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This study examined alcohol use and its association with initial smoking lapses among heavy nondependent drinkers in smoking cessation treatment.

Participants were 236 heavy drinking smokers in a randomized clinical trial testing the efficacy of incorporating brief alcohol intervention into smoking cessation treatment.

Of the 178 participants who reported a smoking lapse, 41.5% lapsed when drinking alcohol. Those who had alcohol-involved lapses had significantly lower tobacco dependence severity and drank more drinks per week than those who had non–alcohol-involved lapses. The majority of alcohol-involved lapses were in a bar/restaurant, with other people, and when they were in a happy/good mood. In survival analyses with alcohol consumption as a time-varying covariate, moderate drinking days were associated …