Coffee and cigarette consumption are high among AA attendees

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* Most AA members drink coffee for its stimulatory effects; more than half smoke to reduce feelings of depression, anxiety and irritability.

More than one million Americans currently participate in the Alcoholics Anonymous (AA) program. While AA participants are reportedly notorious for their coffee drinking and cigarette smoking, very little research has quantified their consumption of these two products. Recent findings confirm that coffee and cigarette use among this population is greater than among the general U.S. population: most AA members drink coffee and more than half smoke.

Results will be published in the October issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Drinking coffee and smoking cigarettes are part of the culture of AA, but we knew little about the degree to which this occurred, how much more prevalent these behaviors were compared to the general American population, or why AA participants actually drank coffee or smoked cigarettes," said Peter R. Martin, professor of psychiatry and pharmacology, director of the Vanderbilt Addiction Center at the Vanderbilt University School of Medicine, and corresponding author for the study.

Martin added that many questions remain about the effects of coffee and cigarettes on recovering alcoholics. "What do cigarettes or coffee do for them; how do they believe that they are affected by smoking and drinking coffee?," he asked. "Is this behavior simply a way to bond or connect in AA meetings, analogous to the peace pipe among North American Indians, or do constituents of these natural compounds result in pharmacological actions that affect the brain? Perhaps most interesting, how do these consummatory behaviors affect the brain and what is their role in recovery?"

While the most common cause of death in long-term recovering alcoholics is related to the health consequences of cigarette smoking, Martin noted, recent epidemiological studies have shown that coffee consumption is not harmful to health and may, in fact, reduce the risk of death from suicide, certain cancers, and other diseases.

While that may be true, noted Robert Swift, professor of psychiatry and human behavior at Brown University Medical School, little is known about coffee's role vis-à-vis abstinence, whether drinking coffee makes it easier or harder to stay sober. "It's possible that coffee is even a gateway drug, with coffee drinking beginning at about the time persons begin using alcohol. In addition, a potential negative interaction is coffee's known negative effects on sleep. Many alcoholics in long-term recovery frequently have trouble with sleep, and coffee consumption could make sleep problems worse."

A strength of this study, Swift added, is that relatively little is known about AA, why some persons are helped by it while others are not. "The authors have been successful in gaining the confidence of AA groups and incorporating them into a research study," he said.

Martin and his colleagues asked participants (n=289) in all open AA meetings during the summer of 2007 in Nashville, TN to self-report a variety of information: a "timeline followback" for coffee, cigarette and alcohol consumption, the AA Affiliation Scale, coffee consumption and effects questions, the Fagerstrom Test for Nicotine Dependence, and the Smoking Effects Questionnaire.

"The most important finding was that not all recovering alcoholics smoke cigarettes while almost all drink coffee," said Martin.

More specifically, most individuals (88.5%) consumed coffee and approximately 33 percent drank more than four cups per day. The most common self-reported reasons were because of coffee's stimulatory effects: feeling better, better concentration, greater alertness. More than half of the respondents (56.9%) smoked cigarettes; of those, 78.7 percent smoked at least half a pack per day, and more than 60 percent were considered highly or very highly dependent. The most common self-reported reasons were because of smoking's reduction of "negative affect," which refers to depression, anxiety and irritability. "Many of these negative affective states are described by patients as contributors or triggers to relapse after periods of sobriety," said Martin.

"I think that it is important for alcohol researchers and clinicians to know that alcoholics, even those who do not use other illicit drugs, are not just addicted to alcohol, but use other psychotropic drugs like caffeine and nicotine," said Swift. "I found it interesting that coffee contains a lot of psychoactive substances, in addition to caffeine. A second important aspect is the finding that rates of smoking are much higher in alcoholics in recovery than in the general population. Smoking kills and is at least as harmful for alcoholics as is alcohol. Yet, AA tolerates or otherwise does not address smoking in its members."

"Yet, if coffee is beneficial and cigarettes are harmful to health, AA members seem to be going in the right direction by reducing smoking and perhaps increasing their coffee drinking," observed Martin. "We are now working on more detailed analyses of results to examine whether these changes in coffee and cigarette use are predictive of recovery from alcoholism per se."

Alcoholism: Clinical & Experimental Research