Results from two pharmacotherapy trials show alcoholic smokers were more severely alcohol dependent but less prone to relapse than alcoholic non-smokers.

AIMS To assess the role of smoking on treatment outcome in quitting alcoholics on the background of the priming or coping hypothesis (Rohsenow et al., 1997). METHODS Data sets of placebo treated patients of the German phase III trial of naltrexone (Gastpar et al., 2002) and of acamprosate treated patients of a German phase IV trial Soyka et al., 2002) were reanalyzed. Differences between smoking and non-smoking alcoholics were evaluated using chi(2)-, t- or ANOVA-tests, relapse rates using survival techniques with Cox regression. RESULTS Smoking alcoholics differed significantly from non-smoking alcoholics regarding sociodemographic variables (e.g. more males, more often living alone) and severity indicators of alcoholism (e.g. quantity, onset, related problems). In the naltrexone study time to first relapse was significantly longer for smoking alcoholics compared to non-smoking alcoholics (hazard ratio = 2.26; P = 0.036). The same effect was seen in the acamprosate study (hazard ratio = 1.34; P = 0.015); estimated abstinence-rates after 24 weeks were 38% for smoking alcoholics compared to 28% for non-smoking alcoholics (P < 0.015). CONCLUSIONS Smoking was significantly associated with better outcome in recovering alcoholics included in two pharmacotherapy trials. Although the underlying mechanisms remain unclear our findings are in favour of the coping hypothesis. The results challenge the validity of the dependence syndrome.