Heavy drinkers are four times more likely to smoke than the general population, according to a new study led by researchers at University College London.

The prevalence of smoking was found to increase in line with alcohol consumption, it found. The more a person drank, the more likely they smoked and the more cigarettes they were likely to smoke in a day.

Tobacco and alcohol are the two most commonly used substances in England. This study, published in The Lancet Regional Health – Europe, is the first to show how closely smoking and drinking habits are linked.

The researchers analysed survey data from 144,583 people in England from the Smoking and Alcohol Toolkit Study, a monthly population survey in England completed over seven years from 2014 to 2021. Participants were assessed as being at risk of alcohol dependence according to their responses to the Alcohol Use Disorders Identification Test (AUDIT).

Respondents who had the highest score in the alcohol dependency test had the highest smoking prevalence, with 76% being current smokers and 81% being past smokers. Over half of people at risk of becoming alcohol dependent were found to smoke, compared to 15% of the general population.

Senior author Dr Sharon Cox from UCL said: ‘When smokers are treated for a drug or alcohol dependency, their smoking habit is often overlooked, and they are more likely to miss out on support to quit. But smoking is no less dangerous to people who are using another substance. What’s more, there is often a strong behavioural connection – the smoking and drinking often happen in tandem – so it may be more effective to treat the two issues together.’

The researchers also found that smokers at risk of alcohol dependence smoked more, with nearly a third of people in this group smoking within five minutes of waking. Smokers at risk of alcohol dependence smoked 14 cigarettes a day on average, compared to 11.5 among non-drinkers and 10.9 among drinkers not at risk.

Lead author Dr Claire Garnett from UCL said: ‘To get close to a ‘smoke-free’ England in 2030, the Government needs to target groups where smoking is highly prevalent. Our study strongly suggests that those who are among the heaviest drinkers in England, who are at risk of becoming dependent on alcohol, should receive targeted smoking cessation support.’

The researchers also suggested that the Government should target heavy drinkers in their quest to achieve a ‘smoke-free’ Britain in 2030, defined as 5% or less adult smoking prevalence.

However, the recommendation comes after an official review concluded this month that the ‘smokefree 2030’ target could be missed by ‘decades’ if the Government does not take immediate action to boost NHS smoking cessation funding. 

And in May, a study undertaken by St Vincent's University Hospital in Dublin found levels of alcohol consumption that are generally considered safe by some countries can be linked to heart failure.