Symposium 21 Tuesday Sept. 25th 9.00 am–10.30 am; Room: Lecture Hall 1
Alcohol and nicotine: Clinical and treatment issues: Chairpersons: Wiesbeck GA (Switzerland), Singer MV (Germany)
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Presentation S21-1
Alcohol and Nicotine: Synergistic mechanisms of organ damage and cancerogenesis
Pfuetzer RH (Germany)
Aims. Alcohol and nicotine are powerful environmental hazards that damage a variety of organs. Generally, when looking at alcohol and nicotine interaction, it is more focused on comorbid alcohol and nicotine dependence. However, coconsumption of both drugs may lead to aggravated organ damage and increased rate of cancer. Epidemiological data suggest that combined smoking and alcohol drinking either aggravate typical alcohol related diseases such as alcoholic liver disease and alcoholic chronic pancreatitis or accelerate the progression of the disease, thus providing evidence that the substances act synergistically. Similar data exist for several cancers, mainly cancer of the upper aerodigestive tract.
In vivo and in vitro experimental data provide insights into several potential mechanisms of organ damage. Generation of reactive oxygen species and oxidative stress, modulation of intracellular signalling and inflammatory response as well as apoptosis may comprise the main mechanisms by which alcohol and smoking damages target organs.
The synergistic role of alcohol and tobacco smoke exposure may be enhanced by a specific genetic background leading to accumulation of toxic metabolites and thereby increasing individual susceptibility to target organ damage through a variety of mechanisms. This includes known predisposing mutations as well as drug metabolizing genes and genes with rather broad functions.
Presentation S21-2
Treatment and management of alcohol- and nicotine-derived internal diseases
Siegmund SV (Germany)
Aims. Alcohol abuse and cigarette smoking are widely associated with each other. Both conditions may cause severe organ damage alone and potentiate each other in their deleterious effects on internal organs.
Methods. The oesophagus, stomach, pancreas and liver are primary target organs for ethanol-related diseases, while nicotine especially affects the cardiovascular system.
Chronic consumption of alcohol causes a significant increase in the risk for squamous carcinoma of the oesophagus, which is exacerbated by cigarette smoking. Similarly, smoking and drinking together may worsen chronic alcoholic pancreatitis.
Even for the development of liver disease or hepatocellular cancer induced by alcohol, smoking has been proved to be particularly detrimental.
Results. Established treatment options and management of alcohol- and nicotine-induced internal diseases primarily comprise lifestyle change, possibly assisted by psychotherapy aiming to achieve abstinence from both substances. Newer medications to facilitate abstinence, e.g. naltrexone and acamprosate, were effective in some chronic alcoholics, but no large multicenter studies have evaluated these medications in patients with nicotine- and alcohol-derived internal diseases. Moreover, in the case of alcoholic liver or pancreatic disease, treatment includes nutritional therapy, management of disease complications, and if necessary surgical treatment or liver transplantation in selected individuals. In Patients with cancer of internal organs induced by ethanol and cigarette smoking or nicotine-induced vascular diseases, subsequent abstinence from smoking and alcohol have also been shown to improve treatment outcome.
Conclusions. Future research needs to define the exact molecular mechanisms and the role of different genetic predispositions for alcohol- and nicotine-induced diseases to delineate new treatment options.
Presentation S21-3
The non-smoking alcoholic: a specific phenotype/genotype? ADHD and smoking in alcoholics
Wodarz N, Johann M (Germany)
Aims. Tobacco dependence is one of the most potent predictors of progression from first drink to alcohol-dependence. In line, only 20–30% of alcohol-dependent subjects are non-smokers. Therefore, we investigated whether non-smoking alcoholics exhibit a specific phenotype or genotype.
Methods. We investigated 1288 alcohol-dependent subjects consecutively admitted to an inpatient abstention program. All were Caucasian of German descent and met the ICD-10 and DSM-IV criteria of alcohol dependence. We analysed phenotypes according to onset, severity, family history and course of the alcohol-dependence considering attention-deficit hyperactivity disorder (ADHD) and antisocial personality disorder (ASPD) as additional variables.
Results. A comorbidity of alcohol and tobacco dependence was significantly associated with increased frequency of ADHD, ASPD, Cloninger type 2 alcoholism and a family history positive for alcohol and/or tobacco dependence. Comorbid subjects had a younger age at onset of alcohol dependence.
Moreover, there was a higher frequency of unemployment, criminal offences and suicidality. Associations to genetic variants at the monoaminergic system will be tested, as well as differences in relapse rates after one, two and five year follow-ups.
Conclusions. Alcohol-dependent subjects with tobacco dependence showed an increased frequency of more severe clinical phenotypes (i.e., Cloninger type 2 alcoholism) with ADHD and/or ASPD. Non-smoking individuals exhibited less aggressive and impulsive behaviours and late onset of alcohol dependence.
Presentation S21-4
Effects of smoking on abstinence duration in detoxified alcohol-dependent subjects
Mueller SE, Petitjean S, Wiesbeck GA (Switzerland)
Aims. Smoking rates among alcoholics range between 80 and 95 percent, which is three times higher than those observed in the general population. Alcohol dependent persons show a more severe dependence of nicotine and a lower ability for successful smoking cessation attempts. This marked coincidence of alcohol and tobacco dependence might be accomplished by similar neurobiolocial interactions of nicotine and alcohol on a variety of levels, namely molecular pharmacology, genetics, pharmacokinetics, functional interactions and conditioning. When focusing on the clinical implications, i.e. the effect of smoking in recovering alcoholics, only few studies addressed this issue.
Methods. To decrease this deficit we analysed data from a German multi-centre study on alcohol-dependence (Wiesbeck et al., 2001) under the aspect of smoking behaviour. To avoid any pharmaceutical interactions only participants of the placebo group were analysed and divided into 3 groups, namely non-smokers, moderate smokers (<20 cigarettes) and heavy smokers (>20 cigarettes). The main outcome variable was abstinence from alcohol observed consecutively over one year and corroborated through biological parameters. In addition, participants had the option to visit self-help groups.
Results. The duration of abstinence was analysed with the Kaplan-Meier survival analysis. Preliminary results showed no significant differences in duration of alcohol abstinence among the groups, though there was a trend that heavy smokers remained abstinent from alcohol for a longer period than moderate or non-smokers. Further subgroup analyses of these data are in progress.