"For people who have been quite dependent on alcohol giving up drinking entirely is often the safest and most attainable goal. "
By Harold Ambler Contributing Writer
Christopher Kahler is professor and chair of the Department of Behavioral and Social Sciences in the Brown University School of Public Health. He received his Ph.D. in Clinical Psychology in 1998 from Rutgers University and joined the Brown Medical School faculty that year.
Kahler’s work focuses on the role of personality and emotion in heavy alcohol use and smoking, the causation, and treatment, of combined heavy drinking and smoking, and the role of alcohol in the treatment of HIV infection. He is currently the principal investigator on an NIAAA-funded laboratory study on alcohol administration and smoking relapse risk, an NIAAA-funded randomized clinical trial of naltrexone for at-risk and problem drinkers seeking smoking cessation treatment, and an NCI-funded treatment development project to adapt positive psychotherapy for use in smoking cessation treatment with low positive affect smokers. He is the scientific director of the NIAAA-funded Alcohol Research Center on HIV.
PBN: What causes most smoking-cessation relapses?
KAHLER: There seem to be a few common types of situations in which people relapse to smoking. First, is that some people have a hard time getting through the initial discomfort of the first 24 hours of quitting and never really get started before they go back to smoking. The second type involves situations in which people feel strong negative emotions like anger or anxiety. The third involves situations in which people are drinking alcohol, often with other people, especially people who smoke.
PBN: Alcoholics Anonymous suggests that members stop drinking entirely – is that usually good advice? Or is there a subset of problem drinkers for whom modifying their drinking is the better choice?
KAHLER: For people who have been quite dependent on alcohol giving up drinking entirely is often the safest and most attainable goal. There are people who have had problems related to drinking who are able to moderate their drinking. But, if someone has tried repeatedly to drink moderately and failed, avoiding alcohol completely is often the best goal.
PBN: How likely is it that a problem drinker, or alcoholic, also smokes cigarettes in 2014?
KAHLER: Part of this depends on how you define problem drinker or alcoholic. About 20 percent of smokers drink alcohol at levels that could be harmful to their health compared to about 7 percent of people who don’t smoke. Generally, problem drinkers are twice as likely to smoke as non-drinkers or moderate drinkers.
PBN: Which is likely to kill someone who does both first, the cigarettes or the alcohol -- or is it possible to say?
KAHLER: It is not truly possible to say for any one individual. Drinking alcohol very heavily can put people in risky situations that can result in death and can put other people’s lives in danger. However, in terms of non-accidental deaths, research suggests that on average alcoholics who smoke are more likely to die of smoking-related illnesses than alcohol-related illnesses. Therefore, it is very important for all people to quit smoking. Heavy drinking and smoking also can interact raising the risk of head and neck cancers 30 to 100 fold if someone does both.
PBN: How does excessive drinking affect the treatment of HIV infection?
KAHLER: Heavy drinking in people living with HIV has been associated with worse medication adherence, lower odds of successfully suppressing the virus, decreased immune function, and increased odds of liver disease, which is a leading cause of death among HIV patients. Alcohol and HIV can both affect cognitive functioning, and heavy drinking has been associated with increased engagement in risky sexual practices that can spread HIV. Therefore, alcohol has a significant impact on both the depth and breadth of the HIV epidemic.