Among 739 smokers in cessation trials, marijuana use had no association with quitting success, while alcohol use after quitting increased smoking urges through positive-reinforcement cravings.
Read this if you use marijuana and want to quit cigarettes and are wondering if you need to stop both.
Marijuana use: no effect on quitting cigarettes at any timepoint
What the researchers found
Researchers analyzed data from 739 adult cigarette smokers across three randomized cessation trials. Alcohol use after a quit attempt increased positive-reinforcement urges to smoke (the desire to smoke for pleasure), and these urges partially explained why drinkers were less likely to stay quit.
Marijuana use, however, was not associated with tobacco abstinence outcomes at any timepoint (weeks 12, 24, 36, or 52). This suggested that modifying marijuana use might not be critical to successful cigarette cessation.
Pretreatment alcohol use also predicted worse outcomes, but through a different mechanism than the positive-reinforcement urge pathway, indicating multiple routes by which alcohol undermines quit attempts.
Why it matters
Clinicians often advise patients to stop all substance use when quitting cigarettes. This study suggested marijuana use does not need to be addressed for tobacco cessation to succeed, while alcohol use is a clear risk factor that does need attention.
The numbers in context
739 participants across 3 trials. Follow-up: weeks 12, 24, 36, 52. Marijuana use: no association with abstinence at any timepoint. Alcohol after quitting: increased positive-reinforcement urge, which mediated reduced abstinence.
How the study worked
Secondary analysis of 739 participants from 3 randomized smoking cessation clinical trials. Alcohol and marijuana use assessed pre-treatment and post-cessation. Biochemically verified 7-day point-prevalence smoking abstinence at weeks 12, 24, 36, and 52. Mediation analysis tested urge pathways.
What this study cannot tell us
Secondary analysis of existing trial data. Marijuana use was likely underreported. The sample may have had low rates of heavy marijuana use. Self-reported marijuana use without biochemical verification.
How to read the evidence
Secondary analysis of three RCTs with good sample size and longitudinal follow-up. Strong for the alcohol finding; marijuana finding limited by potentially low use rates.
When this study was published
Published in 2012. The relationship between cannabis and tobacco use has been studied more as dual-use patterns evolved.
The bigger picture
The practical implication was that smoking cessation programs should focus on alcohol management but need not require marijuana cessation as a precondition. This is relevant for patients in medical marijuana programs who also want to quit tobacco.
Questions still open
- Would heavy marijuana users show different results? Does vaping marijuana (which involves hand-to-mouth behavior similar to cigarettes) have different effects on smoking cessation? Should cessation programs actively address alcohol use?
Common questions
Do I need to quit marijuana to quit cigarettes?
Why does alcohol make it harder to quit smoking?
Read the original research
Alcohol and marijuana use in the context of tobacco dependence treatment: impact on outcome and mediation of effect.
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 14(8), 942-51
Citation
Hendricks, Peter S; Delucchi, Kevin L; Humfleet, Gary L; Hall, Sharon M. (2012). Alcohol and marijuana use in the context of tobacco dependence treatment: impact on outcome and mediation of effect.. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 14(8), 942-51. https://doi.org/10.1093/ntr/ntr312
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