Role of smoking status on motivation to reduce or stop alcohol consumption in patients with an alcohol use disorder admitted to an emergency department.

Abstract

Objective: To examine the role of smoking status on motivation to reduce alcohol consumption in patients admitted to the emergency department (ED) with alcohol use disorder (AUD).

Methods: A standardized questionnaire was administered to patients admitted to the ED of the Hôpital Européen Georges-Pompidou (Paris, France), whatever the cause of admission, as part of an AUD screening, brief intervention, and referral to treatment (SBIRT) program. The questionnaire collected demographic, cognitive impairment assessment variables including school curriculum difficulties and medical characteristics, smoking status, cannabis use and the Fast Alcohol Consumption Evaluation (FACE) for AUD risk assessment. Patients aged 18-90years with a FACE score≥4 for women and≥5 for men were selected. An analogue scale from 0 to 10 was used to assess motivation, estimation of the right time, and self-confidence to reduce or stop alcohol consumption.

Results: Of the 3903 patients included between 2021 and 2023, 803 (21%) presented with TUA, with 72% excessive drinkers and 28% with a probable alcohol dependence. The study population was predominantly male (n=418, 52%). Current smokers accounted for 43% of patients (n=343), and only 8% (n=27) wished to obtain the contact details of the national quitline Tabac-Info-Service, a percentage twice as high as that observed among smokers at low or no risk of AUD. The average age was 48.7years (SD: 21.6), and smokers had a lower average age than the average for all participants (41years, SD: 17.4). On the other hand, former smokers were older on average (58.3years, SD: 20.6). In all, 36% (n=209) of patients with excessive alcohol consumption were smokers while 59% (n=134) of those with probable alcohol dependence were smokers. In terms of school curriculum, 13% (n=108) had experienced learning difficulties (50% of whom were smokers), 42% (n=339) had repeated a year (44% of whom were smokers), and 18% (n=146) had been suspended or excluded from school (53% of whom were smokers). In terms of neurological history, 35% (n=278) had suffered from memory loss and 19% (n=156) from fainting (42%, 53% of whom were smokers respectively). Less than 10% reported epilepsy episodes (8.7%: n=70) or neurodevelopmental disorders (6.4%: n=51). Among them, 54% and 61% respectively were smokers. Past-month cannabis use concerned 14% of patients (n=112), 85% of whom declared they smoked. In the descriptive analyses, more smokers than non-smokers felt that their admission to ED motivated them to reduce or stop their alcohol consumption, considered that it was the right time to do so, and declared a higher level of self-confidence in achieving this objective. In bivariate analyses, motivation and the right time to reduce or stop drinking were significantly associated with being a smoker, but these results were not found in the multivariate analysis.

Conclusion: These results suggest that smoking status does not intervene in motivation to change drinking behaviors following a SBI for AUD risk in patients screened with AUD in the ED. These results support the idea that smoking cessation recommendations can be systematized for all patients visiting the ED, without compromising their motivation to decrease or stop their alcohol consumption.