Varenicline Reduces Smoking, May Reduce Alcohol Use, Among People With Alcohol Use Disorder Who Smoke

Varenicline is effective for tobacco cessation; some preliminary research suggests that it may help with alcohol use disorder as well. Two clinical trials addressed these questions. O’Malley et al randomized 131 people with DSM-IV alcohol dependence and smoking who were seeking treatment for alcohol use to varenicline or placebo and followed them for 16 weeks.

• The primary outcomes—percentage of heavy drinking days (PHDD) and no heavy drinking days (NHDD) during weeks 9–16—were not significantly different between the two groups.
• Varenicline did result in significantly greater abstinence from smoking during the last 28 days of treatment (13% versus 0%, respectively).
• In secondary analyses, varenicline was associated with a significantly greater decrease in PHDD among men, but not among women, in the study.

In the other trial, Hurt et al randomized 33 adults with DSM-IV alcohol abuse or dependence and smoking to varenicline or placebo for 12 weeks.

• Participants were primarily male, white, and middle-aged.
• Seven-day smoking abstinence was more common in the varenicline group at 12 weeks (44% versus 6% in the placebo group).
• Participants in the varenicline group reported 2.8 fewer drinks per drinking day on average at 12 weeks. There were no significant differences between groups in drinks per day, drinking days, or heavy drinking days.

Comments: These studies suggest that varenicline is effective for tobacco cessation, even among those with alcohol use disorder not seeking treatment for smoking. The effects on alcohol use appear to be smaller and inconclusive.

Darius A. Rastegar, MD, Kevin L. Kraemer, MD, MSc, Richard Saitz, MD, MPH

References: O’Malley SS, Zween A, Fucito LM, et al. Effect of varenicline combined with medical management on alcohol use disorder with comorbid cigarette smoking: a randomized clinical trial. JAMA Psychiatry. 2018;75(2):129–138.

Hurt RT, Ebbert JO, Croghan IT, et al. Varenicline for tobacco-dependence treatment in alcohol-dependent smokers: a randomized controlled trial. Drug Alcohol Depend. 2018;184:12–17.