Moderate Alcohol Consumption Predicts Tobacco Use And Illicit Drug Abuse: Implications For Health Screening

Abstract

The health and harm of alcohol consumption has been long debated. In recent decades, multiple epidemiological analyses have demonstrated a strong correlation between moderate consumption and a reduced risk of myocardial infarction, peripheral vascular disease, and ischemic stroke. While moderation may confer a cardiovascular protective effect, the same cannot be said of alcohol abuse, cigarette smoking, and illicit drug use. PURPOSE: To test the predictive power of moderate alcohol use on alcohol abuse and the use of cigarettes and illicit drugs. METHODS: We analyzed the registry of a U.S. hospital in an urban-suburban setting, consisting of 2,306 patients admitted over a 5-year period. At intake, demographic and health data were recorded, including alcohol, tobacco, and illicit drug use, and previous histories thereof. Blood alcohol content (BAC) and toxicology screens were administered to patients suspected of current alcohol or drug use. Logistic regressions tested the effects of alcohol consumption on alcohol abuse, smoking status, and use of illicit drugs. RESULTS: Patients were 52.1 ± 22.4 years of age, 56.0% were men, 11.8% were currently using alcohol (BAC of 0.05 ± 0.10), 5.7% had a history of alcohol abuse, 25.8% reported regular smoking, 5.0% had a history of illicit drug use, and 27.1% had a positive toxicology screen. Holding potential confounders constant, logistic regression found current alcohol use to predict a 13.5-fold increase in the odds of alcohol abuse (p < 0.001; 95% CI of odds ratio: 8.96 to 20.27), a 213% increase in the odds of smoking (p < 0.001; 95% CI of odds ratio: 1.63 to 2.79), and a 209% increase in the odds of illicit drug use (p < 0.001; 95% CI of odds ratio: 1.34 to 3.27). A history of alcohol abuse predicted a 428% increase in the odds of smoking (p < 0.001; 95% CI of odds ratio: 2.95 to 6.22) and a 783% increase in the odds of illicit drug use (p < 0.001; 95% CI of odds ratio: 4.82 to 12.72). CONCLUSIONS: While some cardiovascular benefits correlate with moderate alcohol consumption, there may be a paradoxical effect whereby its association with high-risk behaviors (i.e., smoking and illicit drug use) leads to health detriments in a large subset of drinkers. Accordingly, it might be prudent to consider more than cigarette exposure in pre-exercise health screening practices.