3.8 times https://pubs.niaaa.nih.gov/publications/arh26-2/143-150.htm well-documented Concurrent Alcohol and Tobacco Dependence https://pubs.niaaa.nih.gov/publications/arh26-2/143-150.htm https://pubs.niaaa.nih.gov/publications/arh26-2/143-150.htm increases 23-fold