A preliminary investigation of varenicline for heavy drinking smokers
Varenicline, an approved smoking cessation pharmacotherapy, also shows promise as a potential treatment for alcohol dependence. However, varenicline has not been tested in heavy drinkers, and it remains to be determined whether varenicline could reduce alcohol craving and consumption in smokers who are trying to quit smoking.
We conducted a preliminary study to examine the effect of varenicline on drinking behavior and the effects of extended varenicline pretreatment on smoking.
Thirty heavy drinking smokers received smoking cessation counseling and were randomly assigned to receive either an extended 4-week pretreatment with varenicline 2 mg daily or the usual 1-week pretreatment. Those in the extended pretreatment group received active medication for 8 weeks (i.e., 4 weeks of active pre-treatment followed by 4 weeks of active treatment), and participants in the usual pretreatment group received active medication after a placebo lead in (i.e., 3 weeks of placebo followed by active medication for 5 weeks).
Participants who received varenicline during the first 3 weeks reported significantly greater reductions in alcohol craving and numerically fewer heavy drinking days compared to those who received placebo, and these differences persisted during the open-label phase. Extended pretreatment was associated with numerically greater reductions in cigarette smoking over the entire study period. There were no differences, however, in smoking abstinence rates following the smoking quit date between the two groups.
Findings from this preliminary study suggest that varenicline may be a promising strategy for concurrently reducing heavy drinking and promoting smoking changes in heavy drinkers.
KeywordsSmoking cessation Varenicline Heavy drinking Alcohol craving
- Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale, NJGoogle Scholar
- Cooney JL, Cooney NL, Patten CA, George TP (2004) Comorbidity of nicotine dependence with affective, psychotic and substance use disorders. In: Kranzler HR, Tinsley JA (eds) Dual diagnosis and psychiatric treatment: substance abuse and comorbid disorders, 2nd edn. Marcel Dekker, New York, pp 211–259Google Scholar
- Davis TJ, de Fiebre CM (2006) Alcohol’s actions on neuronal nicotinic acetylcholine receptors. Alcohol Res Health 9:179–185Google Scholar
- Fiore M, Jaen C, Baker T et al (2008) Treating tobacco use and dependence, 2008 update. Clinical practice guideline. USDHHS, Public Health Service, RockvilleGoogle Scholar
- First MB, Spitzer RL, Gibbon M, Williams JBW (1996) Structured clinical interview for DSM-IV Axis I Disorders, research version, patient edition. Biometrics Research, New York State Psychiatric Institute, New YorkGoogle Scholar
- Hughes JR (1995) Clinical implications of the association between smoking and alcoholism. In: Fertig J, Allen JP (eds) Alcohol and tobacco: from basic science to clinical practice (NIAAA research monograph no. 95-3931). Government Printing Office, WashingtonGoogle Scholar
- Johnson B, Ait-Daoud N, Roache J (2005) The COMBINE SAFTEE: a structured instrument for collecting adverse events adapted for clinical studies in the alcoholism field. J Stud Alcohol 66:157–167Google Scholar
- National Institute on Alcohol Abuse and Alcoholism (2004) NIAAA council approves definition of binge drinking. NIAAA NewsletterGoogle Scholar
- Nides M, Oncken C, Gonzales D, Rennard S, Watsky EJ, Anziano R et al (2006) Smoking cessation with varenicline, a selective alpha4beta2 nicotinic receptor partial agonist: results from a 7-week, randomized, placebo- and bupropion-controlled trial with 1-year follow-up. Arch Intern Med 166:1561–1568PubMedCrossRefGoogle Scholar
- Sobell LC, Sobell MB (2003) Alcohol consumption measures. In: Allen JP, Wilson VB (eds) Assessing alcohol problems: a guide for clinicians and researchers, 2nd edn. National Institute on Alcohol Abuse and Alcoholism, Bethesda, pp 75–99Google Scholar