The short- and long-run effects of smoking cessation on alcohol consumption

  • Benjamin UkertEmail author
Research Article


This paper examines the short- and long-term effects of quitting smoking on alcohol consumption using the Lung Health Study, a randomized smoking cessation program. The paper estimates the relationship between smoking and alcohol consumption using several self-reported and objective smoking measures, while also implementing a two-stage least squares estimation strategy that utilizes the randomized smoking cessation program assignment as an instrument for smoking. The analysis leads to three salient findings. First, self-reported and clinically verified smoking measures provide mixed evidence on the short-term impact of quitting smoking on alcohol consumption. Second, the long-term impact of smoking on alcohol consumption, measured with the historic 5 years smoking behavior, suggests that those with the highest average cigarette consumption and those with the longest smoking history see the largest increase in alcohol consumption. Specifically, abstaining from smoking or reducing the average cigarette consumption to the mean level lowers alcohol consumption by roughly 25% per week. As a result, these findings present comprehensive evidence that smoking and drinking are complements in the long-term and that the public health and finance benefits in smoking cessations treatments are undervalued.


Risky behaviors Smoking Drinking Addiction Randomized experiment 

JEL Classification

I1 I12 I18 


  1. Ashley, M., Olin, J., le Riche, W., Kornaczewski, A., Schmidt, W., & Rankin, J. (1977). Morbidity in alcoholics. Evidence for accelerated development of physical disease in women. Archives of Internal Medicine, 137(7), 883–887.CrossRefPubMedGoogle Scholar
  2. Barrett, S. P., Tichauer, M., Leyton, M., & Pihl, R. O. (2006). Nicotine increases alcohol self-administration in non-dependent male smokers. Drug and Alcohol Dependence, 81, 197–204.CrossRefPubMedGoogle Scholar
  3. Bask, M., & Melkersson, M. (2003). Should one use smokeless tobacco in smoking cessation programs? A rational addiction approach. The European Journal of Health Economics (HEPAC), 4(4), 263–270.CrossRefGoogle Scholar
  4. Bask, M., & Melkersson, M. (2004). Rationally addicted to drinking and smoking? Applied Economics, 36(4), 373–381.CrossRefGoogle Scholar
  5. Becker, G., & Murphy, K. (1988). A theory of rational addiction. Journal of Political Economy, 96(4), 675–700.CrossRefGoogle Scholar
  6. Benowitz, N. L., Jacob, P, I. I. I., Kozlowski, L. T., & Yu, L. (1986). Influence of smoking fewer cigarettes on exposure to tar, nicotine, and carbon monoxide. New England Journal of Medicine, 315(21), 1310–1313.CrossRefPubMedGoogle Scholar
  7. Bobo, J., & Husten, C. (2000). Sociocultural influences on smoking and drinking. Alcohol Reserach & Health, 24(4), 225–232.Google Scholar
  8. Cameron, L., & Williams, J. (2001). Cannabis, alcohol and cigarettes: Substitutes or complements? Economic Record, 77(236), 19–34.CrossRefGoogle Scholar
  9. Cawley, J. (2004). The impact of obesity on wages. Journal of Human Resources, 39(2), 451–474.CrossRefGoogle Scholar
  10. CDC News Release. (2014). CDC’s tips from former smokers campaign provided outstanding return on investment. Accessed 1 June 2015.Google Scholar
  11. Chaloupka, F. J. (1991). Rational addictive behavior and cigarette smoking. Journal of Political Economy, 99, 722–742.CrossRefGoogle Scholar
  12. Chou, S. Y., Grossman, M., & Saffer, H. (2004). An economic analysis of adult obesity: Results from the behavioral risk factor surveillance system. Journal of Health Economics, 23(3), 565–587.CrossRefPubMedGoogle Scholar
  13. Connett, J., Kusek, J., Bailey, W., O’Hara, P., Wu, M., & the Lung Health Study Group. (1993). Design of the lung health study: A randomized clinical trial of early intervention for chronic obstructive pulmonary disease. Conntrolled Clinical Trials, 14, 3–19.Google Scholar
  14. Courtemanche, C. (2009). Rising cigarette prices and rising obesity: Coincidence or unintended consequence? Journal of Health Economics, 28(4), 781–798.CrossRefPubMedGoogle Scholar
  15. Courtemanche, C., Tchernis, R., & Ukert, B. (2016). The effect of smoking on obesity: Evidence from a randomized trial. National Bureau of Economic Research, NBER Working Paper No. 21937.Google Scholar
  16. Courtemanche, C., Marton, J., Ukert, B., Yelowitz, A., & Zapata, D. (2017). Early effects of the affordable care act on health care access, risky health behaviors, and self-assessed health. National Bureau of Economic Research, NBER Working Paper No. 23269.Google Scholar
  17. Dallongeville, J., Marecaux, N., Fruchart, J. C., & Amouyel, P. (1998). Cigarette smoking is associated with unhealthy patterns of nutrient intake: A meta-analysis. The Journal of Nutrition, 128(9), 1450–1457.PubMedGoogle Scholar
  18. Decker, S. L., & Schwartz, A. E. (2000). Cigarettes and alcohol: Substitutes or complements?. National Bureau of Economic Research, NBER Working Paper No. 7535.Google Scholar
  19. Dee, T. (1999). The complementarity of teen smoking and drinking. Journal of Health Economics, 18(6), 769–793.CrossRefPubMedGoogle Scholar
  20. Friedman, A. S. (2015). How does electronic cigarette access affect adolescent smoking? Journal of Health Economics, 44, 300–308.CrossRefPubMedGoogle Scholar
  21. Goel, R. K., & Morey, M. J. (1995). The interdependence of cigarette and liquor demand. Southern Economic Journal, 62(2), 451–459.CrossRefGoogle Scholar
  22. Gruber, J., Sen, A., & Stabile, M. (2003). Estimating price elasticities when there is smuggling: The sensitivity of smoking to price in Canada. Journal of Health Economics, 22(5), 821–842.CrossRefPubMedGoogle Scholar
  23. Gulliver, S. B., Kamholz, B. W., & Helstrom, A. W. (2006). Smoking cessation and alcohol abstinence: What do the data tell us? Alcohol Research & Health, 29(3), 208–213.Google Scholar
  24. Hymowitz, N., Sexton, M., Ockene, J., Grandits, G., & MRFIT Research Group. (1991). Baseline factors associated with smoking cessation and relapse. Preventive Medicine, 20(5), 590–601.Google Scholar
  25. Markowitz, S., & Tauras, J. (2009). Substance use among adolescent students with consideration of budget constraints. Review of Economics of the Household, 7(4), 423–446.CrossRefGoogle Scholar
  26. Meyer, B., Mok, D. W., & Sullivan, J. X. (2009). The under-reporting of transfers in household surveys: Its nature and consequences. National Bureau of Economic Research, NBER Working Paper No. 15181.Google Scholar
  27. Murray, R. P., Istvan, J. A., & Voelker, H. T. (1996). Does cessation of smoking cause a change in alcohol consumption? Evidence from the lung health study. Substance Use & Misuse, 31(2), 141–156.CrossRefGoogle Scholar
  28. Murray, R. P., Istvan, J. A., Voelker, H. T., Rigdon, M. A., & Wallace, M. D. (1995). Level of involvement with alcohol and success at smoking cessation in the lung health study. Journal of Studies on Alcohol, 56(1), 74–82.CrossRefPubMedGoogle Scholar
  29. National Center on Addiction and Substance Abuse at Columbia University (CASA), & United States of America. (2009). Shoveling up II: The impact of substance abuse on federal, state and local budgets.Google Scholar
  30. O’Hara, P., Connett, J. E., Lee, W. W., Nides, M., Murray, R., & Wise, R. (1998). Early and late weight gain following smoking cessation in the lung health study. American Journal of Epidemiology, 148(9), 821–830.CrossRefPubMedGoogle Scholar
  31. Pacula, R. L. (1997). The economic modeling of the gateway effect. Health Economics, 6, 521–524.CrossRefPubMedGoogle Scholar
  32. Pacula, R. L. (1998). Does increasing the beer tax reduce marijuana consumption? Journal of Health Economics, 17(5), 557–585.CrossRefPubMedGoogle Scholar
  33. Picone, G. A., Sloan, F., & Trogdon, J. G. (2004). The effect of the tobacco settlement and smoking bans on alcohol consumption. Health Economics, 13(10), 1063–1080.CrossRefPubMedGoogle Scholar
  34. Pierani, P., & Tiezzi, S. (2009). Addiction and interaction between alcohol and tobacco consumption. Empirical Economics, 37(1), 1–23.CrossRefGoogle Scholar
  35. Rodgers, A., Corbett, T., Bramley, D., Riddell, T., Wills, M., Lin, R. B., et al. (2005). Do u smoke after txt? Results of a randomised trial of smoking cessation using mobile phone text messaging. Tobacco Control, 14(4), 255–261.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Sacks, J. J., Gonzales, K. R., Bouchery, E. E., Tomedi, L. E., & Brewer, R. D. (2015). 2010 National and state costs of excessive alcohol consumption. American Journal of Preventive Medicine, 49(5), 73–79.CrossRefGoogle Scholar
  37. Schoenborn, C. A. (2004). Marital status and health: United States, 1999–2002 advance data from vital and health statistics; no 351. Hyattsville, MA: National Center for Health Statistics.Google Scholar
  38. Shrestha, V. (2016). Do young adults substitute cigarettes for alcohol? Learning from the master settlement agreement. Review of Economics of the Household 1–25.Google Scholar
  39. Simon, K., Soni, A., & Cawley, J. (2017). The impact of health insurance on preventive care and health behaviors: Evidence from the first two years of the ACA medicaid expansions. Journal of Policy Analysis and Management, 36(2), 390–417.CrossRefPubMedGoogle Scholar
  40. Soderpalm, B., Ericson, M., Olausson, P., Blomqvist, O., & Engel, J. A. (2000). Nicotinic mechanisms involved in the dopamine activating and reinforcing properties of ethanol. Behavior and Brain Research, 113, 85–96.CrossRefGoogle Scholar
  41. Stock, J. H., Wright, J. H., & Yogo, M. (2002). A survey of weak instruments and weak identification in generalized method of moments. Journal of Business & Economic Statistics, 20(4), 518–529.CrossRefGoogle Scholar
  42. Swan, G. E., Carmelli, D., & Cardon, L. R. (1997). Heavy consumption of cigarettes, alcohol and coffee in male twins. Journal of Studies of Alcohol, 58, 182–190.CrossRefGoogle Scholar
  43. Williams, J., Pacula, R., Chaloupka, F., & Wechsler, H. (2004). Alcohol and marijuana use among college students: Economic complements or substitutes? Health Economics, 13(9), 825–843.CrossRefPubMedGoogle Scholar
  44. Wooldridge, J. M. (2010). Econometric analysis of cross section and panel data. Cambridge: MIT Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaUSA

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