E-cigarettes connected to problematic drinking, study finds

The authors of the new study, from Indiana University-Purdue University Indianapolis in the United States, say it's crucial to consider the knock-on effects of e-cigarette use when evaluating their safety, not just their direct health effects.

Electronic cigarettes, or e-cigarettes, were developed to mimic real cigarettes, giving users the same look, feel and experience as smoking a cigarette. They are widely promoted as a 'healthy' alternative to smoking and as support devices for smoking cessation. More than 6% of the general population -- and 17% of people with addictions -- use e-cigarettes.

Because of the rapid increase in their use, research has focused on their health effects. However, the new study looks at one of the secondary effects of e-cigarette use and suggests that people need to be aware of the link between e-cigarette use and problematic drinking.

"This area of research is extremely important and I don't want it to get pushed to the side," said Alexandra Hershberger, lead author of the study from Indiana University-Purdue University Indianapolis in the United States. "Establishing the direct health effects of e-cigarette use is important but it's vital to look at the secondary effects too."

Previous studies have revealed a strong link between cigarette smoking and drinking, so the researchers hypothesized that a similar connection may be found with e-cigarette use and drinking. They surveyed two groups of people who drink alcohol using a modified version of the Nicotine and Other Substance Interaction Expectancy Questionnaire (NOSIE) to find out whether people expected to use e-cigarettes and alcohol together.

In both groups, of 692 and 714 people, the survey revealed that drinking alcohol leads to e-cigarette use and vice versa. E-cigarette users were significantly more likely to drink problematically than non-users in both groups. What's more, people who expected to use e-cigarettes and alcohol together reported drinking more.

The results suggest that using e-cigarettes to quit smoking could mean people miss out on the benefits of quitting; smoking cessation generally results in people drinking less alcohol, but using e-cigarettes means this decrease may not happen.

"If you quit smoking cold turkey, it affects other behaviors associated with smoking, such as drinking," said Alexandra. "By replacing smoking with e-cigarette use, it could be that you're at risk of continuing behaviors you don't want to continue. This is particularly serious for people with alcohol addiction -- using e-cigarettes could make it harder to stop drinking."

The study also revealed that more women use e-cigarettes socially than men. In general, men report more risk-taking behaviors than women, including smoking, drinking and drug use. The findings suggest that women may not perceive e-cigarette use as risky.

"We were surprised to see higher e-cigarette use in women," said Alexandra. "Generally men tend to report more risk-taking across the board, but in our study, women outnumbered men in terms of e-cigarette use. This could be because women perceive the device differently to other risk-taking behavior; e-cigarettes tend to be viewed more positively than cigarettes. Those views could be driving more use in women than we'd expect."