Tobacco, alcohol and addiction: a guide to the risky substances pillar
Risky Substances
Key points
- People who smoke lose more than 10 years of life on average.
- Quitting before 40 reduces the excess risk of death by about 90%; quitting at any age helps.
- According to the GBD study, the level of alcohol use that minimizes health harm is zero.
- Medications and counseling substantially increase the chances of quitting smoking.
Why this is a separate pillar
Tobacco and alcohol are among the largest preventable causes of early death in the United States and worldwide. Lifestyle medicine calls this pillar “avoiding risky substances” because it covers not only tobacco and alcohol but any addiction that harms health.
Smoking: what you lose and what you can get back
A large study of more than 200,000 U.S. adults found that people who smoke lose more than 10 years of life on average compared with those who never smoked. Quitting before age 40 reduced the excess risk of death by about 90%. People who quit at 25 to 34 gained about 10 years of life, at 35 to 44 about 9 years, and at 45 to 54 about 6 years (Jha et al., 2013).
Quitting helps at any age, and the sooner the better. Free coaching is available from every state quitline at 1-800-QUIT-NOW (1-800-784-8669).
Alcohol: rethinking “moderate drinking”
For a long time, a small amount of alcohol was thought to be good for the heart. Newer data have changed that view.
- The Global Burden of Disease analysis of 195 countries concluded that the level of drinking that minimizes overall health harm is zero (GBD 2016 Alcohol Collaborators, 2018).
- An analysis of data from nearly 600,000 people found that the risk of death began to rise above about 100 g of pure alcohol a week (Wood et al., 2018). That is roughly 7 U.S. standard drinks (one standard drink contains 14 g of alcohol).
In 2023 the WHO stated that there is no safe level of alcohol use for health. The Dietary Guidelines for Americans advise adults who drink to limit intake to 2 drinks or fewer a day for men and 1 or fewer for women, and note that drinking less is better for health than drinking more. Read more in our article on whether any amount of alcohol is safe.
Where to start
- Track what you actually use. Keep a log for one week.
- Identify triggers: stress, social situations, the after-work habit.
- Plan a substitute: a walk, a nonalcoholic drink, a call to a friend.
- Get help. Medication and counseling substantially raise the chances of quitting smoking, and alcohol dependence needs a doctor’s support.
- Tell the people close to you. Support increases your chances of success.
Elsewhere in this section: how to quit smoking and what works; is any amount of alcohol safe?
Frequently asked questions
Is it worth quitting if I have smoked for many years?
Yes. Research shows benefits from quitting at any age. People who quit at 45 to 54 gained about 6 years of life, and those who quit before 40 gained about 9 to 10 years.
Is a little wine good for your heart?
Newer studies that better account for bias do not support a protective effect of moderate drinking. The WHO states that no level of alcohol use is safe for health, and the U.S. Surgeon General has highlighted the link between alcohol and cancer.
Are e-cigarettes safe?
They are not safe, although they are probably less harmful than cigarettes. People who do not smoke should not start. If you want to use them to quit smoking, talk to your doctor.
Sources
- Jha et al. (2013). 21st-Century Hazards of Smoking and Benefits of Cessation in the United States. New England Journal of Medicine 368(4):341-350. doi:10.1056/NEJMsa1211128
- Griswold et al. (2018). Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet 392(10152):1015-1035. doi:10.1016/S0140-6736(18)31310-2
- Wood et al. (2018). Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. The Lancet 391(10129):1513-1523. doi:10.1016/S0140-6736(18)30134-X
- National Cancer Institute. Smokefree.gov. smokefree.gov
- National Institute on Alcohol Abuse and Alcoholism. Rethinking Drinking. www.rethinkingdrinking.niaaa.nih.gov
Keep reading
Risky Substances How to quit smoking: the methods with the best evidence
What Cochrane reviews show about nicotine replacement, varenicline and counseling, what the EAGLES safety trial found and a 5-step plan to quit.
Risky Substances · Myth or factIs any amount of alcohol safe? The myth of the healthy glass of wine
Why newer research does not support the idea that moderate drinking is good for you, what the Global Burden of Disease found and how to cut back.
Risky Substances E-cigarettes and vaping: what we know about harms and benefits
Are vapes safer than cigarettes? What a Cochrane review and a NEJM trial found about quitting smoking, why vaping is not safe and why teens should not start.
Risky Substances tools
AUDIT: the WHO alcohol use test
10 WHO questions about how often and how much you drink, and its consequences.
QuizAUDIT-C: quick alcohol check
The first three AUDIT questions: a one-minute screen widely used in U.S. primary care.
QuizFagerström Test for Nicotine Dependence
6 questions to gauge physical dependence on nicotine.
PDF · PlanQuit smoking plan
A personal plan: quit date, reasons, triggers, substitutes and support.
PDF · TrackerSmoke-free days tracker
A monthly tracker with craving ratings and notes.
PDF · DiaryWeekly drink diary
Record how much you drink and in what situations.