You’re sitting at the bar with your friends, having a great time. A couple of cocktails in, someone pulls out a pack of cigarettes and offers you one. You take it, and light up. That’s what you always do.
But why?
It’s well-known that alcohol lowers people’s inhibitions, but it won’t make people do something they never would do, says Bill Blatt, national director of tobacco programs for the American Lung Association. If you’re already drinking, you might be more likely to reach for a cigarette instead of holding off. Like alcohol itself, cigarettes can be a social lubricant.
The American Lung Association notes there is a social component to cigarette addiction, one that goes hand-in-hand with the physical and mental aspects, Blatt explains.
But there are also more insidious factors at play. “People who have alcohol problems have much higher rates of smoking, probably around 40 percent,” Dr. Steve Schroeder, a professor in the department of medicine and director of the Smoking Cessation Leadership Center at the University of California–San Francisco, tells U.S. News in an email. “In addition, alcohol acts on brain receptors to increase the craving to smoke and decrease the time between cigarettes. It works the other way as well, as smoking increases the desire to drink … and leads to greater alcohol consumption.”

Some people are more likely to want to smoke when they’re drinking than others, says Dr. Maher Karam-Hage, a behavioral science professor and associate medical director of the tobacco treatment program at MD Anderson Cancer Center. That said, it’s unclear whoexactly is more vulnerable. Karam-Hage is involved in a study to determine if an on-the-market medication, topiramate, can help people quit smoking and drinking simultaneously.
“The leading causes of death in alcoholics are all smoking-related illnesses such as lung cancer, chronic lung disease, heart attacks and strokes,” Schroeder says. “Thus treatment strategies promoting abstinence from both alcohol and tobacco may be needed for the many dual users of those substances. Furthermore, nicotine may lessen the perception of intoxication, thereby leading to more alcohol consumption during heavy drinking episodes.”
He adds: “When you look at the numbers, it becomes obvious that there is a huge overlap between smoking and substance-use disorders, including alcoholism”
Though only 15 percent of U.S. adults smoked in the last month – what Schroeder calls a “modern low” – the epidemic is “now concentrated among the most vulnerable,” which includes alcohol and illicit drug users.