The lack of smoking cessation support in alcohol dependence treatment has also been attributed to a fear of jeopardising alcohol treatment outcomes, a high prevalence of smoking among treatment staff, and a lack of demonstrated treatment efficacy in this population.7 It is also commonly reported that health professionals believe people with competing substance dependencies lack the motivation to quit and that quitting will exacerbate use of other substances.6 This not only risks maintaining health inequalities, but it contradicts the advice from several leading health agencies (e.g. Public Health England, US Preventive Services Task Force, and Health Canada) that support should be offered to all smokers, including those from groups with a historically high smoking prevalence rate. There are also a number of advantages of addressing smoking and alcohol dependence simultaneously, such as approaching people when they are open to change (teachable moments), or using relapse prevention skills learned to manage both alcohol and smoking craving.7 Furthermore, people who drink alcohol and smoke cigarettes often engage in these behaviours at the same time and laboratory findings suggest that both alcohol and smoking cues can elicit cravings and consumption of the other drug.17
