Tobacco and alcohol: India’s preventable health disaster
Walk into any street corner shop in India and you’ll find two things sold without much thought: cigarettes and cheap sachets of tobacco. Add alcohol to the mix, now more socially accepted than ever, and you’ve got a public health crisis hiding in plain sight.
India is home to over 260 million tobacco users. That’s nearly one in three adults. Tobacco alone kills more than 1.3 million Indians every year. Let that sink in. More than a million deaths annually from something entirely preventable. And it’s not just lung cancer. Tobacco is linked to heart disease, stroke, chronic lung disease, oral cancers. the list is long and brutal.
Alcohol isn’t far behind. Data suggests that around 14–16% of Indians consume alcohol, with harmful or dependent drinking seen in a significant proportion of users. Alcohol contributes to liver cirrhosis, cancers, road accidents, domestic violence, and mental health disorders. In fact, liver disease is now one of the leading causes of death among young and middle-aged Indian men, and alcohol plays a major role.
What makes this worse is how normal it all feels
Smoking is still seen as stress relief. Drinking is marketed as celebration, success, even masculinity. The warning labels exist, but so does easy access. And aggressive marketing finds new ways to slip through regulations.
The tragedy? None of this is inevitable. These aren’t mysterious diseases without cures. They’re habits. Risk factors.
India doesn’t just have a tobacco and alcohol problem. It has a preventable health disaster unfolding in slow motion and to create more awareness on this, we connected with Dr. Arun Kumar Goel, Chairman Surgical Oncology, Andromeda Cancer Hospital.
How big a role do tobacco and alcohol play in India’s top preventable diseases like cancer, heart disease, and liver disease?
Dr. Arun Kumar Goel: Inadequately managing or using tobacco and alcohol in India are significant contributors to numerous illness, disease, and injury. Tobacco consumption causes a range of lung, mouth, and throat cancers and raises the risk of developing heart disease. Alcohol consumption is associated with liver diseases, several types of cancers, high blood pressure, and heart disease. Together, tobacco and alcohol lead to millions of deaths and illnesses that are preventable.
Are there particular age groups or regions in India that are more affected by tobacco and alcohol use?
Dr. Arun Kumar Goel: Alcohol and tobacco affect young adults and middle-aged individuals; while males have traditionally used tobacco and alcohol more than any other segment of the population, females are also starting to increase their use. In several areas of India, particularly in northeastern states and in urban areas, the consumption of both substances is high as a result of easy accessibility, acceptance by peers, stressful situations, and cultural customs.
How has youth consumption of alcohol and tobacco changed in the last decade?
Dr. Arun Kumar Goel: In the last ten years, young people's consumption of alcohol and tobacco has risen sharply, particularly in urban areas. The rising popularity of certain new product forms, including vaping products and flavoured tobacco; social drinking; and the associated social pressures of peers and social media; have made these products seem fashionable and thereby have led to more early starters than ever before.
What misconceptions do people have about “safe” levels of drinking or occasional tobacco use?
Dr. Arun Kumar Goel: A lot of individuals think that drinking occasionally or smoking lightly isn't going to harm them; they're mistaken. Even small amounts will increase your risk of developing cancer and heart disease as time passes by. Some people also think that drinking alcohol made at home or smoking socially will not pose any risk to them or their health; however, no form of tobacco is safe, and the risks associated with drinking will become greater as you continue to drink regularly.
What are the early warning signs that heavy alcohol or tobacco use is damaging health?
Dr. Arun Kumar Goel: Signs and symptoms of alcohol and/or tobacco use can show up well before you realize there is a problem. Some early warning signs of excessive drinking or smoking are persistent cough; shortness of breath; sores in the mouth; trouble falling asleep; acid reflux; unexplained weight loss; and frequent illnesses. Some early warning signs of alcohol use include: Liver pain, yellow sclera (white part of the eye), personality changes and memory loss. All of these symptoms can appear gradually over time and should not be ignored.
If someone wants to quit today, what practical steps should they take, and what support systems are available?
Dr. Arun Kumar Goel: One way to help quit using any substance is to establish a clear quit date; identify the triggers that make you want to use the substance and enlist support from your family and friends for quitting the drug. Medical assistance with prescription medications, nicotine replacement therapy (NRT), counseling, and de-addiction programs are available to help you reach your goal of being alcohol and/or tobacco-free. There are also government-sponsored hotlines, hospitals, and NGOs in India that offer free or low-cost assistance to quit using tobacco or alcohol.