Drug helps reduce heavy drinking, smoking: study

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A medication intended to help people quit smoking also reduces the rate of alcohol consumption among heavy drinkers, according to a new study that says prescription drugs can be a useful tool in efforts to eliminate unhealthy habits.

The study, documented in the American Journal of Psychiatry, subjected 165 participants who were daily smokers and heavy drinkers to two separate drugs: varenicline (for nicotine addiction) and naltrexone (for excessive alcohol consumption). Previous research has shown varenicline may also be effective at reducing the rate of alcohol intake.

Subjects in the clinical trial were required to be between the ages of 21 and 65 and smoke at least five cigarettes a day, with male participants typically consuming more than 14 drinks per week and female participants seven. All subjects received two milligrams of varenicline twice a day during the 12-week course of the study, but half the group (or 83 people) were also given 50 milligrams of naltrexone every day. The remaining participants received a placebo in addition to the varenicline. All subjects were instructed to drink less and stop smoking.

When researchers followed up with participants six months after the end of the study, they discovered that almost 36 per cent of participants, or 59 people, had broken the habit. The rate of cessation was higher than previous studies of varenicline that had suggested a success rate in the neighbourhood of 25-30 per cent, said Lara Ray, lead author of the study and a professor of psychology and of psychiatry and biobehavioral sciences at UCLA.

“The overall smoking quit rate in the trial is impressive,” she said. “We exceeded the overall expectation for this medication. This is especially important in a diverse group of people.”

Interestingly, participants who received a placebo in addition to varenicline were more successful at kicking the habit (45 per cent) than those given a combination of varenicline and naltrexone (27 per cent), a finding that surprised researchers.

“The quit rate for varenicline alone in this sample is highly encouraging, as this is the first large-scale trial of varenicline efficacy focused solely on heavy-drinking smokers,” Ray said.

While the two drugs were not as effective at stopping smoking when used in combination, they fared better at slowing alcohol consumption than the placebo group. Prior to the study, participants were averaging almost seven alcoholic beverages per drinking day; after the study, subjects who were given both varenicline and naltrexone dropped consumption to just three beverages per week over the 12-week period of study. Those given varenicline plus a placebo reduced consumption to four drinks per week.

“I am excited about both the smoking cessation rates and the drinking reductions,” Ray said. “These findings suggests that desirable outcomes for smoking cessation and drinking reduction are achievable.”

Drinking and smoking — two major health risks that can impact the quality of life and longevity — often go hand in hand with around 20 to 25 per cent of smokers also engaging in heavy drinking, according to the study. Both habits are associated with worse health outcomes when COVID-19 enters the picture.

The findings, which were consistent across gender, showed prescription drugs can play a powerful role in halting unhealthy habits, Ray said. Managing multiple medications can be difficult for patients, however, and may not be necessary in this case.

“Varenicline alone is doing a great job and this trial indicates that there is not much room for naltrexone to make a difference,” she said. “But even medications like varenicline have their limitations. Medication is only part of the solution. There remains much research to be done on addictions and how to treat them.”

For people struggling to get their alcohol and nicotine use under control, this could be an effective option to discuss with a doctor, she said. “There is evidence that varenicline can help them with both. Varenicline appears quite effective at reducing drinking and helping people to quit smoking. Given that varenicline has been found to reduce drinking in trials for alcohol use disorder, it is possible that its effects on both drinking and smoking present an optimal alternative for this group of heavy-drinking smokers.”

Dave Yasvinski is a writer withHealthing.ca

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