Smoking and Drinking

Curing someone of smoking is easy, in my experience. However, treating alcoholism is a different matter. It’s not difficult to cure alcoholism – it’s impossible.

Let me hasten to add that there are many things that can and should be done to help people with an alcohol problem. In this endeavor it’s important to keep in mind an aphorism of that most worthy organization, Alcoholics Anonymous (AA): ‘You are powerless over alcohol.’

Indeed, if you have the misfortune to have inherited the potential to become addicted to drink, and it does seem to be an inherited condition, then, once the addiction takes hold, you only need one drink and you’re out of control. It may not happen immediately and the alcoholic may then gain a false sense of security: ‘I can handle it.’ But they can’t. It means they have got away with it on that occasion. But almost inevitably, sooner or later, and probably sooner rather than later, they won’t get away with it. Then the sufferer is on a bender: drinking continually for two or three or four days and finally collapsing under the table. This is an awful and potentially life-threatening situation.

As an alcoholic you are powerless over alcohol. But if you have been off the drink for a week or more, you are not powerless to decide whether again to have that first drink – or not. It’s only the first one you need to worry about; the rest will look after themselves.

Thus, in theory, once the alcoholic has refrained until the poison – and for alcoholics, alcohol is poison – is out of the system, it’s entirely in their hands whether to take that first drink again, or not. That’s the hard part. And the easy part? There isn’t one. However, what helps a lot is the support of one’s family and especially that of the devoted mentors – ex-drinkers themselves – who give their services to AA.

The point of all this is to emphasis that for an alcoholic who has stopped drinking the decision to start again is a voluntary one. Unfortunately, many alcoholics have other problems in their lives, often related to the alcoholism, so it’s a vicious circle. It’s understandable that under stress they may succumb to the ‘to hell with it, I need a drink’ feeling. But, however misguided, this is a voluntary decision.

Is there any medical treatment that can make drinkers not want to drink anymore?

Some have been tried. There’s disulfiram (Antabuse), which is aversion therapy. The drinker takes this drug regularly and if he or she drinks, immediately suffers very unpleasant symptoms such as nausea, vomiting, palpitations, etc. Not very effective and can be dangerous, so I don’t recommended it.

Then there’s a drug called acamprosate. It’s supposed to reduce ‘cravings’ – there we go again – in abstinent alcoholics. The way it works, insofar as it does works at all, is unknown and it must be used together with counselling. Can’t say it sounds much good. Nonetheless, in England in 2014 the NHS spent £4m on this drug together with disulfiram.

What’s all this got to do with smoking?

Both smoking, and alcohol drinking after a period of abstinence, as I have said, are voluntary activities. Therefore, there’s something odd about trying to boost someone’s willpower or to help them refrain from poisoning themselves, by poisoning them with a prescription drug. (All drugs used in medical treatment are poisons which have wanted and unwanted effects.)

Yet this is the current orthodox approach to smoking cessation. Smokers are likely to be offered either medicinal nicotine (gum or patches) or one of two prescription drugs: bupropion and varenicline. Or both medicinal nicotine and a prescription drug. You want to get off nicotine? Have some more nicotine! Can’t stand the cravings? Take a drug to cause a chemical imbalance in your brain to assist you getting out of the drugged state you’re already in because of your smoking!

Smokers and problem drinkers – all right, alcoholics – are in a similar situation in another sense: they don’t really want to stop smoking or drinking, respectively.

As I said at the beginning of this post, curing individual smokers is easy, and at a population level the problem could be solved by banning tobacco. But I wouldn’t for a moment suggest a return to prohibition as a cure for alcoholism. There is no inconsistency here. Virtually all smokers smoke because they are addicted to nicotine; they feel compelled to do it twenty times a day (or whatever number of cigarettes per day they smoke) every day, for years or decades. Claims that smoking is enjoyable or that it helps in dealing with life’s problems are illusions, as any smoker can demonstrate to himself or herself. But this is where the similarities end. With drinking, unless you’re an alcoholic, which most people are not, you can drink as and when you choose and circumstances permit. And who would dispute that drinking is a civilised pleasure for non-alcoholics who wish to do it?

I had a patient once whom I was trying to help with alcoholism. He was a very sad case. He said he was not interested in social drinking. What he felt compelled to, he told me, four or five evenings a week, was to retire to his room with a DVD and a bottle of vodka which he would proceed to consume over the next two or three hours. He didn’t enjoy it, he said, but it enabled him for a short time to escape the miseries of his life.

It would be better, both for smokers and alcoholics, to treat them with psychological support. Drugs are not a quick fix and should be avoided. (They may be needed in treating acute alcohol withdrawal.)

For smokers, effective psychological support to become nicotine-free can be found here.

Note: the above is intended for general information only and not should not be taken as advice to stop any prescribed medicine.

Text © Gabriel Symonds