experiments, these usually use ‘substances’ such as radishes, chocolates or ice-cream, and tasks such as puzzles and games. However, it could be argued that using self-control on one task (such as resisting urges to drink) could reduce the self-control available to perform another (such as resisting urges to smoke).

Some people will find this approach works. They focus on their most important change and after a period of conscious effort, the change becomes more automatic and habitual. It becomes easier to refuse or avoid drinks, to have a different evening routine, and respond to stress in healthier ways.

When something becomes more automatic and unconscious, it takes less conscious effort, freeing up that effort and focus for the next change.

Making a single change can also be the start of a virtuous circle whereby you feel healthier, more in control, and more confident in your abilities to make changes, which in turn can motivate you to change another behaviour you are unhappy with. You can learn from what worked (and what didn’t) when making one lifestyle change, and apply it to another.

On the other hand, in the process of quitting one habit, some people find themselves increasing their use of something else.

In the case of drinking and smoking, this may be something to do with the fact that you are not just dealing with potentially physically addictive substances, but also the repetitive patterns of putting hand to mouth. So, on a night out, with a drink and a cigarette in hand, sips of alcohol are alternated with puffs of cigarettes – both of which provide some kind of buzz or ‘scratch an itch’ in the brain’s reward system. Take the alcohol away, and maybe smoking will increase in the hope of compensating the brain for the missing reward of alcohol?

Changing both smoking and drinking at the same time

Whatever the behaviour or addiction, people are usually advised to identify their ‘triggers’ or ‘high risk situations’ for that behaviour, and to develop coping strategies to deal with them – the simplest of which being to just avoid it, if that’s possible.

Indeed, it’s common for people who are trying to quit smoking to be advised to be vigilant at times when they are drinking, and even better to avoid alcohol whilst they are in the early weeks of quitting. Interestingly, the equivalent advice is less frequently to given people who continue to smoke whilst trying to stop or cut back on alcohol.

One reason for this is probably because alcohol also lowers inhibitions, reduces our ability to make good decisions, and makes us care less about the consequences of our behaviour. This won’t just affect our ability to resist urges to smoke, but our food choices, who we have sex with, whether we get into unlicensed taxis etc.

Although smoking might not lower our inhibitions in the way that alcohol does, if you frequently smoke and drink alcohol together (and especially if you only smoke whilst drinking alcohol), having a cigarette is likely to create urges, cravings, or thoughts of alcohol whilst you are attempting to cut down or stop drinking. If having a cigarette leads to even a small niggly sensation of ‘I’d usually have a drink right about now’ then it has just become slightly harder to resist that drink.

In fact, some new rat research has revealed how nicotine activates both reward neurons (giving positive reinforcement to keep smoking) as well as stress neurons (giving negative reinforcement) in the brain. People then crave alcohol to calm this stress system – another reason why it could undermine your attempts to cut down or stop drinking if you continue to smoke.

Perhaps, after all, it would be better to just bite the bullet and stop both at once?

Certainly in terms of our ‘self-control muscle’ this could be possible. Recent research has cast doubt on the ego-depletion hypothesis, even suggesting that in some cases self-control can improve and strengthen through successive challenges.


 

So what should I do?

Different approaches will work better for some people than for others. There’s no magic bullet, and effort and focus is always needed to be successful. Here are some questions and suggestions to help you reflect and plan the best strategy for you.

What’s your worst habit?

Only you know how much you really hate one particular habit and want more than anything to be rid of it. Not everyone who smokes and wants to stop is deeply unhappy about how much they are drinking, and not everyone who is unhappy about their drinking wants to address their smoking right now.

I despised myself for my addiction to cigarettes. I was already on 40 a day when I went out one day for a third packet. That was my ‘rock bottom’. I knew there was no genuine pleasure in it – other than the ‘pleasure’ of removing unpleasant withdrawal symptoms. All I felt was guilt, anxiety, and shame. I also knew it was illogical to describe smoking as ‘relaxing’ or to justify it as ‘my only vice’. I HAD to stop (I did, 6 years ago this week!). But I have never felt like this about my relationship with alcohol, even though at times I have needed to work on controlling alcohol and reducing how much I drink.

Get the right attitude

It’s important to have a positive attitude towards quitting. You have probably heard of the term ‘dry drunk’ – someone who has stopped drinking but made no other changes to their life. They may grumble, constantly focus on the fact that they have stopped, that something has gone, is missing, removed from their life (awfulising abstinence). ‘Nature abhors a vacuum’ as the saying goes, and it is likely that, without looking at positive ways to replace what alcohol is providing (social life, relaxation, fun) or relieving (stress, boredom, anxiety), something unhealthy – like smoking more – will fill that space rather than something healthy (not to mention that a relapse is far more likely).

If you approach stopping or cutting down on drinking negatively, simply viewing it as a process of ‘resisting temptation’ and the removal of something from your life, you are turning what is already a challenge into a really tough job.

With a positive and proactive attitude, you can meet the challenge of changing your drinking habits by reminding yourself why you wanted to make that change in the first place, focusing on what benefits you are getting from doing so, and reflecting on what you had been using alcohol for, so that you can meet those needs in healthier ways.

Understand your patterns, rituals and triggers

Your patterns and rituals of smoking and drinking will be unique, and the ways in which they are connected will be personal to you.

For some reason drinking alcohol never caused me to crave a cigarette when I was quitting, so that wasn’t a high-risk situation I needed to worry about. Maybe I was ‘lucky’ in that – on 40 a day – I was pretty much smoking from morning to night, in any situation and any frame of mind, mostly sober and frequently alone, and none were especially precious.

So although smoking was associated with practically every possible situation and mood, alcohol wasn’t a ‘special smoking situation’ for me. But some people only smoke when they’re out, when the kids are in bed, in the evenings, or after a meal – precious moments that punctuate a day and are often closely linked with alcohol. If this is you, then perhaps continuing to smoke will make it harder for you to stop drinking because of how closely associated the two things are for you.

Tips on quitting smoking and drinking

Quit one at a time

If you want to start quitting one thing at a time:

  1. Pick the thing that you will be most happy about stopping, proudest about conquering, which you believe is currently most at odds with your personal values and goals.

  2. Commit not just to ‘giving up’ or removing something from your life, but to replacing it with other more positive, healthy behaviour, activities, or habits.

  3. Accept that temptation and urges are part of the process. You will experience, but you can handle, some discomfort.

  4. Seek all the advice and support you can. Use it.

  5. Work through whatever programme, course, or self-help process you are using.

  6. Do the work on triggers and high risk situations that will help you understand if any other habits, patterns, or associations are making it harder to quit.

  7. Monitor your use of your ‘second habit’ – ensuring it doesn’t escalate or seem to be replacing your ‘first habit’.

Quit both together

If another habit IS making it harder to quit your first habit, or if you are increasing your use of a second habit whilst avoiding your first habit, then you might want to quit both at once. The advice:

  • Pretty much the same as above! Many of the techniques and strategies you will use to stop or cut back on drinking can be used to stop smoking, especially if many of the situations you do them in overlap.

I’d love to hear your thoughts about this article and your own experiences – you can find me on Twitter. I am a chartered psychologist working in London, and very excited to be involved with Club Soda and be part of the community.

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