Psychological distress, tobacco smoking and alcohol use: A population survey in Great Britain.

Aims: Psychological distress, smoking and alcohol use are interconnected. This study explores how distress and smoking independently, and in combination, are associated with alcohol consumption, past attempts and motivation to restrict alcohol use among people in Great Britain. Methods: Pooled cross-sectional data of people (aged ≥ 16) in Great Britain (N = 87326) collected monthly from April 2020 to June 2023 in the nationally representative Smoking and Alcohol Toolkit Study. Multinomial and binary logistic regressions assessed how past 30-day distress (Kessler Psychological Distress Scale) and smoking were associated with alcohol use risk level (AUDIT-C), past-year attempts to restrict alcohol use, and motivation to restrict alcohol use in three months, adjusting for sex, age, socioeconomic and geographic characteristics.Findings.The interaction between distress and smoking on alcohol use risk level was significant. At all distress levels, odds of using alcohol at increasing or high risk were higher among participants who smoked in the past or currently. Moderate or serious distress was associated with lower odds of using alcohol at increasing risk among participants who did not smoke. Higher distress was positively associated with past-year attempts to restrict alcohol use, while smoking in those reporting low-to-moderate distress was negatively associated with past-year attempts. Higher distress was positively associated with motivation to restrict alcohol use in three months. Conclusions: Smoking currently or in the past was independently associated with increased odds of using alcohol at increasing- or high-risk levels. Among those not smoking, higher distress was associated with reduced odds of using alcohol at increasing risk.