Female smokers have the highest alcohol craving in a residential alcoholism treatment cohort

• Alcohol craving is a relevant clinical variable associated with subsequent alcohol relapse.
• Smoking alcoholic women have higher alcohol craving than smoking alcoholic men and nonsmoking alcoholics of both sexes.
• Smoking status by gender and smoking cessation treatment were not associated with alcohol relapse at 12-month follow-up.
• After controlling for confounders, only the Penn Alcohol Craving Scale at admission was associated with alcohol abstinence at 12-month follow-up.

BackgroundCigarette smoking among female and male alcoholics has not been extensively studied as a factor related to intensity of alcohol craving during residential treatment and corresponding sobriety length.MethodsThis retrospective cohort study assessed self-reported sobriety outcomes in patients with alcohol dependence at 3-month intervals over 12 months after completion of a 30-day residential treatment program. Demographic and clinical variables were collected including smoking status, alcohol craving utilizing the Penn Alcohol Craving Scale (PACS), and alcohol relapse. Statistical analyses included Chi-square, ANOVA, Tukey's test, Kaplan–Meier plots and Cox proportional hazards models as appropriate.ResultsOf the 761 alcohol-dependent study subjects, 355 (47%) were current smokers. Alcohol craving intensity was higher in smoking females compared to nonsmoking females (p = 0.0096), smoking males (p < 0.0001), and nonsmoking males (p < 0.0001). Smoking status-by-sex interaction was not associated with post-treatment relapse. After controlling for other variables, higher PACS scores at admission were associated with higher probability of relapse (p = 0.0003).ConclusionsIn this study, female alcoholic smokers experienced the highest level of alcohol craving in an alcohol treatment setting. Interestingly, this did not translate into higher rates of post-treatment relapse. Further research is warranted to explore the neurobiological basis for sex differences in this highly prevalent comorbidity.