Chapter 7: Alcohol & Tobacco

How much alcohol or tobacco is safe for you to consume?

How does alcohol or tobacco impact physical and emotional health?

How many people suffer from diseases causes by alcohol and tobacco?

What are steps you can take to reduce or eliminate your use of alcohol and tobacco?

Chapter 7 Learning Outcomes

By the end of this chapter you will be able to:

  • Define what is meant by a drink.
  • Explain what excessive alcohol consumption entails.
  • Estimate Blood Alcohol Concentrations (BAC).
  • Describe short term and long term effects of alcohol consumption.
  • Explain the harmful effects of Nicotine.
  • Describe the short term and long term effects of tobacco use.

Why is it important for your health to understand the use of alcohol and tobacco? Because each year, 11 million deaths are attributed to the use of tobacco (8 million deaths) or alcohol (3 million deaths).  Using tobacco or alcohol are a lifestyle choice that increases your risk of death.  It is important for you to be aware of the risks.

The use of Alcohol

What is a “drink”?

In the United States, a standard drink contains 0.6 ounces (14.0 grams or 1.2 tablespoons) of pure alcohol. Generally, this amount of pure alcohol is found in:

  • 12-ounces of beer (5% alcohol content).
  • 5-ounces of wine (12% alcohol content).
  • 1.5-ounces of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey).

Understanding Intoxication Levels:  Blood Alcohol Concentration (BAC)

A blood alcohol test measures the level of Alcohol in your blood. This is typically done by using a breathalyzer or a blood test.  Typically a blood alcohol concentration (BAC) greater than 0.08% is an indicator of intoxication, it means that you have 0.08 g of alcohol for every 100 ml of blood in your body.  All states in the United States have adopted 0.08% as the legal limit for operating a motor vehicle for drivers aged 21 years or older (except for Utah, which adopted a 0.05% legal limit in 2018).

The liver is the main organ that processes, or metabolizes, alcohol and it can only process a small amount at a time, which is on average about one standard drink per hour.  If you drink more alcohol than your liver can process then you will begin to feel the effects of intoxication.  As blood alcohol concentration (BAC) increases, so does the effect of alcohol—as well as the risk of harm. When BAC reaches high levels, blackouts (gaps in memory), loss of consciousness (passing out), and death can occur.

It is important to recognize that the “one drink per hour” is an average and the actual time it takes your body to metabolize alcohol can vary for each person, for example it varies between men and women, whether you have eaten food, and the amount of alcohol consumed.

Examples of BAC Differences

  • A male and female who weigh the same, eat the exact same meal, and drink the same amount of alcohol will have different BAC.  Women tend to have higher body fat percentage than men and less total blood volume, which means there will be a higher concentration of alcohol in their blood thus increasing their BAC.
  • Genetic differences can lead to differences in the amounts of enzymes that breakdown alcohol thus impacting the bodies ability to metabolize alcohol and increasing BAC.
  • Females have lower amounts of an enzyme called Alcohol dehydrogenase (ADH).  ADH is responsible for metabolizing alcohol in both the stomach and the liver.  Since women have lower amounts of the enzyme they will have higher BAC than Males.
  • A person who regularly drinks can build up tolerance because their body may increase production of the enzymes that breakdown alcohol.
  • A person who drinks excessively for a long time might cause liver damage, which means their liver cannot effectively metabolize alcohol thus increasing their BAC.
  • Men have a greater ratio of muscle to fat than do women. Muscle has a large amount of blood that flows through the muscle tissue. Fat has a much smaller amount of blood. The functional difference this makes is that alcohol is more diluted in a man’s body due to this larger volume of blood.  Since women tend to have a higher percentage of body fat than men, this results in a higher BAC level for women compared to men.
  • As the percentage of body fat increases, the BAC increases—this is because the total body water is lower, and that means that the alcohol is confined to this smaller volume.
  • Absorption of alcohol is dependent on how quickly it can move through your stomach, this is called the gastric emptying rate.  If your stomach is empty, gastric emptying increases, but if your stomach is full the gastric emptying slows down.  Thus a full stomach will mean that the alcohol will take longer to absorb.

Alcohol Consumption Levels

Although the majority of U.S. adults consume alcoholic beverages, the Dietary Guidelines for Americans recommends limited consumption of alcohol and encourages people who have never drank alcohol to continue to abstain.

For those who choose to consume alcohol it is recommended to limit yourself to a moderate consumption level which is defined as up to 1 drink per day for women and up to 2 drinks per day for men.

People should avoid excessive alcohol consumption, which includes binge drinking, heavy drinking, and any drinking by pregnant women or people younger than age 21.

Binge drinking is the most common form of excessive drinking.  About 66 percent of adults ages 21 through 59 report alcoholic beverage consumption in the past month, and of those, approximately half report binge drinking, sometimes multiple times per month, which can lead to high BAC levels.

A person is considered to be a binge drinker if they consume the following:

  • For women, 4 or more drinks during a single occasion.
  • For men, 5 or more drinks during a single occasion.

A person is considered to be a heavy drinker if they consume the following:

  • For women, 8 or more drinks per week.
  • For men, 15 or more drinks per week.

There are some people who should not drink any alcohol, including those who are:

  • Younger than age 21.
  • Pregnant or may be pregnant.
  • Driving, planning to drive, or participating in other activities requiring skill, coordination, and alertness.
  • Taking certain prescription or over-the-counter medications that can interact with alcohol.
  • Suffering from certain medical conditions.
  • Recovering from alcoholism or are unable to control the amount they drink.

Health Effects of Alcohol Abuse

Drinking too much, on a single occasion or over time, can take a serious toll on your health.  Here’s how alcohol can affect your body:

  • Brain
    • Alcohol interferes with the brain’s communication pathways, and can affect the way the brain looks and works. These disruptions can change mood and behavior, and make it harder to think clearly and move with coordination.
    • Learning and memory problems, including dementia and poor school performance.
    • Mental health problems, including depression and anxiety.
    • Social problems, including lost productivity, family problems, and unemployment.
    • Violence, including homicide, suicide, sexual assault, and intimate partner violence.
  • Heart
    • Drinking a lot over a long time or too much on a single occasion can damage the heart, causing problems including:
      • Cardiomyopathy – Impaired ability of the heart to deliver blood to the body, can lead to heart failure
      • Arrhythmias – Irregular heart beat
      • Stroke
      • High blood pressure
  • Liver
    • Heavy drinking takes a toll on the liver, and can lead to a variety of problems and liver inflammations including:
      • Steatosis, or fatty liver:  A condition where normal liver tissue is replaced by more than 5-6 percent fat. The accumulation of fat can cause inflammation, cell death, and scarring, which can lead to liver fibrosis.
      • Alcoholic hepatitis:  Inflammation of the liver caused by drinking alcohol that can result in scar tissue.
      • Liver Fibrosis:  Occurs when the liver is damaged and the organ develops scar tissue in response to the inflammation.  Advanced liver fibrosis results in cirrhosis, liver failure, and portal hypertension and often requires liver transplantation.
      • Cirrhosis of the liver:  A condition in which your liver is scarred and permanently damaged.
  • Pancreas
    • Alcohol causes the pancreas to produce toxic substances that can eventually lead to pancreatitis, a dangerous inflammation and swelling of the blood vessels in the pancreas that prevents proper digestion.
  • Cancer
    • Drinking too much alcohol can increase your risk of developing certain cancers, including cancers of the mouth, esophagus, throat, liver, and breast
  • Immune System
    • Drinking too much can weaken your immune system, making your body a much easier target for disease. Chronic drinkers are more liable to contract diseases like pneumonia and tuberculosis than people who do not drink too much. Drinking a lot on a single occasion slows your body’s ability to ward off infections, even up to 24 hours after getting drunk.
    • Risky sexual behaviors, including unprotected sex or sex with multiple partners. These behaviors can result in unintended pregnancy or sexually transmitted diseases, including HIV.

Rethinking Drinking

Does alcohol impact my calorie intake?

Alcoholic beverages are not a component of the USDA Dietary Patterns and the calories consumed are considered discretionary.  Alcohol provides 7 calories per gram consumed, and the ingredients in certain mixed drinks, including soda, mixers, and heavy cream, also can contribute to intake of added sugars and saturated fat.  Thus, regular consumption of alcoholic beverages can make it challenging for adults to meet food group and nutrient needs while not consuming excess calories.

Why is being able to “hold your liquor” a concern?

For some people, it takes quite a few drinks to get a buzz or feel relaxed. Often they are unaware that being able to “hold your liquor” isn’t protection from alcohol problems, but instead a reason for caution. They tend to drink more, socialize with people who drink a lot, and develop a tolerance to alcohol. As a result, they have an increased risk for developing alcohol use disorder. The higher alcohol levels can also harm the liver, heart, and brain without the person drinking noticing until it’s too late. And all people who drink need to be aware that even moderate amounts of alcohol can significantly impair driving performance, even when they don’t feel a buzz from drinking.

Why are women’s low-risk limits different from men’s?

Research shows that women start to have alcohol-related problems at lower drinking levels than men do. One reason is that, on average, women weigh less than men. In addition, alcohol disperses in body water, and pound for pound, women have less water in their bodies than men do. So after a man and woman of the same weight drink the same amount of alcohol, the woman’s blood alcohol concentration will tend to be higher, putting her at greater risk for harm.

Isn’t drinking good for the heart?

The short answer is, it is unknown whether light-moderate alcohol consumption has positive health impacts, such as decreasing your risk of cardiovascular disease.  Many studies have indicated that moderate alcohol consumption has protective health benefits (e.g., reducing risk of heart disease), and others show this may not be true.  Thus, there is not a solid conclusion to this question and it warrants more research.

Can I do anything to protect my liver from the effects of too much alcohol?

There are no guarantees that anything will protect the liver from too much alcohol. Liver damage from heavy drinking happens in stages. Some relatively mild damage may happen after a single binge drinking episode, but this reverses itself if the heavy drinking stops. If heavy drinking continues, however, liver damage can progress through several more advanced stages, and repair becomes much more difficult, if not impossible. When the damage goes as far as cirrhosis, the only treatment is liver transplant. The best way to protect your liver’s health is by staying within the low-risk drinking limits or — if you already have liver damage or any signs of an alcohol problem — by quitting.

Also, it’s best if people who drink avoid acetaminophen[1] (found in Tylenol® and other medications). Even the standard recommended dose of acetaminophen can increase the risk of liver damage, particularly among people who drink heavily.

Quitting or Reducing Drinking

The first step, of course, is to decide whether cutting down or quitting is best for you.  If you are thinking about quitting, recognize that one size doesn’t fit all, and it’s important to find options that appeal to you.  Changing habits such as smoking, overeating, or drinking too much can take a lot of effort, and you may not succeed with the first try. Setbacks are common, but you learn more each time. Each try brings you closer to your goal. Whatever course you choose, give it a fair trial.

Rethink drinking: Begin by evaluating your own drinking

Thinking about cutting back on alcohol?

  • Review Tips to Try Cutting Back on Alcohol and select two or three to try in the next week or two. It may help to have reminders to reinforce your decision to make a change, such as automated smartphone alerts that you send yourself.

Support for Quitting Drinking

  • You do not need to quit on your own, there is support available to help you!
  • Try the NIAAA Alcohol Treatment Navigator.  The Navigator helps adults find alcohol treatment for themselves or an adult loved one. The Navigator will steer you toward evidence-based treatment, which applies knowledge gained through decades of carefully designed scientific research. If you are seeking help for a teen, check out these recommended adolescent treatment resources.  If you are seeking treatment for yourself, you are taking an important step in your route to recovery. You may wish to ask someone you trust to help you through the process and for support along the way.
  • Evidence-based behavioral treatments, or “talk therapy,” include:
    • Cognitive-behavioral therapy (CBT).
      • This form of therapy is focused on identifying the feelings and situations (called “cues”) that lead to heavy drinking, and managing stress that can lead to relapse. The goal is to change the thought processes that lead to alcohol misuse and to develop the skills necessary to cope with everyday situations that might trigger problem drinking.
    • Motivational enhancement therapy.
      • This therapy focuses on helping the patient identify the pros and cons of seeking treatment, form a plan for making changes in drinking behavior, build confidence, and develop the skills needed to stick to the plan.
    • Contingency management approaches.
      • This approach is used to reinforce positive behaviors such as abstinence or regular attendance.
    • 12-Step Facilitation Therapy
      • An engagement strategy used in counseling sessions to increase a patient’s active involvement in 12-step-based mutual help groups (such as AA), in addition to professionally-led outpatient treatment. The counselor works with the patient to encourage, review, and reinforce their participation in AA, in a structured process that may include reading assignments, journaling, and setting AA participation goals for the week.

The use of Tobacco

“More doctors smoke Camels than any other cigarette.”

“Reach for a Lucky instead of a sweet.”

“Lucky Strike Cigarettes . . . are less irritating to sensitive and tender throats than other cigarettes.”

“Lucky Strike- To keep a slender figure no one can deny”

“Viceroys filter the smoke!  As your dentist, I recommend Viceroys.”

With doctors, dentists, and researchers proclaiming the healthful effects of smoking, smoking rates increased throughout the first half of the 20th century until 1964.  In 1964 the U.S. Public Health Service released the first publication linking cigarette smoking to lung cancer, laryngeal cancer, and chronic bronchitis, it was known as the Surgeon Generals Report on Smoking and Health.  The report ranked as among the top news stories of 1964.  A year later the Federal Cigarette Labeling and Advertising Act of 1965 was passed requiring cigarette packages to include a health warning this was followed by the Public Health Cigarette Smoking Act of 1969 which regulated the advertising of tobacco products banning cigarette advertising in the broadcast media.  With this report and the two Acts, cigarette smoking began to decline[2].

It is now well known, documented, and accepted that all forms of tobacco are harmful, and there is no safe level of exposure to tobacco. Tobacco use is the leading preventable cause of disease, disability, and death in the United States. According to the Centers for Disease Control and Prevention (CDC), cigarette smoking results in more than 480,000 premature deaths in the United States each year, about 1 in every 5 U.S. deaths.  In 2020, 12.5% (nearly 13 of every 100) U.S. adults aged 18 years or older ) currently smoked cigarettes. This means an estimated 30.8 million adults in the United States currently smoke cigarettes. Over 16 million people live with at least one disease caused by smoking, and 58 million nonsmoking Americans are exposed to secondhand smoke.  Some good news is that smoking has declined from 20.9% (nearly 21 of every 100 adults) in 2005 to 12.5% (nearly 13 of every 100 adults) in 2020.

Tobacco smoke contains more than 7,000 chemical components, and at least 250 of these chemicals are harmful to human health.  Some of the chemicals, and where they are commonly found besides in cigarettes, include:

  • Carbon monoxide is emitted from vehicle exhaust
  • Nicotine is found in pesticide
  • Arsenic and DDT are used in insect poison
  • Hydrogen cyanide was used in the gas chambers in World War II and is currently used in rat poison
  • Acetone is paint stripper and is a component of nail polish remover
  • Ammonia is used in household cleaning products
  • Butane and methanol are found in fuel
  • Cadmium is in car batteries
  • Formaldehyde is used as a tissue and specimen preservative commonly found in science labs.

Secondhand Smoke

The harmful effects of smoking extend far beyond the smoker. Exposure to secondhand smoke can cause serious diseases and death.  Since the 1964 Surgeon General’s Report, 2.5 million adults who were nonsmokers died because they breathed secondhand smoke[3].  Exposure to secondhand smoke causes an estimated 41,000 deaths each year among adults in the United States, causing 7,333 annual deaths from lung cancer and 33,951 annual deaths from heart disease.

Electronic Cigarettes

What are they?

E-cigarettes are battery-operated devices that typically produce a flavored nicotine vapor that looks like tobacco smoke.  E-cigarettes are sometimes called “e-cigs,” “vapes,” “e-hookahs,” “vape pens,” and “electronic nicotine delivery systems (ENDS).”  Some e-cigarettes look like regular cigarettes, cigars, or pipes. Some look like USB flash drives, pens, and other everyday items.

Are e-cigarettes less harmful than regular cigarettes?

Although e-cigarette vapor does not contain the tar currently responsible for most lung cancer and other lung diseases, that doesn’t mean e-cigarettes are safe.  Many studies suggest e-cigarettes and noncombustible tobacco products may be less harmful than combustible cigarettes. However, there is not yet enough evidence to support claims that e-cigarettes and other ENDS are effective tools for quitting smoking.

E-cigarette aerosol generally contains fewer toxic chemicals than the deadly mix of 7,000 chemicals in smoke from regular cigarettes. However, e-cigarette aerosol is not harmless. It can contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents.  It is difficult for consumers to know what e-cigarette products contain. For example, some e-cigarettes marketed as containing zero percent nicotine have been found to contain nicotine

The U.S. Food and Drug Administration (FDA) has established rules for e-cigarettes and their liquid solutions in an effort to help protect the public from the dangers of tobacco use. Because e-cigarettes contain nicotine derived from tobacco, they are now subject to government regulation as tobacco products, including the requirement that both in-store and online purchasers be at least 18 years of age.

Can e-cigarettes help people quit smoking traditional cigarettes?

Because they deliver nicotine without burning tobacco, e-cigarettes are thought by many to be a safer alternative to conventional cigarettes, and some people even think they may help smokers lower nicotine cravings while they are trying to quit smoking.  However, e-cigarettes are not currently approved by the FDA as a quit smoking aid. The U.S. Preventive Services Task Force, a group of health experts that makes recommendations about preventive health care, has concluded that evidence is insufficient to recommend e-cigarettes for smoking cessation in adults.

In a 2021 review of 61 studies focused on the use of e-cigarettes as a tool for quitting[4], the researchers were moderately confident that nicotine e-cigarettes help more people to stop smoking than nicotine replacement therapy or nicotine-free e-cigarettes, however more research is needed.

Smokeless Tobacco (Chewing Tobacco)

Smokeless tobacco is associated with many health problems. Smokeless tobacco contains cancer-causing agents and nicotine, which is highly addictive. Because young people who use smokeless tobacco can become addicted to nicotine, they may be more likely to also become cigarette smokers later.

Smokeless tobacco comes in three types:  Chewing tobacco (loose leaf, plug, or twist and may come in flavors), Snuff (moist, dry, or in packets [U.S. snus]), and Dissolvables (lozenges, sticks, strips, orbs).

Using smokeless tobacco:

  • Can lead to nicotine addiction
  • Causes cancer of the mouth, esophagus (the passage that connects the throat to the stomach), and pancreas
  • Is associated with diseases of the mouth
  • Can increase risks for early delivery and stillbirth when used during pregnancy
  • Can cause nicotine poisoning in children
  • May increase the risk for death from heart disease and stroke

Health Effects of Tobacco Use

Smoking leads to disease and disability and harms nearly every organ of the body.

Although nicotine is addictive and can be toxic if ingested in high doses, it does not cause cancer—other chemicals are responsible for most of the severe health consequences of tobacco use. Tobacco smoke is a complex mixture of chemicals such as carbon monoxide, tar, formaldehyde, cyanide, and ammonia—many of which are known carcinogens. Carbon monoxide increases the chance of cardiovascular diseases. Tar exposes the user to an increased risk of lung cancer, emphysema, and bronchial disorders.  Smoking has also been linked to leukemia, cataracts, and pneumonia. On average, adults who smoke die 10 years earlier than nonsmokers.

Smoking and Cancer

Cigarette smoking accounts for about one-third of all cancers, including cancers of the blood (acute myeloid leukemia), bladder, cervix, colon, rectum, esophagus, kidney, renal pelvis, larynx, liver, mouth, throat, pancreas, stomach, trachea, lungs, and bronchi.  If nobody smoked, one of every three cancer deaths in the United States would not happen.

Although smoking increases your risk of almost all cancers, it directly accounts for about 85-90 percent of lung cancer cases, or nearly 9 out of 10 lung cancers are caused by smoking cigarettes.  Smokeless tobacco (such as chewing tobacco and snuff) also increases the risk of cancer, especially oral cancers.  More people in the United States, both men and women, die from lung cancer than any other type of cancer.   Although the risks of smoking are more clear today than in 1964, smokers have a greater risk for lung cancer today than they did in 1964, even though they smoke fewer cigarettes.

Quitting smoking lowers the risks for cancers of the lung, mouth, throat, esophagus, and larynx.

  • Within 5 years of quitting, your chance of getting cancer of the mouth, throat, esophagus, and bladder is cut in half.
  • Ten years after you quit smoking, your risk of dying from lung cancer drops by half.

Smoking and Cardiovascular Disease

In addition to cancer, smoking causes lung diseases such as chronic bronchitis and emphysema, and increases the risk of heart disease, including stroke, heart attack, vascular disease, and aneurysm.  One out of every four deaths from Cardiovascular Disease is caused by a person choosing to smoke.

Smoking can:

  • Raise triglycerides (a type of fat in your blood)
  • Lower “good” cholesterol (HDL)
  • Make blood sticky and more likely to clot, which can block blood flow to the heart and brainDamage cells that line the blood vessels
  • Increase the buildup of plaque (fat, cholesterol, calcium, and other substances) in blood vessels
  • Cause thickening and narrowing of blood vessels
Secondhand Smoke and CVD

Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25-30 percent and lung cancer by 20-30 percent.  Non-smokers exposed to secondhand smoke may experience coughing, overproduction of phlegm, reduced lung function and respiratory infections, including pneumonia and bronchitis.  Breathing secondhand smoke can interfere with the normal functioning of the heart, blood, and vascular systems in ways that increase your risk of having a heart attack. Even briefly breathing secondhand smoke can damage the lining of blood vessels and cause your blood to become stickier. These changes can cause a deadly heart attack.

Each year about 150,000 – 300,000 children younger than 18 months old experience respiratory tract infections caused by secondhand smoke. Children exposed to secondhand smoke are at an increased risk of ear infections, severe asthma, respiratory infections and death. In fact, more than 100,000 babies have died in the past 50 years from sudden infant death syndrome (SIDS), and other health complications as a result of parental smoking.  Children who grow up with parents who smoke are more likely to become smokers, thus placing themselves (and their future families) at risk for the same health problems as their parents when they become adults.

There is no safe level of exposure to tobacco smoke.

Smoking and Your Brain

Cigarettes and other forms of tobacco—including cigars, pipe tobacco, snuff, and chewing tobacco—contain the addictive drug nicotine. Nicotine is readily absorbed into the bloodstream when a tobacco product is chewed, inhaled, or smoked. A typical smoker will take 10 puffs on a cigarette over the period of about 5 minutes that the cigarette is lit. Thus, a person who smokes about 1 pack (25 cigarettes) daily gets 250 “hits” of nicotine each day.

Upon entering the bloodstream, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, respiration, and heart rate.

Similar to other addictive drugs like cocaine and heroin, nicotine increases levels of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure. For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction—a condition of compulsive drug seeking and use, even in the face of negative consequences. Studies suggest that additional compounds in tobacco smoke, such as acetaldehyde, may enhance nicotine’s effects on the brain.

When an addicted user tries to quit, he or she experiences withdrawal symptoms including irritability, attention difficulties, sleep disturbances, increased appetite, and powerful cravings for tobacco. Treatments can help smokers manage these symptoms and improve the likelihood of successfully quitting.

Quitting Smoking

Although quitting can be difficult, the health benefits of smoking cessation are immediate and substantial—including reduced risk for cancers, heart disease, and stroke.

What are the benefits of quitting smoking?

You will see immediate positive health improvements upon the cessation of smoking these include:

  • Within 20 minutes, your heart rate and blood pressure drop.
  • 12 hours, the carbon monoxide level in your blood drops to normal.
  • 2-12 weeks, your circulation improves and your lung function increases.
  • 1-9 months, coughing and shortness of breath decrease.
  • 1 year, your risk of coronary heart disease is about half that of a smoker’s.
  • 5 years, your stroke risk is reduced to that of a nonsmoker 5 to 15 years after quitting.
  • 10 years, your risk of lung cancer falls to about half that of a smoker and your risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decreases.
  • 15 years, the risk of coronary heart disease is that of a nonsmoker’s.

In addition, people who quit smoking will have an improved sense of smell, and food will taste better.

How does quitting smoking impact life expectancy?

Data from the U.S. National Health Interview Survey show that people who quit smoking, regardless of their age, are less likely to die from smoking-related illness than those who continue to smoke. Smokers who quit before age 40 reduced their chance of dying prematurely from smoking-related diseases by about 90 percent, and those who quit by age 45-54 reduced their chance of dying prematurely by about two-thirds.

People who quit smoking, regardless of their age, have substantial gains in life expectancy compared with those who continue to smoke. Those who quit between the ages of 25 and 34 years lived about 10 years longer; those who quit between ages 35 and 44 lived about 9 years longer; those who quit between ages 45 and 54 lived about 6 years longer; and those who quit between ages 55 and 64 lived about 4 years longer.

Does quitting smoking lower the risk of cancer?

Yes. Quitting smoking reduces the risk of developing and dying from cancer. Although it is never too late to get a benefit from quitting, the benefit is strongest among those who quit at a younger age.

The risk of premature death and the chance of developing cancer from smoking depend on many factors, including the number of years a person smokes, the number of cigarettes he or she smokes per day, the age at which he or she began smoking, and whether or not he or she was already ill at the time of quitting. For people who have already developed cancer, quitting smoking reduces the risk of developing a second cancer.

Should someone already diagnosed with cancer bother to quit smoking?

Yes. Cigarette smoking has a profound adverse impact on health outcomes in cancer patients. For patients with some cancers, quitting smoking at the time of diagnosis may reduce the risk of dying by 30 percent to 40 percent. For those having surgery, chemotherapy, or other treatments, quitting smoking helps improve the body’s ability to heal and respond to therapy. It also lowers the risk of pneumonia and respiratory failure. Moreover, quitting smoking may lower the risk of the cancer returning, of dying from the cancer, of a second cancer developing, and of dying from other causes.

Treatments for Tobacco Addiction

Tobacco addiction is a chronic disease that often requires multiple attempts to quit. Although some smokers are able to quit without help, many others need assistance. Both behavioral interventions (counseling) and medication can help smokers quit; but the combination of medication with counseling is more effective than either alone.

The U.S. Department of Health and Human Services’ (HHS) has established a national toll-free quitline, 800-QUIT-NOW, to serve as an access point for any smoker seeking information and assistance in quitting. NIDA’s scientists are looking at ways to make smoking cessation easier by developing tools to make behavioral support available over the internet or through text-based messaging. In addition, NIDA is developing strategies designed to help vulnerable or hard-to-reach populations quit smoking.

Behavioral Treatments

Behavioral treatments employ a variety of methods to help smokers quit, ranging from self-help materials to counseling. These interventions teach people to recognize high-risk situations and develop coping strategies to deal with them.

Nicotine Replacement Treatments

Nicotine replacement therapies (NRTs) were the first pharmacological treatments approved by the Food and Drug Administration (FDA) for use in smoking cessation therapy. Current FDA-approved NRT products include nicotine chewing gum, the nicotine transdermal patch, nasal sprays, inhalers, and lozenges. NRTs deliver a controlled dose of nicotine to a smoker in order to relieve withdrawal symptoms during the smoking cessation process. They are most successful when used in combination with behavioral treatments.

Other Medications

Bupropion and varenicline are two FDA-approved non-nicotine medications that have helped people quit smoking. Bupropion, a medication that goes by the trade name Zyban, was approved by the FDA in 1997, and Varenicline tartrate (trade name: Chantix) was approved in 2006. It targets nicotine receptors in the brain, easing withdrawal symptoms and blocking the effects of nicotine if people resume smoking.

Current Treatment Research

Scientists are currently developing new smoking cessation therapies. For example, they are working on a nicotine vaccine, which would block nicotine’s reinforcing effects by causing the immune system to bind to nicotine in the bloodstream preventing it from reaching the brain. In addition, some medications already in use might work better if they are used together. Scientists are looking for ways to target several relapse symptoms at the same time—like withdrawal, craving and depression.

Key Takeaways for Chapter 7

  • Both alcohol and tobacco increase your risk of disease
  • A drink is considered 12-ounces of beer, 5-ounces of wine, or 1.5-ounces of 80-proof liquor
  • BAC, Blood Alcohol Concentration, measures how much alcohol is in the blood.
  • People should avoid binge drinking and heavy drinking.
  • Nicotine is the drug in tobacco.
  • Secondhand smoke is harmful to non-smokers.


  1. Mitchell, R. A., Rathi, S., Dahiya, M., Zhu, J., Hussaini, T., & Yoshida, E. M. (2020). Public awareness of acetaminophen and risks of drug induced liver injury: Results of a large outpatient clinic survey. PLoS ONE, 15(3), 1–9.
  2. Cummings, K. M., & Proctor, R. N. (2014). The changing public image of smoking in the United States: 1964-2014. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 23(1), 32–36.
  3. National Center for Chronic Disease Prevention and Health Promotion (U.S.). Office on Smoking and Health (2014). Let's make the next generation tobacco-free : your guide to the 50th anniversary Surgeon General’s Report on Smoking and Health Corporate
  4. Hartmann-Boyce J, McRobbieH, ButlerAR, LindsonN, BullenC, BeghR, TheodoulouA, NotleyC, RigottiNA, TurnerT, FanshaweTR, HajekP.Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2021, Issue 9. Art. No.: CD010216. DOI: 10.1002/14651858.CD010216.pub6.


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