Tuesday, October 6, 2009

Nicotine Alcohol Marijuana

We have known for some time that continued use of Nicotine in patients recovering from alcohol dependence significantly affects risk of relapse but a recent study in The Journal of Addictive Medicine empasized how great the effect is. The information came from a study that was actually looking at another issue and that is the effect of use of acamprosate (Campral) in alcoholism. Acamprosate is designed to reduce alcohol cravings and the evidence so far is unclear about how much it really helps. This study of 601 patients over a six month period in those alcoholics who smoked showed about 14% of good response rate vs. 7% for placebo.

For alcoholic smokers there were several factors that predicted a poor outcome regarding alcohol relapse rates over the six month period. Those factors were smoking while sick in bed, difficulty refraining from smoking in public areas and smoking more than 20 cigarettes per day. The ionteresting thing is that for those who had any of these factors the relapse rate was the same as those who continued to smoke marijuana in this early recovery period. Those of us in the field of addiction are well aware of the phenomenon of cross tolerance in which the use of one drug increase the possibilty of abuse of any other drug. What is suprising here is that the cross tolerance effects of nicotine are the same as marijuana. We would not consider any alcoholic who smoked marijuana to truly be in recovery and this evidence suggests that the same is true for nicotine. I want to repeat this. The cross tolerence effects increasing alcohol relapse rates are the same whether one is smoking tobacco or marijuana! To me that is striking.

Thought for the day

If you smoke in early alcohol recovery it doesn't matter whether it is tobacco or marijuana that you smoke.

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