Sex differences in stimulus expectancy and pharmacologic effects of a moderate dose of alcohol on smoking lapse risk in a laboratory analogue study

Alcohol use is often implicated in initial lapses to smoking during quit smoking attempts. Mechanisms explaining this association are unknown but could include (a) learned associations between drinking and smoking or (b) direct pharmacologic effects of alcohol. In a 2 (told alcohol vs. told placebo) x 2 (0.4 g/kg vs. 0.0 g/kg ethanol) between-subjects balanced placebo design, we examined instruction and beverage condition effects on smokers' ability to resist initiating smoking and whether these effects differed by sex. Participants were 96 heavy alcohol drinkers, smoking 10-30 cigarettes per day. After 15 h of smoking abstinence, participants consumed either an alcoholic or a nonalcoholic beverage and 35 min later completed a smoking lapse task. Overall, neither instructions nor beverage contents influenced behavior on the smoking lapse task. However, the instruction condition had different effects in men and women. Women, but not men, were more likely to smoke and reported expecting greater satisfaction from smoking when they were told alcohol compared to told placebo. The effects of instruction condition on smoking behavior were not mediated by self-reported expected satisfaction from smoking. Women may be more likely to choose to smoke after drinking moderate amounts of alcohol because of their expectations rather than the pharmacological effects of the alcohol.