Smoking Status Helps Identify Individuals at Higher Risk for Alcohol Misuse

[Admin]

April 10, 2007 — Assessment of smoking status may help identify individuals at higher risk for alcohol misuse and serve as a reminder to conduct alcohol screening in the primary care setting, according to the results of a study reported in the April 9 issue of the Archives of Internal Medicine.

"Screening for alcohol use in primary care settings is recommended by clinical care guidelines but is not adhered to as strongly as screening for smoking," write Sherry A. McKee, PhD, from the Yale University School of Medicine in New Haven, Connecticut, and colleagues. "It has been proposed that smoking status could be used to enhance the identification of alcohol misuse in primary care and other medical settings, but national data are lacking. Our objective was to investigate smoking status as a clinical indicator for alcohol misuse in a national sample of US adults, following clinical care guidelines for the assessment of these behaviors."

The investigators analyzed data from a sample of 42,374 US adults enrolled in the National Epidemiological Survey on Alcohol and Related Conditions (wave I, 2001 - 2002), and they determined odds ratios (ORs) and test characteristics of smoking behavior (daily, occasional, or former) for the detection of hazardous drinking behavior and alcohol-related diagnoses. Criteria for alcohol-related diagnoses were those of the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV.

Compared with never smokers, daily, occasional, and ex-smokers were more likely to be hazardous drinkers (OR, 3.23; 95% confidence interval [CI], 3.02 - 3.46; OR, 5.33; 95% CI, 4.70 - 6.04; and OR, 1.19; 95% CI, 1.10 - 1.28, respectively). Daily and occasional smokers were more likely to have alcohol-related diagnoses (OR, 3.52; 95% CI, 3.19 - 3.90; and OR, 5.39; 95% CI, 4.60 - 6.31, respectively).

Current smoking status (occasional smokers plus daily smokers) was helpful in detecting hazardous drinking, with sensitivity of 42.5%; specificity, 81.9%; positive predictive value, 45.3% (vs population rate of 26.1%); and positive likelihood ratio, 2.34. For detection of alcohol diagnoses, sensitivity of current smoking was 51.4%; specificity, 78.0%; positive predictive value, 17.8% (vs population rate of 8.5%); and positive likelihood ratio, 2.33.

"Occasional and daily smokers were at heightened risk for hazardous drinking and alcohol use diagnoses," the authors write. "Smoking status can be used as a clinical indicator for alcohol misuse and as a reminder for alcohol screening in general.... Improved screening approaches such as one that uses smoking behavior as a 'trigger' to identify alcohol misuse become even more vital in promoting optimal patient management and outcomes."

The National Institute on Alcohol Abuse and Alcoholism and the Robert Wood Johnson Foundation supported this study. Dr. O'Malley has disclosed various financial relationships with GlaxoSmithKline, Eli Lilly, OrthoMcNeill, Bristol Myers, Mallinckrodt Pharmaceuticals, and Sanofi-Aventis, and he is the inventor on patents held by Yale University for naltrexone and smoking cessation. The other authors have disclosed no relevant financial relationships.

Arch Intern Med. 2007;167:716-721.