As Health and Social Care Select Committee take evidence, new study finds that 2 million people in England at risk of serious illness through alcohol and smoking

• New study finds 1 in 20 people in England smoke and drink at levels that pose a risk to health, increasing their chances of serious illness
• Since the Covid-19 pandemic smokers have been more likely to drink alcohol at levels that put them at risk of harm. Raising from 21% in 2019 to 30% by 2022.
• Half of people who both smoke and drink at risky levels report experiencing psychological distress in the last month and 45% have been diagnosed with a mental health condition
• More action is needed to prevent the joint harms from tobacco and alcohol

A new study published in the journal Addictive Behaviors has demonstrated the scale of people experiencing combined harms from alcohol and tobacco. The study, conducted by researchers at University College London, the University of Bristol and King’s College London in collaboration with Action on Smoking and Health, surveyed over 150,000 adults in England between March 2014 and March 2022.

This comes as the Health and Social Care Select Committee takes evidence on tobacco and alcohol harms on Tuesday 6th February.

The study demonstrated that the proportion of smokers that also drink at levels which increase their risk of harm to their health (i.e., through development of cancer, liver disease and cardiovascular disease) increased during the pandemic and has remained high since. People were defined as drinking at risky levels if there was a significant risk of harm to their physical or mental health and if their drinking may have negative social and financial consequences.

People who smoke and drink at these levels also have higher rates of mental ill health compared with those who do not.

The study authors call on the Health Select Committee to explore the level of targeted support to help this group with their smoking, drinking and mental health and the ways in which harms can be prevented through coherent approaches to reducing the harms from smoking and alcohol on society.

Hazel Cheeseman, Deputy Chief Executive at ASH and one of the report’s authors, said:

“Smoking steals on average 10 years of life. When people who smoke also drink over recommended limits, not only does it make it harder to stop smoking, but also increases the risk of ill health and premature death for smokers. Failure to act on alcohol risks slowing progress on smoking. We are providing this evidence to the Health Select Committee to highlight the overlap between these two risky behaviours, and the need to address them together rather than separately.”

In the evidence session Hazel also raised concerns that the lessons from tobacco control on protecting health policy from industry influence are not lost for alcohol: “only by keeping them at arms length have we seen progress.” [https://x.com/InstAlcStud/status/1754851864560976261?s=20]

Professor Sir Ian Gilmore, Chair of the Alcohol Health Alliance, added:

“This study shows a worrying trend towards increased alcohol use amongst people who already smoke. Alcohol is harmful to both physical and mental health and smoking multiplies the risks. Government should learn lessons from successes in tobacco control to reduce harms from alcohol, including introducing an evidence-based strategy that tackles price, promotion and availability, and ensures adequate funding for treatment services.”

Dr Claire Garnett, Research Fellow and lead study author said:

“This study found that those people who both drink at increasing-and-higher-risk levels and smoke have higher rates of psychological distress and mental health conditions. Given the multiplicative effect that this group will experience from both behaviours on their risk of cancer, it is important to focus on this group and provide targeted support to help them reduce their harm from both alcohol and tobacco.”

Smoking and drinking alcohol at harmful levels multiplies the health risks from both products and drinking alcohol can make it harder to quit smoking. The added complications of high rates of poorer mental health means that quitting smoking may not be prioritised either by the individual or health care practitioners, and this is concerning.

Health organisations are calling for policy action to reduce harm from smoking and alcohol.

Key findings

• Between April 2020 and March 2022 an average of 4.6% of people both smoked and drunk alcohol at risky levels. This equates to around 2 million people in England alone.
• People who smoked and drank at risky levels were less likely to be trying to cut down on their drinking or smoking.
• A quarter (27.2%) of at risk drinkers smoked in 2022.
• Nearly 1 in 3 smokers (30.3%) drank at risky levels in 2022.
• Rates of risky drinking among smokers increased at the start of the Covid-19 pandemic in 2020 and has remained high since
• People who combined smoking and at risk drinking, compared with those who did neither, were more likely to be younger, male, white and have a higher level of education
• People who combined smoking and risky drinking, compared with adults who did neither, were also more likely to have experienced psychological distress in the past month (49%) and been diagnosed with a mental health condition since the age of 16 (45%)
  

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