Cigarette Taxes Make Us Drink

Twenty-somethings are more likely to binge drink when cigarette prices are higher. The unintended consequences of state taxation policies may warrant more consideration.

RTX8QFMMAIN.jpgMichaela Rehle/Reuters Doctor: Do you smoke? 

Patient: Only when I drink. 

Doctor: How often do you drink? 

Patient: Most days. 

That's actually a pretty common exchange. It's no secret that smoking is the designer handbag to many people's complete drinking ensemble. It's the same stimulant-depressant combo that makes Red Bull and vodka such fond bedfellows. Same with Four Loko, speedballs (RIP Chris Farley), double tall mocha Valium, methamphetamine grigio, The Rollercoaster (Xanax, cocaine, phenobarbital), The Banana Split (Mocha frappucino, Lunesta, banana), The Double Dip (deep tissue massage, Zumba, vacuuming), etc. So it makes sense that when access to one part of the formula changes, consumption patterns of the other change as well. 

New health policy research shows that, at least for twenty-somethings, increases in cigarette prices (often due to state cigarette taxes) result in significant increases in harmful drinking behaviors. The same association was seen in people older than 65, except they weren't binging as much. The researchers did a great job controlling for other variables, so the deduction that the relationship is causal is compelling.

Taxation often has unintended social and economic consequences, sure, but this instance is particularly relevant in the overall war-on-[access to]-drugs psychology. Cigarette taxes are bringing in a lot of revenue and decreasing smoking rates, but as overall public health goes, are they as beneficial as they initially seem? People have vices, and we're not going to stop having them. When vice X gets harder to come by, we'll supplement it with vice Y. Taking a cue from Jurassic Park, "Nature finds a way... [to party]." 

But it's not as simple as that, either. In this study, increased cigarette prices didn't even decrease smoking in people under 30. So they were drinking more, but still smoking. Maybe getting drunker to ease the lamentation of dropping $11 on a pack of cigarettes. I don't know. It's weird. But that's the point. Everything is intertwined and the trickle-down of health policy is never as simple as it seems.


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James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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