A study has found that one in 20 people in England smoke and drink at levels that pose a risk to health, increasing their chances of serious illness.

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

This comes as the Health and Social Care Select Committee took evidence on tobacco and alcohol harms on February 6, 2024.

The study demonstrated that the proportion of smokers who also drink at levels which increase their risk of harm to their health (i.e., through the 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.

Key findings

  • Between April 2020 and March 2022 an average of 4.6 per cent of people both smoked and drunk alcohol at risky levels. This equates to around 2m 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 per cent) of at-risk drinkers smoked in 2022.
  • Nearly one in three smokers (30.3 per cent) 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 per cent) and been diagnosed with a mental health condition since the age of 16 (45 per cent).

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 arm's length have we seen progress.”

Ian Gilmore, a professor and 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.”

Claire Garnett, a 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.”

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