Temporal sequence of incident cigarette, coffee, and alcohol use among AA participants

Abstract

Background: Cigarettes and coffee are widely used psychoactive substances among alcoholics. Due to the devastating public health impact of alcohol use disorders, it is important to determine if using cigarettes or coffee may influence alcoholism. Previous studies indicate that cigarette smoking is associated with progression of alcohol dependence, but the effects of coffee drinking have yet to be investigated. Objectives: To retrospectively determine the temporal sequence of incident cigarette, coffee, and alcohol use and attributed subjective effects in AA participants. Methods: Volunteers at all Nashville open-AA meetings (n = 289 [126 women], completion rate = 94.1%) were administered a Lifetime Drinking History modified to also include lifetime cigarette and coffee consumption, as well as coffee consumption and effects questions, the Fagerstrom Test for Nicotine Dependence, and the Smoking Effects Questionnaire. Results: Average ages (years) at first regular use of alcohol, cigarettes, and coffee were 15.4 (IQR: 13.0–18.0), 16.7 (IQR: 13.0–18.5), and 18.5 (IQR: 14.0–23.5), respectively. In a subset who used all three substances (n = 236;102 women) alcohol consumption preceded cigarette smoking (p < .001) and coffee drinking (p < .001), and cigarette smoking preceded coffee drinking (p < .001); these relationships did not differ by gender. Conclusions: Recovering alcoholics started regular alcohol consumption prior to cigarette smoking and coffee drinking. Scientific Significance: In AA participants, coffee does not precede initiation of regular smoking or alcohol drinking as might be anticipated for a gateway drug.

• alcohol
• Alcoholics Anonymous
• cigarette
• coffee
• gateway drug

ACKNOWLEDGEMENTS

This study was supported by NIDA (R01 DA015713 and T32 DA021123) and NIAAA (R01 AA014969) grants to PRM. We would like to recognize Darcy Roberto Lima, M.D., Ph.D., for prompting our interest in the health benefits of coffee, Tomas de Paulis, Ph.D., and Adriana Farah, Ph.D., for providing the basic chemical and pharmacologic substrates of this research, A.J. Reid Finlayson, M.D., and Edward F. Fischer, Ph.D., for contributing to our insight into Alcoholics Anonymous (AA) demographics and culture, and Nashville's AA members for supporting this research and contributing to advancing our understanding of alcoholism.

Declaration of Interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.