Heavy-Drinking Smokers' Treatment Needs and Preferences: A Mixed-Methods Study

•Heavy-drinking smokers are more motivated to change their smoking than drinking.•Heavy-drinking smokers perceive that drinking increases their smoking.•Many heavy-drinking smokers prefer treatment for both to be integrated.•Heavy-drinking smokers prefer personalized feedback about smoking and drinking health effects.

The purpose of this mixed methods study was to describe the smoking and psychological characteristics of heavy-drinking smokers, their perceptions of smoking and drinking, and their smoking and alcohol treatment preferences to inform an integrated smoking and alcohol intervention. Heavy-drinking smokers (N = 26) completed standardized surveys and participated in semi-structured focus group interviews. Participants reported a strong association between their smoking and drinking. Participants were more motivated to quit smoking than to reduce their drinking but perceived greater barriers to smoking cessation. Stress/negative affect was closely linked with both behaviors. They expressed overall enthusiasm for a smoking and alcohol intervention but had specific format and content preferences. Half preferred an integrated treatment format whereas others preferred a sequential treatment model. The most preferred content included personalized health feedback and a way to monitor health gains after behavior changes.