Why People Continue Using Harmful Substances Despite Knowing the Risks

Introduction: Despite widespread awareness of the severe health risks of tobacco and alcohol, many people continue to consume these substances. This paradox is driven by a complex interplay of addiction, psychology, social environment, cultural norms, economic factors, and barriers to quitting. The following report examines these factors in depth and discusses potential solutions, with a focus on global insights and the situation in India.

1. Behavioral and Psychological Insights

(File:Smoking Warning.jpg – Wikimedia Commons) Addiction and Reward Pathways: One major reason individuals keep using tobacco or alcohol is addiction – a chronic, relapsing condition characterized by compulsive substance use despite harmful consequences (Understanding Drug Use and Addiction DrugFacts | National Institute on Drug Abuse (NIDA)) (Why People Start Using Tobacco, and Why It’s Hard to Stop | American Cancer Society). Addictive substances hijack the brain’s reward circuit by flooding it with dopamine, producing pleasurable effects that reinforce use (Understanding Drug Use and Addiction DrugFacts | National Institute on Drug Abuse (NIDA)) (Why People Start Using Tobacco, and Why It’s Hard to Stop | American Cancer Society). For example, nicotine from tobacco rapidly triggers dopamine release, which creates a rewarding feeling and relief from stress or unpleasant emotions (Why Quitting Smoking Is Hard | Quit Smoking | Tips From Former Smokers | CDC) (Why People Start Using Tobacco, and Why It’s Hard to Stop | American Cancer Society). The brain learns to associate the substance with pleasure and emotional relief, motivating repeated use. Over time, the brain adapts by reducing its sensitivity to the substance, a process known as tolerance, so the user needs higher doses to get the same effect (Understanding Drug Use and Addiction DrugFacts | National Institute on Drug Abuse (NIDA)). These neuroadaptations also weaken self-control and decision-making, making it exceedingly difficult to resist cravings (Understanding Drug Use and Addiction DrugFacts | National Institute on Drug Abuse (NIDA)) (Understanding Drug Use and Addiction DrugFacts | National Institute on Drug Abuse (NIDA)). In essence, addiction “changes the brain in ways that make quitting hard, even for those who want to” (Understanding Drug Use and Addiction DrugFacts | National Institute on Drug Abuse (NIDA)). The user becomes trapped in a cycle of seeking the substance to feel normal or avoid negative feelings, which explains why people continue to use tobacco or alcohol even when they know it’s harming them (Why People Start Using Tobacco, and Why It’s Hard to Stop | American Cancer Society).

Habit Formation and Reinforcement: Beyond chemical addiction, habitual behavior plays a powerful role. Many substance users develop routines and cues linked to their use – for instance, a smoker lighting up with morning tea, or a drinker unwinding each evening with alcohol. These behaviors become deeply ingrained through operant conditioning: the immediate relief or pleasure acts as positive reinforcement, strengthening the habit loop. Nicotine’s effects wear off within minutes, leaving the person irritable or “edgy,” which often triggers another cigarette to alleviate the discomfort (Why People Start Using Tobacco, and Why It’s Hard to Stop | American Cancer Society). This creates a reinforcing loop of negative reinforcement (using the substance to avoid withdrawal symptoms) on top of the positive reinforcement of pleasure. Over time, users also associate certain moods, places, or social situations with substance use, which makes those cues trigger powerful cravings. Quitting then requires breaking not only a chemical dependence but also disrupting well-established routines. As the CDC notes, “you have to get used to daily routines that don’t involve smoking,” which can be challenging when so many activities have been paired with a cigarette or drink (Why Quitting Smoking Is Hard | Quit Smoking | Tips From Former Smokers | CDC). This habitual aspect means that even if the mind knows the health risks, the automatic behavior can continue almost on autopilot.

Denial, Cognitive Biases, and Risk Perception: Psychological factors such as denial and cognitive biases also help explain continued use in the face of known dangers. Many users hold “self-exempting” beliefs – rationalizations that the general risks don’t apply to them personally (Risk denial about smoking hazards and readiness to quit among French smokers: an exploratory study – PubMed) (Risk denial about smoking hazards and readiness to quit among French smokers: an exploratory study – PubMed). For example, smokers often convince themselves that “my intake is too low to harm me” or “my way of smoking is different, so I won’t get sick” (Risk denial about smoking hazards and readiness to quit among French smokers: an exploratory study – PubMed). These beliefs reduce cognitive dissonance – the mental discomfort of doing something one knows is unhealthy – by downplaying the threat. Such denial is common: a French survey found self-exempting beliefs widespread, and those who believed their low consumption was harmless or that they had protective smoking habits were significantly less ready to quit (Risk denial about smoking hazards and readiness to quit among French smokers: an exploratory study – PubMed). Other cognitive biases include optimism bias (the belief that one is less likely than others to be harmed) and present bias (overvaluing immediate rewards over future risks). A person might acknowledge that smoking causes cancer in general, yet think “Something else will get me first” or “I’ll quit before it seriously affects me.” This mental bargaining allows them to continue usage without feeling reckless. Moreover, addiction itself impairs risk evaluation – the brain’s reward system becomes so focused on the substance that it prioritizes the next dose over long-term well-being (Understanding Drug Use and Addiction DrugFacts | National Institute on Drug Abuse (NIDA)). In summary, addiction-driven brain changes, deeply conditioned habits, and cognitive denial mechanisms all contribute to why individuals persist in using harmful substances, even while carrying packs labeled “Smoking can cause a slow and painful death.” (Understanding Drug Use and Addiction DrugFacts | National Institute on Drug Abuse (NIDA)) (File:Smoking Warning.jpg – Wikimedia Commons)

Withdrawal and Negative Reinforcement: Once dependence has set in, stopping use brings withdrawal symptoms that can drive people back to the substance. The body and brain, now accustomed to the drug’s presence, react strongly when it’s absent. Nicotine withdrawal, for instance, commonly causes anxiety, irritability, difficulty concentrating, increased appetite, and intense cravings (Why Quitting Smoking Is Hard | Quit Smoking | Tips From Former Smokers | CDC) (Why People Start Using Tobacco, and Why It’s Hard to Stop | American Cancer Society). These symptoms can begin within hours of the last cigarette and make the person “feel generally uncomfortable” until they smoke again (Why Quitting Smoking Is Hard | Quit Smoking | Tips From Former Smokers | CDC). Knowing that quitting will bring these unpleasant effects creates fear and aversion toward stopping. Many smokers try to quit and relapse because the withdrawal feelings are hard to tolerate – as one source notes, “your brain gets irritable” without nicotine, pushing you to resume smoking to feel normal (Why Quitting Smoking Is Hard | Quit Smoking | Tips From Former Smokers | CDC). Alcohol withdrawal can be even more severe: over half of people with alcohol use disorder experience symptoms like tremors, sweating, and anxiety when they try to quit, and a small percentage suffer delirium tremens, a dangerous syndrome of confusion, rapid heart rate, and seizures that can be life-threatening without treatment (Delirium Tremens – StatPearls – NCBI Bookshelf). The dread of these symptoms becomes a major barrier to quitting. In essence, the substance is used not to get high at this stage, but to stave off withdrawal – a form of negative reinforcement where removing the drug causes pain and taking it again provides relief. This physiological dependency powerfully perpetuates use.

2. Cultural and Social Influences

(File:Alcohol consumption per capita world map.PNG – Wikipedia) Cultural Norms and Acceptance: The decision to continue smoking or drinking is not made in a vacuum – it’s heavily influenced by cultural context and social norms. Around the world, different societies have varying attitudes toward tobacco and alcohol use, which can either discourage or normalize these behaviors. In India, for example, tobacco use (both smoking and smokeless forms) has deep cultural roots. Chewing betel quid with tobacco (paan) is a centuries-old tradition in South Asia, offered in social and religious settings, which has lent a sense of normalcy to smokeless tobacco use (Betel Nut Use: The South Asian Story – PubMed). Likewise, bidis (hand-rolled tobacco leaves) are popular among certain communities and often viewed as a routine part of daily life. Such cultural embeddedness means individuals may grow up seeing tobacco as a benign or even customary practice, blunting the impact of health warnings. With alcohol, India presents a mixed picture – some communities (influenced by religious or moral views) strongly disapprove of drinking, whereas in other contexts alcohol is an accepted feature of celebrations and hospitality. Globally, cultural norms play a pivotal role in substance use patterns. In many European cultures, moderate drinking is woven into the fabric of daily social life (wine with meals, beer at gatherings), sending a message that alcohol use is ordinary and expected. In contrast, societies with more conservative norms regarding alcohol tend to have lower drinking rates ( Social and Cultural Contexts of Alcohol Use: Influences in a Social–Ecological Framework – PMC ) ( Social and Cultural Contexts of Alcohol Use: Influences in a Social–Ecological Framework – PMC ). Studies have found that cultural beliefs and values are strong predictors of drinking behavior ( Social and Cultural Contexts of Alcohol Use: Influences in a Social–Ecological Framework – PMC ). For instance, in some Latin American cultures, a concept of machismo encourages heavy drinking among men as a sign of masculinity ( Social and Cultural Contexts of Alcohol Use: Influences in a Social–Ecological Framework – PMC ). On the other hand, groups with more stringent norms (for example, certain religious communities or ethnic groups) show significantly lower usage due to social disapproval ( Social and Cultural Contexts of Alcohol Use: Influences in a Social–Ecological Framework – PMC ). These norms shape an individual’s mindset: if smoking or drinking is seen as a normal adult behavior in one’s culture, people are more likely to continue doing it without feeling an urgent need to quit.

Media and the Normalization of Use: Modern cultural influences are often transmitted through media and entertainment, which can powerfully normalize harmful substance use. In India and worldwide, depictions of smoking and drinking in films, television, and advertising have historically glamorized these behaviors. Until recently, Bollywood movies frequently showed heroes or villains smoking cigarettes or puffing on a hookah, and liquor consumption is still a common trope in song-and-dance sequences and party scenes. This on-screen exposure has real impacts: a large-scale Indian survey found that higher exposure to visual media (especially frequent movie attendance or TV viewing) was associated with significantly increased tobacco use among both men and women ( Movies and TV Influence Tobacco Use in India: Findings from a National Survey – PMC ) ( Movies and TV Influence Tobacco Use in India: Findings from a National Survey – PMC ). Essentially, seeing favorite stars smoke or drink can make these habits seem fashionable or cool, especially to impressionable youth. Research indicates that exposure to smoking in entertainment content leads to greater initiation among young people “possibly through social modeling and by reducing resistance to counter-arguments.” ( Movies and TV Influence Tobacco Use in India: Findings from a National Survey – PMC ) In other words, when media constantly portrays cigarette or alcohol use as normal behavior, viewers (consciously or subconsciously) start to accept it as such and tune out health warnings. Advertising has also been a big part of this social influence. Though many countries including India ban direct tobacco or liquor ads, the industries often find surrogate ways to market – such as using brand names on soda or music concerts – keeping their products visible to consumers. Globally, the alcohol industry’s marketing is pervasive, from sports sponsorships to social media campaigns, which increases the acceptability of drinking and even lowers the age of onset as young people are drawn in ( SAFER – Alcohol advertising ). The World Health Organization warns that exposure to alcohol marketing is linked to earlier and heavier drinking among youth ( SAFER – Alcohol advertising ). In summary, media and advertising help create a social environment where tobacco and alcohol use are seen as normative, attractive, or sophisticated, which encourages individuals to continue using these substances and makes quitting socially harder. (It is notable that media can also be used in the opposite direction – public health campaigns – which will be discussed later.)

Peer Pressure and Social Identity: Perhaps one of the most immediate social factors keeping people hooked is peer influence. Humans are social creatures, and we often mirror the behaviors of our friends, colleagues, and family. If one’s peer group frequently smokes or drinks, it becomes much more difficult for an individual to quit or abstain. This is especially true in adolescence and young adulthood, when social acceptance feels paramount. Many smokers begin due to peer pressure, and that same pressure or group norm can maintain the habit. Studies consistently show that having friends who smoke is strongly associated with both starting to smoke and continuing smoking ( Recent Findings on Peer Group Influences on Adolescent Substance Use – PMC ) ( Recent Findings on Peer Group Influences on Adolescent Substance Use – PMC ). In fact, research suggests peer smoking is a robust predictor of an adolescent’s future smoking trajectory ( Recent Findings on Peer Group Influences on Adolescent Substance Use – PMC ). The influence of peers can even outweigh other factors; one analysis found that teenagers are more likely to be influenced to smoke by seeing cigarette ads and peers smoking than by their own knowledge of health risks (The Dark Tactics of Big Tobacco: Unveiling Their Targeting Strategies). Social settings where alcohol is the norm (college parties, nightlife scenes, or certain professional networking events) create a similar effect – one feels pressure to drink to “fit in” or belong. Social identity theory holds that people adopt behaviors that align with their desired group. So if being a “cool college student” or a member of a certain work clique involves smoking/drinking, individuals may continue those behaviors to affirm their identity in that group. Notably, in collectivist cultures like India, peer influence can be especially potent. A meta-analysis comparing cultures found that peer behavior had even stronger effects on substance use in collectivistic societies (which emphasize group harmony) than in individualistic ones ( The Influence of Peer Behavior as a Function of Social and Cultural Closeness: A Meta-Analysis of Normative Influence on Adolescent Smoking Initiation and Continuation – PMC ) ( The Influence of Peer Behavior as a Function of Social and Cultural Closeness: A Meta-Analysis of Normative Influence on Adolescent Smoking Initiation and Continuation – PMC ). In such contexts, the fear of social ostracism or deviating from group norms can lead people to keep smoking or drinking when alone they might prefer to stop. Finally, beyond active peer pressure, there is the concept of social support for use: if one’s spouse, family, or close friends also use tobacco/alcohol, there is mutual reinforcement (e.g. sharing cigarettes, drinking together) and less impetus to quit. Conversely, if one person tries to quit but their environment stays the same, they face constant cues and offers, making relapse more likely. In summary, the social fabric surrounding an individual can strongly sustain harmful substance use – through peer pressure, cultural normalization, and the desire to belong – even when that individual knows the health risks intellectually.

3. Economic and Availability Factors

Affordability and Accessibility: Economic factors significantly affect why people continue consuming tobacco and alcohol. A key driver is affordability – when these products are cheap relative to income, consumption tends to be higher. In India, for instance, tobacco is available in many low-cost forms (such as bidis or single cigarettes sold loosely for just a few rupees), which keeps it within easy reach of even the poorest users. Similarly, cheap locally brewed alcohol or inexpensive liquor allows regular drinking without immediate financial strain. The consequence is that users can sustain their habit without the deterrent of cost until severe health issues arise. Studies have shown that raising prices via taxes can curb consumption: economic analyses in India find that a 10% increase in tobacco price is estimated to cut bidi smoking by about 9% and cigarette smoking by about 3–5%, as cost-sensitive users reduce or quit ([PDF] Tobacco Taxes in India). However, when prices remain low or don’t keep up with inflation, tobacco and alcohol use persists or even grows. One report noted that India’s tobacco tax structure historically was not very effective – cigarettes became more affordable over time, undermining public health efforts ( Journal of Family Medicine and Primary Care ) ( Journal of Family Medicine and Primary Care ). Indeed, India continues to be the second largest consumer of tobacco in the world, with 28.6% of adults (about 267 million people) using some form of tobacco ( Journal of Family Medicine and Primary Care ). High affordability is part of the reason; many people simply do not face a financial barrier to continuing their habit. Besides price, physical availability plays a role. In India, tobacco products are ubiquitous – from urban markets to tiny rural kiosks – making it effortless for users to get their next fix. Although laws prohibit sale to minors and near schools, enforcement is lax (The Journey to Reducing Harms Related to Tobacco Use in India) (How will we enforce a smoking age limit? – Times of India), so access remains easy for youth as well. For alcohol, states that have dense retail outlet networks and late selling hours see higher alcohol consumption, since the convenience lowers the threshold for buying frequently. In contrast, places that have state-controlled alcohol shops with limited hours (as in some Scandinavian countries) create a natural curb on consumption. In summary, when harmful substances are cheap and readily available, people are more likely to continue using them, as neither their wallet nor their environment is pushing them to stop.

Marketing and Industry Tactics: The tobacco and alcohol industries have long employed sophisticated marketing tactics to maintain and grow their consumer base, directly impacting continued use. Decades of advertising – from the Marlboro cowboy to glamorous liquor ads – created strong psychological brand loyalties and positive associations that persist even now. While direct ads for cigarettes are banned in many countries (including India), tobacco companies often shift their spending to subtler forms of promotion. They use point-of-sale displays, sponsorships, and brand stretching (like putting a cigarette brand name on T-shirts or water bottles) to keep their products in the public eye ( SAFER – Alcohol advertising ). This kind of surrogate marketing is common: for example, in India where liquor advertising on TV is illegal, alcohol brands sponsor music concerts, sports events, or soda products with identical branding (Exclusive: India plans tougher ad curbs on liquor makers such as …) (Government seeks to curb liquor companies’ surrogate advertising). The effect is that people, especially the young, continue to be exposed to pro-tobacco and pro-alcohol messages despite formal ad bans. Such marketing normalizes consumption and can create a false impression of ubiquity (the sense that “everyone is using it”). Moreover, the industry targets populations strategically – youth are a prime target because hooking them early can create lifelong customers. The WHO has pointed out that tobacco companies design marketing specifically to “help them addict the world’s youth”, knowing that adolescents are more impressionable (Tobacco and nicotine industry tactics addict youth for life). Research shows teens can be three times more sensitive to tobacco ads than adults (Marketing of Tobacco to Children and Youth – NASSP). So even as these youths grow into adults who know the health risks, the deep-rooted positive brand image and identity (e.g. the rugged smoker, the suave beer drinker) make it psychologically harder to quit. Additionally, tobacco and alcohol products themselves are engineered in ways that encourage continued use. Tobacco is often blended with additives to make nicotine hit faster or taste smoother, reinforcing addiction. Many cheap alcoholic drinks have high alcohol content and are sold in large volumes, providing more intoxicating “value” that can foster dependency. Finally, corporate lobbying and policy interference can weaken government regulation – for instance, delaying tax increases or watering down health warnings – which keeps products more affordable and less regulated, as noted by health authorities ( Tobacco use declines despite tobacco industry efforts to jeopardize progress ). All these economic and commercial factors combine to create an environment where the easiest path for a consumer is to keep using the product. Unless strong countermeasures are in place, the market availability and promotion of tobacco and alcohol perpetuate their consumption even among informed users.

Effectiveness of Regulations: Governments have recognized these issues and implemented various regulations to reduce harmful substance use – including taxation, advertising bans, packaging warnings, age restrictions, and smoke-free/drug-free zones. The effectiveness of these measures can influence why some people eventually quit while others continue. Evidence from around the world shows that price increases via higher taxes are the single most effective policy to reduce tobacco use (Raising taxes on tobacco – World Health Organization (WHO)). When cigarettes or alcohol become more expensive, consumption drops, especially among youth and lower-income users who are price-sensitive (Death and Taxes: Economics of Tobacco Control). In countries that have aggressively raised tobacco taxes (like Australia and France), smoking rates have declined substantially. India too has increased tobacco taxes and introduced a nationwide Goods and Services Tax (GST) to simplify the tax system. However, the tax on tobacco in India has been criticized as not high enough or not uniform – for example, bidis have historically had very low tax, keeping them cheap ( Journal of Family Medicine and Primary Care ) ( Journal of Family Medicine and Primary Care ). As a result, while there was a small dip in cigarette affordability right after GST, it didn’t last ( Journal of Family Medicine and Primary Care ). This highlights that strong taxation needs to be sustained and cover all products to be effective. Aside from taxes, health warnings and packaging laws aim to inform and shock consumers. India mandates large graphic warnings on 85% of tobacco pack surfaces and even includes a quit-line number, hoping that constant visual reminders of disease prompt users to reconsider. Such warnings have had some impact on awareness, though addicted users often become habituated to them. Similarly, restrictions on smoking in public places and bans on tobacco/alcohol advertising help de-normalize use. When these rules are well-enforced (e.g. strict fines for smoking in restaurants, or removal of billboards advertising liquor), they reduce passive encouragement to indulge. The success of comprehensive regulations is evident in certain case studies: countries that fully implemented WHO’s MPOWER measures (which include monitoring use, protecting from smoke, offering quit help, warning about dangers, enforcing bans, and raising taxes) have seen sharp declines in tobacco use. Brazil is a striking example – through a mix of high taxes, strong warning labels, complete advertising bans, and extensive public health campaigns, Brazil achieved a ~35% drop in adult smoking prevalence between 1989 and 2003 ( Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989–2003) – PMC ) ( Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989–2003) – PMC ), and continued to see declines thereafter. The latest WHO report notes that Brazil has reduced tobacco use by 35% since 2010 alone by maintaining these controls ( Tobacco use declines despite tobacco industry efforts to jeopardize progress ). This shows that when regulations are comprehensive and sustained, many people either quit or never start, leading to fewer continuing users. On the flip side, weak implementation or partial measures yield smaller effects. In India, for instance, while there is a ban on advertising and public smoking, enforcement issues (like ongoing surrogate ads and frequent violations of smoking bans) mean the impact is less than ideal. Many people continue to smoke or chew tobacco because they still encounter plenty of opportunities and triggers to do so. In summary, sound policies and their enforcement can significantly tilt the scales against continued substance use – but if these measures are lacking or not robust, economic and social forces will continue to favor ongoing consumption. Government action thus directly influences how easy or hard it is for individuals to keep using versus to quit.

4. Barriers to Quitting

Withdrawal Symptoms and Physical Dependence: One of the most immediate barriers to quitting tobacco or alcohol is the array of withdrawal symptoms that manifest once a person stops using. As discussed earlier, the body becomes physically dependent on substances like nicotine and ethanol; when intake suddenly ceases, the user experiences distressing physical and psychological symptoms. For smokers, nicotine withdrawal can set in within hours: they may feel irritability, anxiety, restlessness, difficulty concentrating, headaches, increased appetite, and intense cravings (Why Quitting Smoking Is Hard | Quit Smoking | Tips From Former Smokers | CDC). These symptoms peak in the first week or two of quitting and gradually subside, but during that period the urge to relieve them by smoking is very strong. Many smokers who attempt to quit relapse within the first week because the discomfort drives them back to cigarettes for relief. Essentially, the pain of withdrawal eclipses the distant benefit of quitting, in that moment. In the case of alcohol, withdrawal can be even more formidable. Those who are heavy drinkers can experience tremors (the “shakes”), sweating, nausea, anxiety, and insomnia when they stop drinking. In more severe alcohol dependence, withdrawal can escalate to seizures or delirium tremens (DTs), which involves confusion, hallucinations, and dangerous spikes in blood pressure and heart rate (Delirium Tremens – StatPearls – NCBI Bookshelf). DTs can be fatal if not properly managed, so quitting alcohol often requires medical supervision. The fear of these severe symptoms makes many dependent drinkers hesitant to attempt quitting (“What if it kills me to stop?”). Thus, fear of withdrawal is a huge barrier – users may choose to continue a known harmful habit rather than face the short-term agony and risks of stopping. Even with cessation aids available (like nicotine replacement therapy or medical detox for alcohol), not everyone has access or trust in these, so withdrawal remains a daunting hurdle.

Psychological Dependence and Emotional Factors: Beyond the physical aspect, quitting is also a psychological battle. Over years of use, people often come to rely on tobacco or alcohol as a coping mechanism for stress, boredom, or negative emotions. For instance, a smoker might reach for a cigarette every time they feel anxious or upset, using nicotine’s calming effect as a crutch. A drinker might use alcohol to unwind from work or to temporarily escape personal problems. These substances can “self-medicate” underlying issues like anxiety, depression, or social insecurity. When contemplating quitting, individuals fear losing this emotional coping tool. “If I give up smoking, what will I do when I’m stressed?” is a common worry. Indeed, research has noted that people who use tobacco to manage unpleasant feelings have a harder time quitting because those feelings surge when the substance is removed (Why People Start Smoking and Why It’s Hard to Stop). Quitting requires finding new ways to deal with stress or loneliness – which is not easy and often not immediately as effective as the drug was. This psychological dependence creates cravings that are tied to mood and situation, not just chemical withdrawal. For example, someone may be doing fine nicotine-wise after a month of quitting, but a personal crisis hits and suddenly the psychological craving for a cigarette as comfort becomes overwhelming. Another psychological barrier is lack of confidence and fear of failure. Many long-term users have tried to quit multiple times and relapsed, which can create a defeatist attitude: “I’ve failed before; maybe I just can’t quit.” This mindset can demotivate future quit attempts. The habit is so ingrained in daily life and self-image that imagining life without it can cause anxiety. Some smokers also fear weight gain after quitting (since nicotine suppresses appetite and increases metabolism slightly), and indeed a modest weight gain is common. This concern, especially among women, can be a deterrent to quitting cigarettes. Similarly, someone who drinks socially might fear that quitting alcohol will isolate them or make social interactions awkward (a psychological barrier tied to identity and social confidence). All these factors contribute to a phenomenon where users often feel that continuing the habit is the path of least resistance; quitting, by contrast, appears stressful, painful, and fraught with potential emotional turmoil.

Lack of Support and Resources: Another crucial barrier to quitting harmful substances is the lack of effective support systems. Quitting is difficult to do alone, and the availability of counseling, medications, and social support can make the difference between success and relapse. Unfortunately, many people do not receive or seek help when attempting to quit. According to the U.S. CDC, while about two-thirds of adult smokers want to quit and over half try to quit each year, less than 1 in 10 succeed in quitting annually (Smoking Cessation: Fast Facts | Smoking and Tobacco Use | CDC) (Smoking Cessation: Fast Facts | Smoking and Tobacco Use | CDC). One reason for this low success rate is that the majority try to quit “cold turkey” without assistance – often underestimating how tough nicotine addiction can be. Data show that only about 38% of smokers who tried to quit used proven treatments like counseling or medication (Smoking Cessation: Fast Facts | Smoking and Tobacco Use | CDC). The rest went without, meaning they had to battle withdrawal and cravings with willpower alone. Many are not aware of or do not have access to cessation aids. In India, for instance, specialized stop-smoking clinics and support groups are relatively few in number given the huge population of tobacco users. Rural areas in particular may have virtually no cessation services. This gap in support leaves people on their own, greatly reducing their chances of quitting successfully. Even family and social support can be lacking: if one’s family members also smoke or drink, they might not be very encouraging of the person’s quit attempt (sometimes even sabotaging it inadvertently by continuing to offer the substance). In other cases, family and friends might want to help but not know how – quitting can be a lonely journey if no one around you understands the process. Behavioral counseling has been shown to improve quit rates by providing strategies to cope with cravings and changing routines, but many users never talk to a healthcare professional about quitting. The CDC noted that only about half of smokers who saw a doctor in a given year were advised to quit or offered help (Smoking Cessation: Fast Facts | Smoking and Tobacco Use | CDC). This indicates missed opportunities in the healthcare system to intervene. Additionally, access to nicotine replacement therapy (NRT) or medications like varenicline can double the chances of success, but these may be costly or unavailable for many individuals, or people may not know about them. For alcohol, formal treatment programs (rehab, therapy, support groups like AA) have proven efficacy, yet stigma and denial often prevent people from utilizing them until their dependence is very severe. In summary, when individuals lack support – whether medical, social, or informational – quitting becomes far more daunting. The path of continuing to smoke or drink might feel “easier” than stepping into the unknown challenge of cessation without a safety net. Overcoming addiction is difficult but entirely possible; however, the absence of support structures is a barrier that leaves many people stuck in their harmful habits longer than they would be if help were readily available.

5. Solutions and Recommendations

Breaking the cycle of harmful substance use requires multi-faceted strategies targeting the behavioral, social, and economic drivers discussed. Effective solutions involve not only individual willpower, but also strong policy measures, education and culture-change efforts, and supportive resources to help users quit. Here we outline key approaches, with examples of successful interventions from around the world:

Strengthening Policy and Regulation: Government action is crucial to reshape the environment that sustains tobacco and alcohol use. Key policies include raising taxes to increase prices (making these substances less affordable), banning or severely restricting advertising and promotions, enforcing minimum age laws, and mandating prominent health warnings. Higher taxes are particularly powerful – the WHO states that significantly increasing tobacco taxes is the most cost-effective measure to reduce use (Raising taxes on tobacco – World Health Organization (WHO)), and many countries have seen consumption drop following tax hikes. For example, Australia’s sharp tax increases and plain packaging law contributed to smoking rates falling to record lows in recent years. Comprehensive smoking bans in public places protect non-smokers and also help smokers reduce consumption by removing cues and convenient opportunities. Likewise, limiting the density of alcohol outlets and hours of sale (as done in some Nordic countries and parts of the U.S.) can reduce overall alcohol intake in the community. The experience of Brazil illustrates the impact of combined regulations: Brazil implemented high tobacco taxes, a nationwide advertising ban, large graphic warnings, and free cessation support as part of a national program. As a result, Brazil’s smoking rate plummeted from 34.8% in 1989 to about 18% by 2008 ( Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989–2003) – PMC ), one of the fastest declines in the world. The WHO commended Brazil, noting it achieved a 35% relative reduction in tobacco use in just the past decade by rigorously applying these policies ( Tobacco use declines despite tobacco industry efforts to jeopardize progress ). This success story shows that strong regulations do change behavior on a large scale – fewer people start, many users cut down or quit, and social norms shift against tobacco. Governments should also close loopholes (e.g. ban surrogate ads, as India is now moving to do for alcohol (Exclusive: India plans tougher ad curbs on liquor makers such as …)) and resist industry interference that tries to dilute policies ( Tobacco use declines despite tobacco industry efforts to jeopardize progress ). In summary, recommendation #1 is for governments to adopt and enforce evidence-based measures (tax, restrict, inform, and protect) to create an environment that discourages continued use and supports healthy choices.
Education and Cultural Change: Since cultural and social norms strongly influence substance use, education campaigns and community interventions are needed to change perceptions and behaviors. Public health education should start early – school-based programs can teach children and teenagers about the real risks of smoking and drinking, and equip them with refusal skills to resist peer pressure. Mass media campaigns are another powerful tool: hard-hitting anti-tobacco media campaigns (like India’s National Tobacco Control Program spots that play before movies, or the U.S. CDC’s “Tips From Former Smokers” ads) have prompted many users to attempt quitting by graphically depicting the health consequences. These campaigns serve to counter the years of pro-use messaging and can reshape social norms by making tobacco use less cool and more socially unacceptable. Community-based approaches can also yield impressive results. A shining example is Iceland’s approach to teen substance use: In the late 1990s, Iceland had one of the highest rates of teen drinking in Europe, but by 2016, it had one of the lowest. This was achieved through a holistic program that involved parents, schools, and local governments providing extensive after-school activities (sports, arts, clubs) to engage youth, imposing curfews for teenagers, and getting parents to sign agreements to not allow unsupervised parties (How Iceland Saved Its Teenagers – BBC News – YouTube). These efforts offered young people healthier outlets and strengthened parent-child bonds, drastically reducing teenage alcohol and drug use. Iceland’s success (How Iceland Saved Its Teenagers – BBC News – YouTube) teaches that changing the social environment and providing alternatives (fun, purpose, belonging that don’t involve substances) can break the cycle of use. Culturally sensitive campaigns are important in places like India – messaging that resonates with local values (for instance, highlighting the impact of alcohol on family wellbeing or linking tobacco to oral cancer which is well-known in India) can drive the point home. Leveraging influential figures (sports stars, actors in their personal capacity, community leaders) to speak against tobacco and alcohol can also chip away at their allure. Over time, sustained education and advocacy can lead to a generation with different attitudes – one in which lighting a cigarette is seen as unusual and undesirable rather than a normal rite of passage. Recommendation #2 is to invest in education and culture-change initiatives that denormalize tobacco and alcohol use: implement creative media campaigns, empower schools and communities with prevention programs, and celebrate a substance-free lifestyle as the healthy, aspirational norm.
Accessible Cessation Support and Technology: Given the significant barriers to quitting, providing robust support to those trying to quit is essential. Healthcare systems and governments should make cessation aids widely accessible and affordable. This includes training healthcare providers to routinely advise patients to quit and to offer help, setting up toll-free quitlines (India, for example, has a quitline number displayed on tobacco packs now), and expanding tobacco/alcohol cessation clinics. Counseling (even brief advice from a doctor) significantly improves quit rates (Smoking Cessation: Fast Facts | Smoking and Tobacco Use | CDC), and medications like NRT, bupropion, or varenicline roughly double the chances of success. Removing cost barriers (through insurance or government programs) would encourage more people to use these proven aids. Alongside traditional support, technology-based interventions are increasingly valuable. Smartphone apps, online forums, and text-messaging programs can reach users who may not otherwise access help. There are now many quit-smoking apps that track progress, provide daily tips, and give motivational encouragement. Research shows some of these apps can be effective – for instance, a randomized trial in Finland found that a tailored quit-smoking app tripled the success rate of quitting (20% of app users quit vs 7% of a control group using pamphlets) over a 3-month follow-up ( New mobile app shows dramatic success in smoking cessation ). The app, which used techniques like cognitive behavioral therapy exercises and virtual support, helped more smokers stay off cigarettes ( New mobile app shows dramatic success in smoking cessation ). This demonstrates how digital tools can complement traditional methods by delivering support right to the user’s pocket at craving moments. Online support groups and social networks can also be harnessed – many ex-users credit forums (like Reddit’s stop-smoking community or Alcoholics Anonymous online meetings) for providing understanding peers and practical tips around the clock. Governments and NGOs should promote these resources so that people know help is available and that they don’t have to quit alone. Moreover, integrating cessation support into primary healthcare (making “quit checks” a routine part of visits) and into workplaces (worksite wellness programs to quit smoking or drinking) can nudge more individuals to take advantage of support. In sum, recommendation #3 is to greatly enhance cessation support systems: make quit-smoking and quit-drinking aids easy to access, leverage technology (apps, SMS, social media) to deliver support, and ensure every user knows that effective help exists to overcome withdrawal and cravings. When people feel supported and see quitting as feasible with help, they are more likely to attempt and succeed in breaking free from addiction.

Conclusion: People continue to smoke cigarettes or consume alcohol despite knowing the risks due to a confluence of addiction’s grip, psychological rationalizations, social reinforcements, and systemic factors. Understanding these reasons is the first step toward addressing them. By implementing strong policies (to disincentivize use and limit access), by shifting cultural norms and educating citizens (to erode the social appeal of these substances), and by providing empathetic support and tools for quitting, societies can help individuals overcome these habits. The progress seen in various countries – whether it’s declining global tobacco use (from 1 in 3 adults in 2000 to about 1 in 5 in 2022) ( Tobacco use declines despite tobacco industry efforts to jeopardize progress ) or communities with dramatic drops in drinking – offers hope. In India, continued efforts under initiatives like the National Tobacco Control Program, stricter enforcement of laws, and greater public awareness can gradually change the trajectory of tobacco and alcohol use. Ultimately, reducing consumption of harmful substances is a collective effort: it requires sustained commitment from governments, communities, families, and individuals alike. The benefits of success are immense – longer and healthier lives, less burden of disease, and social and economic gains. It is not an easy journey, but as case studies show, people can and do quit in large numbers when the right conditions and supports are in place (Smoking Cessation: Fast Facts | Smoking and Tobacco Use | CDC) (Smoking Cessation: Fast Facts | Smoking and Tobacco Use | CDC). Replacing the culture of tobacco and alcohol with one that values health is both the challenge and the goal in the years ahead.

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