This Combination of Medicines May Help Heavy-Drinking Smokers Quit

Drinking a beer and smoking cigarettes.

Rainer Fuhrmann / EyeEm / Getty Images

Key Takeaways

  • Alcohol and nicotine addiction often go hand in hand, which often increases the health risks faced by patients.
  • A new clinical trial found that a combination of the medications varenicline and naltrexone may help heavy-drinking smokers quit at a rate higher than expected.
  • Experts say treating both addictions simultaneously is crucial.

The combination of alcohol and tobacco abuse increases the risk of health issues for thousands of Americans each year. Now, researchers are trying to figure out whether there are medications that can be safely and effectively combined to address both addictions simultaneously.

In a recent clinical trial conducted by the UCLA Brain Research Institute, scientists tested different combinations of alcohol and tobacco medications on a cohort of heavy-drinking smokers to determine how to best help them quit.

They found that not only can smoking cessation and drinking reduction be successfully targeted with medication, but that a combination of the drugs varenicline and naltrexone may help heavy-drinking smokers quit at a rate higher than expected.

“Currently, there are no FDA-approved pharmacotherapy treatment options specifically tailored for heavy-drinking smokers,” study author ReJoyce Green, a clinical psychology PhD candidate from the UCLA Addictions Lab, tells Verywell. “Research must continue to evaluate how existing or novel medications can be used to treat heavy drinking smokers."

How to Treat Addictions That Go Hand In Hand

Both alcohol and tobacco addiction are major public health issues. Tobacco-related disease is 2 to 4 times more prevalent among people with alcohol addiction. And compared to the 34% risk of alcohol-related death for non-smokers with alcohol addiction, there is a 51% risk of dying of tobacco-related causes for smokers with alcohol addiction.

The researchers identified an established treatment for alcohol use disorder, naltrexone, and one for smoking, varenicline (commercially known as Chantix). They then analyzed a group of 165 adults who were heavy alcohol users and smokers.

Participants all smoked at least five cigarettes a day. Women consumed more than 7 drinks a week, while men drank more than 14.

For a period of 12 weeks, the researchers gave all of them a dose of varenicline daily during the trial (2 milligrams). Half of the group also received naltrexone (50 milligrams) and the others received a placebo.

Twenty-six weeks after the study’s conclusion, 59 participants had quit smoking—nearly 36% of the full cohort. This was a higher rate than researchers anticipated. Previous studies suggested varenicline has a success rate of about 25 to 30%.

Surprisingly, those who received a placebo as their second pill instead of naltrexone were more likely to quit smoking than the people who were assigned to receive naltrexone. The former had a quitting rate of 45% compared to 27% of those taking naltrexone.

However, those who were taking both medications were slightly more likely to reduce their alcohol consumption than the people who took the placebo. They reduced their weekly drinking to three drinks a day, while those who took a placebo drank four drinks on average.

“These results advance the field of pharmacotherapy treatment options for heavy drinking smokers by demonstrating that for smoking cessation varenicline alone may serve as a sufficient aid,” Green says. “But for drinking outcomes, there could be an added benefit of combined varenicline and naltrexone.”

What This Means For You

If you struggle with alcohol addiction and smoking tobacco, ask your clinician about the possibility of combining different medications such as naltrexone and varenicline. If you struggle with substance abuse you can also call SAMHSA’s National Helpline, 1-800-662-HELP (4357). It's confidential, free, and runs 24-hour-a-day, 365-day-a-year.

Adding More Treatment Options to the Roster

These findings suggest that the use of the right medication can target both smoking and drinking addiction in a patient.

“The findings point to a complex problem facing the addiction field: many people suffer from multiple addictions that are occurring at the same time and treating these co-occurring addictions may be different and more difficult than treating either addiction alone,” Erin Calipari, PhD, assistant professor of pharmacology at the Vanderbilt University School of Medicine, tells Verywell. “These findings are really important for clinicians that are treating individuals with substance use disorders.”

But because even medications like varenicline have their limitations, scientists still call for more research on the subject. According to Green, looking forward, they'll need to continue examining the effects of different dosages of naltrexone. 

Indra Cidambi, MD, medical director at Center for Network Therapy, tells Verywell that pharmacotherapy should go hand in hand with psychotherapy, and research like this can help improve that relationship.

“Many studies have proved that a combination of medication with therapy delivers better outcomes,” Cidambi says. “It is heartening to see more medications being proved to be effective through clinical trials, as it increases treatment options.”

She explains that when the abuse of one substance is ignored—say, treating alcohol addiction now and tobacco later—the reward pathways in the brain remain open. This can lead individuals back to the abuse of the other substance.

Fine-tuning how to combine medication to treat both addictions simultaneously can help addiction treatment professionals better care for their patients.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Ray LA, Green R, Enders C, et al. Efficacy of combining varenicline and naltrexone for smoking cessation and drinking reduction: a randomized clinical trial. Am J Psychiatry. doi:10.1176/appi.ajp.2020.20070993

  2. Apollonio D, Philipps R, Bero L. Interventions for tobacco use cessation in people in treatment for or recovery from substance abuseCochrane Database Syst Rev. 2012;12:1-10. doi:10.1002/14651858.CD010274

By Sofia Quaglia
Sofia Quaglia is a science and health writer based between Italy, the United Kingdom, and the United States.