ELSEVIER Journal of Substance Abuse Treatment, Vol. 14, No. 6, pp. 521-527, 1997 Copyright 0 1997 Elsevier Science Inc. Printed in the USA. All rights reserved 0740-5472/97 $17.00 + .oO PI1 SO740-5472(97)00049-4 ARTICLE Nicotine Dependence and Withdrawal in Alcoholic and Nonalcoholic Ever-smokers JUDITH L. MARKS, PhD,* ELIZABETH M. HILL, PhD,t CYNTHIA S. POMERLEAU, PhD,* SHARON A. MUDD, phD,t AND FREDERIC C. BLOW, PhDt University of Michigan *Behavioral Medicine Program and Department of Psychiatry, tAlcoho1 Research Center, Ann Arbor, MI Abstract - zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA W e compared nicotine dependence and withdrawal in male alcoholic and control ever-smok- ers, controlling for relevant demographic and clinical variables. Alcoholics were more likely to meet cri- teria for moderate or severe nicotine dependence and endorse more nicotine dependence symptoms. Symptoms reported more frequently by alcoholics included: (a) using nicotine in larger amounts or over a longer time than intended; (b) continued use despite problems caused or exacerbated by nicotine; (c) marked tolerance; and (d) experiencing characteristic nicotine withdrawal symptoms. Alcoholics also smoked more heavily. Other than “ headaches, ” and “ decreased heart rate, ” alcoholics consistently endorsed nicotine withdrawal symptoms at a higher rate. After controlling for demographic and clinical variables and level of nicotine dependence, only “ feel depressed” differed significantly between groups. Our research supports previous zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA finding s suggesting that nicotine dependence is more severe in those with a history of alcohol dependence. As a result, alcoholics may experience greater discomfort from nicotine withdrawal upon smoking cessation. 0 1997 Elsevier Science Inc. Keywords-nicotine dependence; cigarette smoking; alcoholism; alcohol dependence; substance abuse. INTRODUCTION SMOKING HAS DECLINED DRAMATICALLY in the United States in response to public health campaigns warning about the health hazards of smoking. In 1965, 53.4% of adult males and 34.1% of adult females were current smokers, compared to 28.1% of males and 23.5% of fe- males in 1991 (Office on Smoking and Health, 1994). In- - This research was supported by NIAAA Center Grant P50-AA-07378 to the University of Michigan Department of Psychiatry, Alcohol Re- search Center, NIDA Training Grant T32-DA-07267 to the University of Michigan Substance Abuse Research Center, and NIDA Grant DA- 06529 to the University of Michigan Department of Psychiatry, Behav- ioral Medicine Program. creasingly, the news media inform us about health haz- ards from passive as well as active exposure to cigarette smoke; and increasing limitations are being imposed on where smokers are allowed to smoke. In spite of these trends, the frequency of smoking remains high in certain groups. Those at risk include people with major depres- sive disorder, schizophrenia, anxiety disorders (Glass- man, 1993; Hughes, Hatsukami, Mitchell, & Dahlgren, 1986), attention deficit disorder (Downey, Pomerleau & Pomerleau, 1996; Downey, Stelson, Pomerleau, & Gior- dani, 1997). Alcoholics are also among those at risk (Glassman 1993; Hughes, et al., 1986); up to 90% of adults with alcohol problems smoke (Dreher & Fraser, 1967; Istvan & Matarazzo, 1984). Requests for reprints should be addressed to Judith L. Marks, PhD, Department of Psychiatry, Behavioral Medicine Program, 475 Market Place, Suite L, Ann Arbor, MI 48108. While the diagnosis and treatment of nicotine depen- dence have not typically been undertaken in conjunction with the diagnosis and treatment of other chemical de- - Received June 14, 1996; Revised February 3, 1997; Accepted March 3 1, 1997. 521