This chapter reviews the literature in relation to drinking and smoking behaviour. It also looks at the concurrent use of alcohol and tobacco within student life. For the purpose of this study the author had two research objectives, which were, to explore the reasons students consume alcohol and smoke tobacco and to investigate the relationship between both.
Numerous studies have shown an association between cigarette smoking and alcohol drinking. The National Institute of Health (2010) found that even small amounts of alcohol boost the pleasurable effects of nicotine, inducing people to smoke more when drinking alcoholic beverages. Medical profession have highlighted that the alcohol dose dependent effect increases the urge to smoke.
“Data from epidemiological studies have shown that people who drink alcohol are more likely to smoke and the heavier the drinking pattern, the heavier the smoking”. (King, 2005) (Page number)
Findings from Kings study (2005) indicate that smoking urge is higher after consuming four alcohol drinks in comparison to the lower urges after consuming two alcohol drinks, and increases were not observed after consuming a placebo beverage” In other words, “The greater the alcohol consumption, the greater the urge to smoke” (Page Number)
Research has indicated that links to alcohol addiction may be heredity. Findings from the Granada study believe that heredity may be responsible for almost 50% of the likelihood that a person will become addicted to alcohol. Alcoholism and Drug Addiction group whom carried out the study at the University of Granada revealed that the lack of beta-endorphins, which is hereditary, marks a genetic weakness to alcoholism.
The studies findings indicate that an individual’s brain with low beta-endorphin levels becomes accustomed to the presence of an external surplus, diminishing its own supply and triggering dependence on the external source -in this case, alcohol.
Beta-endorphin is a kind of “morphine” released by the brain in response to several situations, such as pain. In this way, beta-endorphins can be considered an “endogenous pain reliever” to numb or dull pains. According to José Rico Irles (Year and page number) head of research at the university, “although alcohol consumption does not affect all people in the same way, differences in beta-endorphin levels make some subjects more vulnerable to alcohol. Therefore, they are more likely to become alcohol dependent”.
1.2 Alcohol Behaviour
According to Alcohol Action Ireland (2010), over one in four accident and emergency cases have alcoholâ€‘related injuries. Alcohol is also a factor in one in four traumatic brain injuries. Research carried out by Alcohol Action Ireland found that alcohol related deaths increased between 1995 and 2004.
Ethanol (found in beer, wine and spirits) is the most commonly used alcohol consumed by humans. (International Centre for Alcohol Policies) According to Gossop two thirds of the US population drink alcohol. The average American spends more than 5% of their annual budget on alcohol, consuming 2.6 gallons of spirits, 2.2 gallons of wine, and 26.6 gallons of beer every year. Almost half of the UK’s population over the age of 16 drink alcohol. (Gossop, 2007).
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An Irish survey carried out by CLAN indicates high-risk alcohol use is prevalent among college students, to the extent that profound binge drinking is seen as the norm of college life. The results from this survey demonstrate that this drinking culture is promoted in college, often with heavy drinkers being praised as die-hard revellers instead of being critiqued. The CLAN goes on to state that Irish third-level students spend more money a month on alcohol than they do on food and it clarifies speculation that regular binge drinking can wreck havoc on academic performance, as well as on social relationships.
Controversially although Ireland has the highest rate of non-drinkers in Europe, (20%, in comparison to Germany’s 5%) it also has one of the highest rates of alcohol consumption, at present topping the poll for binge-drinking statistics. (Alcohol-statistics-in-europe.com)
According to Hope, Dring and Dring (2003) there were both positive and negative reasons as to why students drink. Positive reasons such as sociability relaxation and enjoyment occupy the dominant number of reasons people drink. One in four students reported having a drink with there meals, of which more females than males reported such a practice. However one in ten students used alcohol to forget worries and one in twenty used alcohol when they were anxious or depressed. More males than females said they drank just to be polite. Hope et al (2003)
1.3 Tobacco Behaviour
The World Health Organisation (2010) states that tobacco is one of the greatest causes of preventable and premature deaths in human history and that it kills up to half of its users. The annual death toll of more than five million could rise to more than eight million by 2030 unless urgent action is taken to control the tobacco epidemic. According to the WHO, smoking is estimated to be the cause of approximately 7000 deaths in Ireland each year, chiefly by illness such as lung cancer, heart disease, stroke and emphysema. Smoking can also cause gum disease, bad breath, poor skin and yellow teeth. (WHO, 2010)
According to Chick & Cantwell, (2001) evidence suggests that smoking is mainly initiated originally by teenagers. The onset is usually the result of one or many of the following factors; curiosity, assertion of independence, rebelliousness, stress, and perhaps more than any other factor by peer pressure (Chick & Cantwell, 2001).
The CLAN survey’s research findings show that everyone knows smoking is bad for your health, but there seems to be many harmful effects to which many smokers all around the world are still oblivious. For example; a survey in china found that only 68 percent of current smokers in China believe that smoking leads to lung cancer and only 36 percent believe that smoking causes coronary heart disease (Hope, et al. 2003).
Another survey carried out in Britain showed that a shocking 99% of woman surveyed were unaware of the direct link between smoking and cervical cancer. (Gossop, 2007)
1.4 Alcohol and tobacco go hand in hand
Mckee, Hinson, Rounsaville, Petrelli (2004) state that although research has shown that many young people dabble with substances such as alcohol and tobacco from as young as 13, substance use in relation to tobacco and alcohol has been reported to peak in early adulthood. The college years appear to be a time of increased risk for smoking initiation and movement into regular patterns of use. College smokers are more likely to be non-daily smokers, also known as party smokers. Alcohol and tobacco are known to be strongly related behaviours and the association between both substances seems to get stronger with the heavier use of either substances. Recent studies have found that smoking urges increase rapidly following heavy drinking, even among light smokers (King & Epstein, 2005)
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Nichter, Nicthter, Carkoglu and Lloyd-Richardson (2010) suggests that virtually every college event and social occasion revolves around drinking and there is a significant distinction between “party time” and “normal time”, According to Nichter, et al (2010) (page number) parties were viewed as places to “kick back, relax and chill and where everyday rules for behaviour didn’t apply”. The majority of party smokers believed that smoking while drinking was “not really smoking” and was therefore socially acceptable. This research highlights the commonality of smoking cigarettes as a behaviour that goes along with drinking. They found that some party smokers described drinking and smoking as “going together like peanut butter and jelly” or “like milk and cookies”.
Nitcher explains at college parties and particularly in your freshman years, focus is on creating an image, getting noticed and also trying to fit in and be cool. For college males, smoking while having a drink “helped a guy look really manly” and “gave off a bad boy image”. Among females there is a powerful focus on being liked and a need to engage in similar behaviours to ones friends (Nichter et al., 2010).
There are numerous functions of smoking and drinking described by Nitcher et al. (2010). One of which is Social Facilitation. A key reason for having a cigarette with a drink at parties is because smoking is usually done outside. Having a cigarette provides a reason to go outdoors with an individual or a group, therefore, the co-consumption of alcohol and tobacco aids social interaction. Alcohol diminishes ones level of willpower giving an individual the confidence to do things they would not normally do. The best crack at parties is usually outdoors so when individuals go outside to socialise with peers, instead of doing nothing, they are faced with the opportunity to “join in” with the rest of the crowd. Nichter et al. (2010) observed that when males were drinking with females it was sometimes difficult to maintain a conversation, but smoking a cigarette with a female, who was also smoking, seemed to smoothen out the conversation. One male interviewee noted:
“It’s just easier to talk when I’ve been drinking and smoking. A cigarette honestly just gives you a buzz and boosts your self confidence. It also gives you a minute to get your thoughts straight”.
Several party smokers described how “the urge to smoke just comes when drinking”. Nitcher et al. (2010) found that for novice smokers, after a couple of drinks, smoking cigarettes became physically easier to do. They tended to suffer less from throat irritation and coughed less. Drinking and smoking together also washed away the cigarettes bad taste. This research also found that another useful function of the concurrent use of alcohol and tobacco is the physical sensations experienced. Alcohol and smoking together create a “buzz” that is unattainable when either substance is taken separately. However, having a cigarette, while drinking, can also help an individual feel calmer, relaxed and more sober.
Research has shown that despite the amount of “social smoking” party smokers might be involved in most party smokers did not want to become “regular” or “real” smokers. In fact, they believed that they were at little risk of dependency upon alcohol and tobacco. As one woman in a focus group commented “People like me and my friends don’t get addicted to either substance” (Nichter et al., 2010) Given this naÃ¯ve belief among students, that they were not at risk for transitioning from social smoking to more regular patterns of use, it seems critical to educate students about the possibility of addiction, even if smoking at low levels.
The above research indicates that there is a correlation between student drinking and smoking and it would appear that alcohol consumption can often lead to students’ use of tobacco. This is a prevalent health concern which the proposed research aims to explore. Research availability concerning levels and concurrent use of alcohol and tobacco is limited in an Irish context. The proposed research aims to highlight this relationship and
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