Smoking May Boost
Problem Drinking in Teens
By Rick Ansorge
WEDNESDAY, Nov. 29 (HealthDay
News) -- Smoking may prime the adolescent brain to
be more vulnerable to
alcoholism and other addictions, a new study
"The younger they start smoking,
the more their brains appear to be more susceptible
to other addictions," said study co-author Richard
epidemiologist at the Washington University
School of Medicine in St. Louis. "So, the longer we
can delay these behaviors, the better."
The findings are published in the
December issue of Alcoholism: Clinical &
"Everybody knows that smokers,
especially in adolescence, have a higher likelihood
of alcohol problems and dependence," Grucza said.
"We wanted to see if that was solely attributable to
the fact that they drink more than nonsmokers do or
if the story was more complicated."
Grucza and a colleague reviewed
survey data on the smoking and drinking practices of
nearly 75,000 subjects aged 12-20, collected from
2002-2004 by the U.S. National Surveys on Drug Use
Compared to adolescent nonsmokers
who drink alcohol, they found that adolescent
smokers have more than a 50 percent higher risk of
an alcohol-use disorder -- anything from
alcohol abuse and dependence to alcohol-related
trouble with the law.
The researchers also found that
the smokers' risk of an alcohol-related disorder is
elevated even when they drink the same amount of
alcohol as nonsmokers, and that the risk is
especially high among younger smokers and lighter
drinkers. Among 15- to 17-year-olds who drank fewer
than eight drinks a month, the prevalence of an
alcohol problem was 20 percent in smokers, compared
to only 5 percent in nonsmokers.
"This study provides additional
important evidence that both smoking and drinking
behaviors among U.S. youth are serious epidemics and
also pediatric diseases -- ones increasingly
understood as having origins and roots in early life
behaviors and conditions," said Dr. Elissa Weitzman,
of the Harvard School of Public Health, who was not
part of the study. "Smoking and drinking present a
troubling nexus of interacting risks. Use of one is
a good indication that use and abuse of the other
may be present, too," she said.
Weitzman said her own research has
shown that youths who became regular smokers by age
15 were at a fivefold higher risk of developing an
alcohol-related disorder by ages 18-21, compared to
their nonsmoking peers who drink alcohol.
"The evidence is accumulating that
early and youthful smoking and drinking are
signposts of serious health problems and not -- as
many continue to contend -- rites of passage typical
of youthful exploration," she said.
"Youth, their parents and family
members, health-care providers, teachers and
counselors all would do well to take seriously the
strong indication for other substance use from
observation of use of just one of these substances,"
Weitzman said. "This may be especially the case for
tobacco, where youthful smoking provides a stunning
indicator of risk for problem levels of drinking in
adolescence and young adulthood."
Grucza cautioned that his study
documents only an association between adolescent
smoking and problem drinking. "We're going to look
further to see if it's a true cause-and-effect
relationship," he said. "Even if it's not, then
seeing who smokes can help us identify who's at risk
for alcoholism and other addictions."
His findings mirror those of
researchers who have studied animal models of
addiction. "There are fairly striking parallels
in the animal literature, which show that
nicotine exposure during the animal equivalent
of adolescence affects the brain's central-reward
circuitry that is involved in all addictions," he
said. "The adolescent brain is still very much in
development. Unlike most people who start smoking in
adulthood, adolescents who start smoking quickly
become dependent on nicotine."
The health consequences are
severe, Grucza added, because smoking and alcohol --
either separately or together -- account for more
than 20 percent of deaths each year in the United
Although rates of adolescent
smoking and drinking have declined since the 1970s,
they've flattened out during the past decade and
remain at alarmingly high levels, Grucza said.
"When people talk about 'gateway'
drugs, they often focus on illegal drugs such as
marijuana," Grucza said. "But the biggest public
health problems are smoking and alcohol, with
smoking being the single most important preventable
cause of death."
"We need to look earlier in the
'gateway' series and see how smoking affects that
process," Grucza said.
A. Grucza, Ph.D., M.P.E., department of psychiatry,
Washington University School of Medicine, St. Louis,
Mo; Elissa R. Weitzman, Sc.D., Division of
Adolescent Medicine & Children's Hospital
Informatics Program, Children's Hospital
Boston/Harvard Medical School and department of
society, human development and health, Harvard
School of Public Health, Boston; December 2006
Alcoholism: Clinical & Experimental Research
Copyright © 2006
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