Intensity of symptoms from alcohol withdrawal in alcohol-dependent patients: comparison between smokers and non-smokers

In patients with a dual dependence on alcohol and tobacco, the spontaneous discourse among doctors is not to encourage them to consider preparing to give up both substances. The argument put forward is that withdrawal would be more difficult. We wanted to compare the intensity of withdrawal symptoms in patients hospitalised for alcohol detoxification between smokers and non-smokers.

We compared patients hospitalised for alcohol detoxification who smoke versus non-smokers who received replacement therapy through benzodiazepines and not nicotine replacement. The blood pressure and the cardiac frequency measure on the first day of hospitalisation, the doses of Diazepam dispensed on the first day, and the Clinical Institute Withdrawal Assessment of Alcohol Scale Revised (CIWA-Ar) score on the second day were compared.

A trend emerged whereby smoking patients undergoing alcohol detoxification showed higher blood pressure, higher cardiac frequency and required higher doses of benzodiazepines on the first day of hospitalisation. Patients who smoke also had higher CIWA-Ar scores on the second day of hospitalisation.

From a physiological point of view, the intensity of the symptoms of alcoholic withdrawal seems to be greater in hospitalised patients who smoke vs. non-smokers in the first two days. Does giving up both substances at the same time result in fewer withdrawal symptoms? And in this case, should a double replacement be recommended: benzodiazepines and nicotine replacement therapy?

To be able to refine the recommendations on alcohol-tobacco dual withdrawal programmes, other studies are needed to compare giving up both substances with or without nicotine replacement.