Psychological distress, tobacco smoking and alcohol use: a population survey in Great Britain
Background: There is a bi-directional relationship between higher mental distress and increasing alcohol use. Simultaneously, mental distress and alcohol use are both independently exacerbated by tobacco smoking. This study provides an up-to-date population level analysis of how tobacco smoking and past 30-day mental distress are independently and in combination associated with alcohol use intensity, past attempts and motivation to restrict alcohol use in the future among adults from Great Britain.
Methods: Pooled data of adults (≥18+) in Great Britain (N=87326) collected monthly from April 2020 to June 2023 in 39 cross-sectional household survey waves from the Smoking and Alcohol Toolkit Study, a nationally representative phone survey. Participants’ alcohol use risk levels (Alcohol Use Disorder Identification test for consumption, AUDIT-C), attempts to restrict alcohol use in the past 12 months, and motivation to restrict alcohol use in the next 3 months were separately regressed on participants’ smoking status, past 30-day mental distress levels (Kessler Psychological Distress scale, K6), sex, age, socioeconomic status and geographic region in Great Britain using univariable and multivariable logistic regressions. Common reasons for restricting alcohol use were described.
Results: Smoking was associated with higher odds of using alcohol at increasing/high risk levels (aOR(former)=1.78, 95% CI: 1.70-1.87; aOR(current)=1.74, 95% CI: 1.64-1.85) but with lower odds of having tried to restrict alcohol use in the past 12 months (aOR(current)=0.50, 95% CI: 0.43-0.56). Experiencing moderate or serious distress levels in the past 30 days were associated with lower odds of using alcohol at increasing/high risk levels (aOR=0.87, 95% CI: 0.82-0.92 & aOR=0.76, 95% CI: 0.67-0.85, respectively) but with higher odds of having tried to restrict alcohol use in the past 12 months (aOR=1.62, 95% CI: 1.46-1.79 & aOR=1.67, 95% CI: 1.33-2.08) or intending to restrict alcohol use in the next 3 months (aOR=1.40, 95% CI: 1.20-1.63 & aOR=1.52, 95% CI: 1.10-2.08). Compared with never and former smoking, participants who were currently smoking showed higher odds of past attempts to restrict alcohol use and using alcohol at increasing/high risk levels with increasing mental distress levels. Weight loss (43.2%), improving fitness (43.1%) and concerns about future health (36.4) were most mentioned reasons for attempting to restrict alcohol use.
Conclusions: While smoking was associated with increased odds of using alcohol at higher risk levels, experiencing higher mental distress showed association with reduced odds of risky alcohol use. Attempts to restrict alcohol use in the past year were associated with higher mental distress, and this effect was most pronounced among people who currently smoke.
