, Volume 231, Issue 24, pp 4649–4657 | Cite as

Acute effects of low and high dose alcohol on smoking lapse behavior in a laboratory analogue task

  • Christopher W. Kahler
  • Jane Metrik
  • Nichea S. Spillane
  • Anne Day
  • Adam M. Leventhal
  • Sherry A. McKee
  • Jennifer W. Tidey
  • John E. McGeary
  • Valerie S. Knopik
  • Damaris J. Rohsenow
Original Investigation



Smoking lapses (i.e., returns to smoking after quitting) often occur following alcohol consumption with observational data suggesting greater quantities of alcohol lead to greater risk. However, a causal dose-dependent effect of alcohol consumption on smoking lapse behavior has not been established, and the mechanisms that might account for such an effect have not been tested.


In a within-subjects design, we examined the effects of low- (0.4 g/kg) and high-dose (0.8 g/kg) alcohol, relative to placebo, on smokers’ ability to resist initiating smoking after acute smoking abstinence.


Participants were 100 heavy alcohol drinkers, smoking 10–30 cigarettes per day. Across three separate days, participants consumed placebo, low-dose, or high-dose alcohol following 3 h of smoking abstinence and, 35 min later, were offered the opportunity to smoke while resisting smoking was monetarily reinforced proportional to the amount of time delayed.


Consistent with a dose–response effect, participants smoked 3.35 min (95 % confidence intervals (CI) [−7.09, 0.40], p = .08) earlier following low-dose alcohol and 6.36 min (95 % CI [−9.99, −2.73], p = .0006) earlier following high-dose alcohol compared to drinking a placebo beverage. Effects of dose on smoking behavior were partially mediated by increases in urge to smoke. There was no evidence that alcohol’s effects on urge to smoke or ability to resist smoking were mediated through its stimulating or sedating effects.


Alcohol can reduce the ability to resist smoking in a dose-dependent fashion, in part, due to its effect on increasing the intensity of smoking urges.


Alcohol Smoking relapse Craving Urge to smoke Stimulation Alcohol administration 



This study was funded by the National Institute on Alcohol Abuse and Alcoholism, grant R01AA016978 to Dr. Kahler, by a Senior Research Career Scientist award from the Department of Veterans Affairs to Dr. Rohsenow, by National Institute on Drug Abuse grant K08-DA025041 to Dr. Leventhal, and by National Institute on Drug Abuse grant K08-DA029094 to Dr. Spillane. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Conflict of interest

The authors have no financial relationship with the study sponsor, and no conflicts of interest to disclose.


  1. Anthony JC, Echeagaray-Wagner F (2000) Epidemiologic analysis of alcohol and tobacco use. Alcohol Res Health 24:201–208PubMedGoogle Scholar
  2. Augustson EM, Wanke KL, Rogers S, Bergen AW, Chatterjee N, Synder K, Albanes D, Taylor PR, Caporaso NE (2008) Predictors of Sustained Smoking Cessation: A Prospective Analysis of Chronic Smokers From the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study. Am J Public Health 98:549–555PubMedCentralPubMedCrossRefGoogle Scholar
  3. Baer JS, Lichtenstein E (1988) Classification and prediction of smoking relapse episodes: an exploration of individual differences. J Consult Clin Psychol 56:104–110PubMedCrossRefGoogle Scholar
  4. Borland R (1990) Slip-ups and relapse in attempts to quit smoking. Addict Behav 15:235–245PubMedCrossRefGoogle Scholar
  5. Brandon TH, Drobes DJ, Unrod M, Heckman BW, Oliver JA, Roetzheim RC, Karver SB, Small BJ (2011) Varenicline effects on craving, cue reactivity, and smoking reward. Psychopharmacology 218:391–403PubMedCrossRefGoogle Scholar
  6. Burton SM, Tiffany ST (1997) The effect of alcohol consumption on craving to smoke. Addiction 92:15–26PubMedCrossRefGoogle Scholar
  7. Businelle MS, Lam CY, Kendzor DE, Cofta-Woerpel L, McClure JB, Cinciripini PM, Wetter DW (2013) Alcohol consumption and urges to smoke among women during a smoking cessation attempt. Exp Clin Psychopharmacol 21:29–37PubMedCrossRefGoogle Scholar
  8. Chiolero A, Wietlisbach V, Ruffieux C, Paccaud F, Cornuz J (2006) Clustering of risk behaviors with cigarette consumption: a population-based survey. Prev Med 42:348–353PubMedCrossRefGoogle Scholar
  9. Cox LS, Tiffany ST, Christen AG (2001) Evaluation of the brief questionnaire of smoking urges (QSU-brief) in laboratory and clinical settings. Nicotine Tob Res Off J Soc Res Nicotine Tob 3:7–16CrossRefGoogle Scholar
  10. David SP, Lancaster T, Stead LF, Evins AE and Prochaska JJ (2013) Opioid antagonists for smoking cessation. The Cochrane database of systematic reviews 6:CD003086Google Scholar
  11. Davidson D, Hutchison K, Dagon C, Swift R (2002) Assessing the stimulant effects of alcohol in humans. Pharmacol Biochem Behav 72:151–156PubMedCrossRefGoogle Scholar
  12. Dawson DA (2000) Drinking as a risk factor for sustained smoking. Drug Alcohol Depend 59:235–249PubMedCrossRefGoogle Scholar
  13. Day AM, Kahler CW, Spillane NS, Metrik J, Rohsenow DJ (2014) Length of smoking deprivation moderates the effects of alcohol administration on urge to smoke. Addict Behav 39:976–979PubMedCrossRefGoogle Scholar
  14. Dollar KM, Homish GG, Kozlowski LT, Leonard KE (2009) Spousal and alcohol-related predictors of smoking cessation: a longitudinal study in a community sample of married couples. Am J Public Health 99:231–233PubMedCentralPubMedCrossRefGoogle Scholar
  15. Epstein AM, Sher TG, Young MA, King AC (2007) Tobacco chippers show robust increases in smoking urge after alcohol consumption. Psychopharmacology (Berlin) 190:321–329CrossRefGoogle Scholar
  16. Falk DE, Yi HY, Hiller-Sturmhofel S (2006) An epidemiologic analysis of co-occurring alcohol and tobacco use and disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Res Health 29:162–171PubMedGoogle Scholar
  17. First MB, Spitzer RL, Gibbon M, Williams JBW (1995) Structured Clinical Interview for DSM-IV Axis I Disorders. New York State Psychiatric Institute, New YorkGoogle Scholar
  18. Friel PN, Logan BK, O'Malley D, Baer JS (1999) Development of dosing guidelines for reaching selected target breath alcohol concentrations. J Stud Alcohol 60:555–565PubMedGoogle Scholar
  19. Gray JA (1994) Three fundamental emotion systems. In: Davidson RJ, Ekman P (eds) The nature of emotion: fundamental questions. Oxford University Press, New York, pp 243–247Google Scholar
  20. Gwaltney CJ, Shiffman S, Sayette MA (2005) Situational correlates of abstinence self-efficacy. J Abnorm Psychol 114:649–660PubMedCrossRefGoogle Scholar
  21. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO (1991) The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict 86:1119–1127PubMedCrossRefGoogle Scholar
  22. Humfleet G, Munoz R, Sees K, Reus V, Hall S (1999) History of alcohol or drug problems, current use of alcohol or marijuana, and success in quitting smoking. Addict Behav 24:149–154PubMedCrossRefGoogle Scholar
  23. Hymowitz N, Cummings KM, Hyland A, Lynn WR, Pechacek TF, Hartwell TD (1997) Predictors of smoking cessation in a cohort of adult smokers followed for five years. Tob Control 6:S57–S62PubMedCentralPubMedCrossRefGoogle Scholar
  24. Kahler CW, Metrik J, LaChance HR, Ramsey SE, Abrams DB, Monti PM, Brown RA (2008a) Addressing heavy drinking in smoking cessation treatment: a randomized clinical trial. J Consult Clin Psychol 76:852–862PubMedCentralPubMedCrossRefGoogle Scholar
  25. Kahler CW, Strong DR, Papandonatos GD, Colby SM, Clark MA, Boergers J, Niaura R, Abrams DB, Buka SL (2008b) Cigarette smoking and the lifetime alcohol involvement continuum. Drug Alcohol Depend 93:111–120PubMedCentralPubMedCrossRefGoogle Scholar
  26. Kahler CW, Borland R, Hyland A, McKee SA, Thompson ME, Cummings KM (2009) Alcohol consumption and quitting smoking in the International Tobacco Control (ITC) Four Country Survey. Drug Alcohol Depend 100:214–220PubMedCentralPubMedCrossRefGoogle Scholar
  27. Kahler CW, Spillane NS, Metrik J (2010) Alcohol use and initial smoking lapses among heavy drinkers in smoking cessation treatment. Nicotine Tob Res Off J Soc Res Nicotine Tob 12:781–785CrossRefGoogle Scholar
  28. Kahler CW, Metrik J, Spillane NS, Leventhal AM, McKee SA, Tidey JW, McGeary JE, Knopik VS, Rohsenow DJ (2012) Sex differences in stimulus expectancy and pharmacologic effects of a moderate dose of alcohol on smoking lapse risk in a laboratory analogue study. Psychopharmacology 222:71–80PubMedCentralPubMedCrossRefGoogle Scholar
  29. King AC, Epstein AM (2005) Alcohol dose-dependent increases in smoking urge in light smokers. Alcohol Clin Exp Res 29:547–552PubMedCrossRefGoogle Scholar
  30. King AC, Volpicelli JR, Frazer A, O'Brien CP (1997) Effect of naltrexone on subjective alcohol response in subjects at high and low risk for future alcohol dependence. Psychopharmacology 129:15–22PubMedCrossRefGoogle Scholar
  31. King AC, Houle T, de Wit H, Holdstock L, Schuster A (2002) Biphasic alcohol response differs in heavy versus light drinkers. Alcohol Clin Exp Res 26:827–835PubMedCrossRefGoogle Scholar
  32. King AC, Cao D, Vanier C, Wilcox T (2009) Naltrexone decreases heavy drinking rates in smoking cessation treatment: an exploratory study. Alcohol Clin Exp Res 33:1044–1050PubMedCrossRefGoogle Scholar
  33. Kouri EM, McCarthy EM, Faust AH, Lukas SE (2004) Pretreatment with transdermal nicotine enhances some of ethanol's acute effects in men. Drug Alcohol Depend 75:55–65PubMedCrossRefGoogle Scholar
  34. Leeman RF, McKee SA, Toll BA, Krishnan-Sarin S, Cooney JL, Makuch RW, O'Malley SS (2008) Risk factors for treatment failure in smokers: relationship to alcohol use and to lifetime history of an alcohol use disorder. Nicotine Tob Res Off J Soc Res Nicotine Tob 10:1793–1809CrossRefGoogle Scholar
  35. Little HJ (2000) Behavioral mechanisms underlying the link between smoking and drinking. Alcohol Res Health 24:215–224PubMedGoogle Scholar
  36. MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V (2002) A comparison of methods to test mediation and other intervening variable effects. Psychol Methods 7:83–104PubMedCentralPubMedCrossRefGoogle Scholar
  37. Marlatt GA, Gordon JR (1985) Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press, New YorkGoogle Scholar
  38. Martin CS, Earleywine M, Musty RE, Perrine MW, Swift RM (1993) Development and validation of the Biphasic Alcohol Effects Scale. Alcohol Clin Exp Res 17:140–146PubMedCrossRefGoogle Scholar
  39. McKee SA, Krishnan-Sarin S, Shi J, Mase T, O'Malley SM (2006) Modeling the effect of alcohol on smoking lapse behavior. Psychopharmacology 189:201–210PubMedCentralPubMedCrossRefGoogle Scholar
  40. McKee SA, Harrison EL, O'Malley SS, Krishnan-Sarin S, Shi J, Tetrault JM, Picciotto MR, Petrakis IL, Estevez N, Balchunas E (2009) Varenicline reduces alcohol self-administration in heavy-drinking smokers. Biol Psychiatry 66:185–190PubMedCentralPubMedCrossRefGoogle Scholar
  41. McKee SA, Sinha R, Weinberger AH, Sofuoglu M, Harrison EL, Lavery M, Wanzer J (2011) Stress decreases the ability to resist smoking and potentiates smoking intensity and reward. J Psychopharmacol 25:490–502PubMedCentralPubMedCrossRefGoogle Scholar
  42. Murray RP, Istvan JA, Voelker HT, Rigdon MA, Wallace MD (1995) Level of involvement with alcohol and success at smoking cessation in the lung health study. J Stud Alcohol 56:74–82PubMedGoogle Scholar
  43. Osler M, Prescott E, Godtfredsen N, Hein HO, Schnohr P (1999) Gender and determinants of smoking cessation: a longitudinal study. Prev Med 29:57–62PubMedCrossRefGoogle Scholar
  44. Ostafin BD, Palfai TP (2006) Implicit cognition and cross-addictive behaviors. In: Weirs RW, Stacy AW (eds) Handbook of implicit cognition and addiction. Sage Publications, Thousand OaksGoogle Scholar
  45. Perkins KA, Sexton JE, DiMarco A, Grobe JE, Scierka A, Stiller RL (1995) Subjective and cardiovascular responses to nicotine combined with alcohol in male and female smokers. Psychopharmacology (Berlin) 119:205–212CrossRefGoogle Scholar
  46. Ray LA, Miranda R Jr, Kahler CW, Leventhal AM, Monti PM, Swift R, Hutchison KE (2007) Pharmacological effects of naltrexone and intravenous alcohol on craving for cigarettes among light smokers: a pilot study. Psychopharmacology 193:449–456PubMedCrossRefGoogle Scholar
  47. Rohsenow DJ, Marlatt GA (1981) The balanced placebo design: methodological considerations. Addict Behav 6:107–122PubMedCrossRefGoogle Scholar
  48. Sayette MA, Martin CS, Wertz JM, Perrott MA, Peters AR (2005) The effects of alcohol on cigarette craving in heavy smokers and tobacco chippers. Psychol Addict Behav J Soc Psychol Addict Behav 19:263–270CrossRefGoogle Scholar
  49. Sherman SE, Wang MM, Nguyen B (1996) Predictors of success in a smoking cessation clinic. J Gen Intern Med 11:702–704PubMedCrossRefGoogle Scholar
  50. Shiffman S (1982) Relapse following smoking cessation: a situational analysis. J Consult Clin Psychol 50:71–86PubMedCrossRefGoogle Scholar
  51. Shiffman S, Gwaltney CJ (2008) Does heightened affect make smoking cues more salient? J Abnorm Psychol 117:618–624PubMedCrossRefGoogle Scholar
  52. Shiffman S, Paty JA, Gnys M, Kassel JA, Hickcos M (1996) First lapses to smoking: within-subjects analysis of real-time reports. J Consult Clin Psychol 64:366–379PubMedCrossRefGoogle Scholar
  53. Shiffman S, Tindle H, Li X, Scholl S, Dunbar M, Mitchell-Miland C (2012) Characteristics and smoking patterns of intermittent smokers. Exp Clin Psychopharmacol 20:264–277PubMedCentralPubMedCrossRefGoogle Scholar
  54. Smith PM, Kraemer HC, Miller NH, Debusk RF, Taylor CB (1999) In-hospital smoking cessation programs: who responds, who doesn't? J Consult Clin Psychol 67:19–27PubMedCrossRefGoogle Scholar
  55. Sobell LC, Sobell MB (1996) Timeline followback: A calendar method for assessing alcohol and drug use. Addiction Research Foundation, TorontoGoogle Scholar
  56. Sorlie PD, Kannel WB (1990) A description of cigarette smoking cessation and resumption in the Framingham Study. Prev Med 19:335–345PubMedCrossRefGoogle Scholar
  57. Tofighi D, MacKinnon DP (2011) RMediation: an R package for mediation analysis confidence intervals. Behav Res Methods 43:692–700PubMedCentralPubMedCrossRefGoogle Scholar
  58. Westman E, Levin E, Rose J (1992) Smoking while wearing the nicotine patch: Is smoking satisfying or harmful? Clin Res 40:871AGoogle Scholar
  59. Wise RA (1996) Neurobiology of addiction. Curr Opin Neurobiol 6:243–251PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Christopher W. Kahler
    • 1
  • Jane Metrik
    • 2
    • 1
  • Nichea S. Spillane
    • 1
  • Anne Day
    • 1
  • Adam M. Leventhal
    • 3
  • Sherry A. McKee
    • 4
  • Jennifer W. Tidey
    • 1
  • John E. McGeary
    • 2
    • 5
    • 6
  • Valerie S. Knopik
    • 5
    • 6
  • Damaris J. Rohsenow
    • 2
    • 1
  1. 1.Center for Alcohol and Addiction StudiesBrown University School of Public HealthProvidenceUSA
  2. 2.Providence VA Medical CenterProvidenceUSA
  3. 3.Departments of Preventive Medicine and PsychologyUniversity of Southern California Keck School of MedicineLos AngelesUSA
  4. 4.Department of PsychiatryYale University School of MedicineNew HavenUSA
  5. 5.Division of Behavioral Genetics, Rhode Island HospitalBrown UniversityProvidenceUSA
  6. 6.Department of Psychiatry and Human Behavior, Alpert Medical SchoolBrown UniversityProvidenceUSA

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