Alcohol versus cigarettes

Dear Alice,

I was curious on which is more dangerous drinking alcohol or smoking cigarettes?

Dear Reader,

It’s impossible to determine whether drinking alcohol or smoking cigarettes is worse for a person's health because the ways they’re ingested and the effects they have on the body are highly variable. However, as you mention in your question, both pose potential health risks, especially when used in different contexts and in large quantities. Many years ago, the risks of drinking and smoking were unknown. Fortunately, contemporary research has more clearly defined the negative side effects of alcohol consumption and cigarette smoking, so now it's possible to be informed about potential risks associated with using either substance. While some health experts do advise on levels of drinking that are considered lower risk by sex assigned at birth, recent research indicates that there may actually be no level of drinking alcohol that is free from harm. On the other hand, there is no safe level of cigarette use. Want to know more? Keep on reading!

First, a little more info about alcohol: For those assigned male at birth, excessive drinking is defined as consuming 15 or more drinks in a week or frequently having five or more drinks at a time. For those assigned female at birth, excessive drinking is considered consuming 8 or more drinks in a week or frequently drinking four or more drinks at a time. Excessive alcohol consumption is known to contribute to many serious health problems, including the development of 60 major types of disease and approximately 2.5 million deaths per year, more than human immunodeficiency virus (HIV) or tuberculosis. The key word here is excessive. The following list includes some of the ailments that have been directly associated with excessive alcohol consumption:

  • Unintentional injuries due to impairment of psychomotor abilities, such as falls, drowning, and poisoning
  • Intentional injuries, including suicide and self-harm
  • Weakened immune system, which increases susceptibility to the common cold and other viruses
  • Cancers of the throat, mouth, liver, esophagus, breast, and colon
  • Neuropsychiatric disorders, such as epilepsy and withdrawal-induced seizures
  • Heart damage leading to stroke and high blood pressure
  • Liver complications
  • Pancreatitis

Globally, alcohol is ranked as one of the highest risk factors for death and disability-adjusted life years.  In fact, because alcohol is known to reduce inhibitions, people are more inclined to take risks while under the influence, including engaging in unprotected sex. Further, when protection isn't used, the risk of transmitting sexually transmitted infections (STIs), such as chlamydia, gonorrhea, herpes, and HIV, increases. Keep in mind that all of these risks are exacerbated by the fact that alcohol is an addictive substance — addiction can increase exposure to these risks. The most critical factors with alcohol are how much is consumed (short and long-term) and the decisions a person makes after consuming. Harm reduction strategies, such as consuming alcohol in moderation, can help mitigate these short- and long-term effects. If you find that drinking in moderation is challenging or that your drinking is causing harm, you may want to speak with a health care provider or mental health professional to learn more about how to stop drinking. You may also find it helpful to seek out help from support groups. The National institute on Alcohol Abuse and Alcoholism has an Alcohol Treatment Navigator that can help you find treatment options that may be appropriate for you.

As for cigarettes, it’s key to note that they're highly addictive. There are more than 4,000 chemicals found in the average cigarette, and the purpose of some of these chemicals is to stimulate addiction, which increases the urge to smoke more frequently. There is also a genetic component that contributes to the addiction factor for most people. However, given the health effects strongly associated with smoking, there is no safe amount of cigarette use.

Cigarette smoke inhalation is linked with many diseases and ailments that are also associated with alcohol consumption. These diseases include:

  • Cardiovascular diseases such as abdominal aortic aneurysm, cerebrovascular disease, and coronary heart disease
  • Reproductive effects, such as reduced female fertility, preterm delivery, low birth weight, and fetal death
  • Cancers of the bladder, cervix, esophagus, kidney, lungs, and mouth
  • A weakened immune system
  • Coughing, wheezing, lung function decline, and susceptibility to acute respiratory illnesses such as pneumonia

Cigarette smoking causes approximately six million preventable deaths per year (which includes nonsmokers who are exposed to smoke in their environments), almost half a million of which are in the US alone. It makes up six to eight percent of health care costs in the country. In fact, tobacco kills up to half of its users. Users of newer electronic cigarettes (e-cigarettes) are also not likely to be exempt from health risks and have been associated with serious lung illness and even death (to read more on what is currently known, check out E-cigarettes — Effects on health? Smoking cessation tool?). What is known is that the increase in e-cigarette use has outpaced the ability to measure the health effects in both the long- and short-term, although more information is emerging. However, for smokers who want to quit, smoking cessation programs may be available through many health care providers. Smokefree.gov also has more information about tobacco cessation resources. Perhaps more promising is the fact that the degenerative effects of cigarette smoke on the lungs are reversible to a point, so quitting can provide health benefits.

It's hard to say which poses more risk. However, having more knowledge can help lead to more informed choices about whether to use or not use these substances in the future. For more information about alcohol and cigarettes, take a look at other Q&As in the Alcohol and Other Drugs archives. If you're concerned about your own use, you could also reach out to the health promotion office or a substance abuse prevention educator to discuss these substances on and your relationship with them.

Last updated Nov 02, 2018
Originally published Dec 14, 2012

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