The Time-Varying Effect of Alcohol Use on Cigarette Smoking Relapse Risk

Background: Alcohol consumption promotes lapses to smoking among smokers trying to quit, perhaps particularly among smokers with lower dependence. We assessed how the role of alcohol in lapses varies over time. Methods: This is a secondary analysis of ecological momentary assessment data collected from 159 daily smokers (mean age=43.90 (SD=10.41), 56.60% female) who drink alcohol. During the 4 weeks following initial cessation (quit >24 hours), a logistic time-varying effect model (TVEM) modeled momentary assessments of lapses and temptations to smoke compared to randomly-selected moments as a function of concurrently-assessed recent alcohol use (past 15 minutes). Time was examined continuously. Results: Recent alcohol use was associated with smoking lapses, particularly for less nicotine dependent individuals, and the association varied across time. For individuals who did not smoke within 5 minutes of waking, alcohol use became a significant predictor of lapse on Day 1 post-quit, increased in strength until Day 7, then decreased such that alcohol use was no longer associated with lapse by Day 25. For this subgroup, the associations between alcohol use and temptations were relatively stable and significant from Day 1 to 22 post-quit. Results were similar when dependence was assessed by the Nicotine Dependence Symptom Scale. Conclusions: The association between drinking and smoking lapse and temptations varies over time, peaking early in smoking abstinence and declining thereafter. This could reflect progressive relapse of most vulnerable individuals or habituation to alcohol as a smoking cue. Interventions to prevent alcohol-related lapses are essential early in the quit period.