There is strong evidence indicating that tobacco use and heavy drinking frequently co-occur. Smokers are more than three times as likely as non-smokers to meet criteria for alcohol abuse or dependence (i.e., an alcohol use disorder, AUD) (McKee et al, 2007), and approximately 35% of individuals with an AUD are nicotine dependent (Grant et al., 2004a,b). Alcohol consumption is strongly associated with increased rates of smoking (McKee et al, 2006) and conversely, smoking increases alcohol consumption (Barrett et al., 2006). High comorbidity is particularly alarming given evidence that heavy alcohol consumption and smoking are leading causes of disease and death (Centers for Disease Control and Prevention [CDC], 2008; Meister et al., 2000; Mokdad et al., 2004), and the relative morbidity and mortality increases with combined versus singular abuse of alcohol and tobacco (Blot et al, 1988; Klatsky and Armstrong, 1992; Marrero et al., 2005; Pelucchi et al., 2007; Rosengren et al., 1988; Vaillant et al., 1991).
