Alcohol and tobacco misuse: Reducing aerodigestive cancer risk

Abstract

Significant concerns over the health, social and economic burdens of the two most common, and frequently co-misused drugs of abuse, alcohol and tobacco, has encouraged focused but separate health promotion and disease prevention policies. However, this separation of focus means that while individuals who present with alcohol-related problems are increasingly supported to attain and maintain abstinence from alcohol they are not routinely assisted to refrain from smoking. This is tragically inopportune as alcohol and tobacco have an established “synergistic” effect on aerodigestive cancer risk. Moreover, even when patients successfully tackle their alcohol problems they remain at increased risk for developing these cancers, especially if they continue to smoke. A case series is presented together with a discussion on how service provision for co-misuse could be improved to obviate aerodigestive cancer risk. Given the prevalence of alcohol and tobacco use in the United Kingdom, these observations may have far reaching implications for the individual, health provider(s) and wider society.

Keywords: Tobacco; Alcohol; Substance misuse; Co-dependence; Behavioural control; Early intervention; Preventive therapy; Aerodigestive cancer; Mortality

Core tip: What is already known? Most people who drink heavily also smoke; alcohol and smoking synergistically increase aerodigestive cancer risk; people with alcohol problems and/or liver injury, are supported to attain and maintain abstinence, from alcohol but much less effort is employed to help them achieve smoking cessation. What is the key message? Patients who maintain abstinence from alcohol remain at risk for aerodigestive cancers for several years, especially if they continue to smoke. How might it impact on future clinical practice? Smoking behaviour should be addressed in co-dependent individuals if the health benefits of long-term abstinence from alcohol are to be maximized.