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Do Drinking and Smoking Hurt Your Mental Health?

You may have heard that drinking and smoking are likely to go together. But, is the use of cigarettes and alcohol linked to your mental health? Alcohol and tobacco have their own impact on mental health when used separately and can have interactions with one another used taken simultaneously.

How Is Alcohol Use Linked to Mental Health?

Most studies on the connection between alcohol use and mental health focus on “problematic drinking that causes clinical impairment and distress.”1  This is the definition of alcohol use disorder (AUD), the name mental health professionals use to describe the behaviors and symptoms commonly called “alcoholism” or “alcohol addiction.”

Studies show many people in treatment for alcohol use disorder also have mood disturbances and secondary mental health conditions. One study found that 80% of patients in treatment for AUD reported a mood problem with one of the following features:2

There is some discussion about whether alcohol use leads to your mental health issues or if it is the other way around—mental health issues cause your AUD.

If you have AUD and try to stop drinking, you will likely experience negative psychological effects as symptoms of alcohol withdrawal. Anxiety and depression are sometimes made worse by alcohol use, with about 1/4 of people who recently detoxed from alcohol experiencing some form of depression.3

The opposite can also be true that your mental health issues lead to AUD. You might drink alcohol as a way of “self-medicating,” or alleviating your mental health symptoms. Drinking alcohol releases dopamine in your brain, providing a euphoric and relaxing feeling, which masks the symptoms of depression and anxiety.

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How Are Drinking and Smoking Linked?

Cigarettes and alcohol are two of the most commonly used substances, and they are often used simultaneously. The reasons for this are varied:4

  • Both substances are legal
  • Alcohol and nicotine are easy to access
  • Drinking alcohol can increase the pleasant effects of nicotine, like feelings of calm
  • Both substances activate the reward center of your brain, which can encourage a repeating pattern of drinking and smoking

Studies show that if you use alcohol or tobacco, you are more likely to use the other. According to research:4

  • If you have five or more drinks per week, you are 2.4 times more likely to smoke than someone who has five drinks or fewer per year.
  • If you smoke, you are 3 times more likely to drink excessively than a nonsmoker.
  • If you quit smoking, you are five times more likely to relapse in tobacco use during a drinking episode.
  • If you drink and smoke, you have a higher risk of heart, liver, and lung disease than someone who only smokes or only drinks.

You may also notice that if you develop a habit of smoking and drinking simultaneously, your brain associates the two substances and expects the effects of both in the future. When you drink, your brain will send craving signals for nicotine as well, and the other way around. Your body is learning to associate the two and want them simultaneously.

What Are the Reasons for Drinking and Smoking?

It is not clear what causes drinking and smoking to occur simultaneously for so many people, but some studies have given insight into factors that raise your risk of using both substances. Some of those risk factors include:5

  • Life stressors such as losing a job or loved one
  • Lack of social support
  • Underdevelopment of other coping skills
  • Underlying mental health conditions, such as clinical depression or an anxiety disorder
  • History of substance misuse or relapse with either substance
  • Family history of drinking and/or smoking

Addictive Nature of Alcohol and Nicotine

Both nicotine and alcohol are highly addictive substances. This is because both substances activate the same reward center of your brain. Nerve cells in your brain release dopamine in the nucleus accumbens and prefrontal cortex when you drink alcohol and when you use nicotine.5

The release of dopamine produces feelings of euphoria and relaxation. When this activation is triggered by substances, it is more intense than natural sources of dopamine, such as food you enjoy. Your brain releases dopamine with each puff on a cigarette, potentially releasing large amounts of dopamine multiple times a day depending on how much you smoke. Your brain chemistry adjusts to expect and crave the intense “high” that happens when massive amounts of neurochemicals are released due to cigarettes and alcohol.

Stopping your use of alcohol and nicotine is also difficult because both substances will cause withdrawal symptoms when you stop using them.

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Types of Tobacco Use

It is not just the act of smoking that is linked to alcohol use but also the use of tobacco and nicotine in general. Some of the smokeless versions of tobacco include:

  • Vaping or e-cigarettes
  • Chew
  • Snuff
  • Dip

Not only is smoking linked to alcohol use, but another study showed that snuff users reported regularly using alcohol to the point of inebriation at an earlier age than smokers and those who never used tobacco.6

This further corroborates the idea that the substances of nicotine and alcohol share a connection beyond just the actions of smoking and drinking.

How Do Drinking and Smoking Impact Mental Health?

If you drink alcohol and use nicotine, you raise your risk of also developing or worsening mental health issues.

Individuals with mental health conditions consume 38% of all alcohol and 40% of all cigarettes in the United States. Even passive or second-hand smoke, when combined with alcohol consumption, is associated with psychological distress.7

Nicotine and alcohol use are often used to alleviate negative mental health symptoms such as:3

  • Depression
  • Stress
  • Anxiety
  • Sadness
  • Anger

Additionally, nicotine users report using it to improve:3

  • Attention
  • Ability to learn
  • Reaction time
  • Problem-solving skills

Even though drinking and smoking provide temporary relief of some mental health symptoms, both substances are associated with worsening symptoms after the “crash” and increasing symptoms intensity over time. Alcohol and nicotine also affect the effectiveness of any mental health treatment you may be receiving.

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What Are the Mental Health Risks of Drinking and Smoking?

You may already be familiar with some of the health risks involved with drinking and smoking such as cancer, cardiovascular damage, and liver disease.

Long-Term Risks

There are also many long-term risks to your mental health when you drink alcohol and use nicotine, such as:2

  • Depression
  • Anxiety
  • Disrupted hormone production
  • Problems with emotion regulation
  • Memory issues, including the potential development of dementia
  • Psychosis, or experiencing detachment from reality
  • Antisocial behavior

Withdrawal-Related Risks

If you try to quit drinking or smoking, you may also experience withdrawal symptoms that impact your mental health. These include:8,9

  • Irritability
  • Agitation
  • Feeling jumpy and restless
  • Difficulty concentrating
  • Sadness
  • Anxiety or nervousness
  • Depression
  • Fatigue
  • Mood swings
  • Nightmares
  • Not thinking clearly
  • Difficulty sleeping
  • Hallucinations, or seeing, hearing, or feeling things that aren’t there
  • Severe confusion

Stopping your use of alcohol and nicotine can be difficult because of this impact on your mental health. If you want to quit drinking and/or smoking, you can reach out to medical professionals that create treatment plans to help you manage your mental health during the recovery process.

If you or someone you know struggles with alcohol misuse, please call 800-839-1686Who Answers? to speak to a specialist about addiction treatment options, including medically assisted detox to minimize withdrawal complications.


  1. National Library of Medicine. (2022, February 03). Alcohol Use Disorder (AUD). U.S. Department of Health and Human Services National Institutes of Health.
  2. Shivani, R., Goldsmith, R.J., & Anthenelli, R.M. (2002). Alcoholism and Psychiatric DisordersAlcohol Research & Health, 26(2), 90-98.
  3. Crocq M. A. (2003). Alcohol, nicotine, caffeine, and mental disordersDialogues in clinical neuroscience5(2), 175–185
  4. Rose, J.E., Brauer, L.H., Behm, F.M., Cramblett, M., Calkins, K., & Lawhon, D. (2004). Psychopharmacological interactions between nicotine and ethanolNicotine & Tobacco Research, 6(1), 133–144.
  5. Drobes, D.J. (2002). Concurrent Alcohol and Tobacco Dependence. National Institutes of Health.
  6. Rauwolf, K.K., Berglund, K.J., Berggren, U., Balldin, J., & Fahlke, C. (2017). Influence of Smoking and Smokeless Tobacco on the Progression, Severity and Treatment Outcome in Alcohol-Dependent IndividualsAlcohol and Alcoholism, 52(4), 477–482.
  7. Mirbaba, M. (2017, April 26). Heavy-Drinking Smokers: Pathophysiology and Pharmacologic Treatment Options | American Journal of Psychiatry Residents’ Journal (psychiatryonline.org)American Journal of Psychiatry, 11(6), 8-11.
  8. Centers for Disease Control and Prevention. (2021, December 3). Tobacco Use and Quitting Among Individuals With Behavioral Health Conditions. United States Department of Health and Human Services.
  9. National Library of Medicine. (2021, January 17). Alcohol withdrawal: MedlinePlus Medical Encyclopedia. U.S. Department of Health and Human Services National Institutes of Health.

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