Avoiding Risky Substances: The Sixth Pillar of Lifestyle Medicine

This pillar is often where healthcare gets preachy, judgmental, and ultimately unhelpful.

Let me be clear about my approach: I'm not here to shame you. I'm here to give you honest information so you can make informed decisions about your own life.

What you do with that information is up to you.

Why This Pillar Is Different

The first five pillars are about adding things: more nourishing food, more movement, better sleep, stress skills, connection. This pillar is about recognizing when certain substances are working against your health goals.

Notice I said "working against your health goals"—not "morally wrong" or "making you a bad person."

Substances are tools. Some tools help you build the life you want. Others get in the way. The question isn't whether a substance is inherently good or evil—it's whether your current relationship with it is serving your goals.

Tobacco: The Clearest Case

Let's start with the most straightforward one: tobacco use, particularly smoking, has no health benefits and significant harms.

The effects of smoking include:

• Dramatically increased risk of heart disease, stroke, and multiple cancers

• Impaired wound healing (this directly affects chiropractic treatment outcomes)

• Increased inflammation throughout the body

• Accelerated spinal disc degeneration

• Reduced bone density

• Impaired blood flow to tissues

• Respiratory damage

For patients working on pain management and healing, smoking is one of the most significant barriers to progress. Blood flow matters for healing. Inflammation matters for pain. Disc health matters for spinal conditions. Smoking works against all of these.

The good news: quitting produces measurable health improvements within weeks, and most of the excess risk reverses over time. It's never too late to benefit from stopping.

If you want to quit but have struggled, that's not a character flaw—nicotine addiction is real and challenging. Evidence-based approaches include:

• Nicotine replacement therapy (patches, gum, lozenges)

• Prescription medications (varenicline, bupropion)

• Behavioral support and counseling

• Combination approaches (usually most effective)

I can refer you to smoking cessation resources if you're interested. No judgment, just support.

Alcohol: More Complicated

Alcohol is culturally normalized in ways that make honest conversation difficult. It's also where harm reduction matters most.

What the research actually shows:

The idea that moderate drinking is healthy has been significantly weakened by recent research. Earlier studies showing benefits were often confounded—moderate drinkers differed from non-drinkers in many ways beyond alcohol consumption.

Current evidence suggests:

• There is no level of alcohol consumption that is completely safe

• Even moderate drinking is associated with increased risk of certain cancers

• Cardiovascular "benefits" were likely overstated in earlier research

• Risk increases with consumption in a dose-dependent way

That said:

• Low levels of drinking pose relatively small absolute risks for most people

• Cultural, social, and pleasure aspects of drinking are real

• Absolutist approaches backfire for many people

• Harm reduction works better than abstinence demands for most

When alcohol becomes problematic:

Concern is warranted when:

• Drinking interferes with responsibilities or relationships

• You regularly drink more than intended

• Attempts to cut back fail repeatedly

• Tolerance has increased significantly

• Withdrawal symptoms occur

• Drinking to cope with emotions becomes the primary coping mechanism

• Physical health is being affected (sleep, weight, liver function, etc.)

Alcohol and pain:

Alcohol has a complex relationship with pain:

• Initially numbs pain perception

• Disrupts sleep architecture, which increases next-day pain

• Contributes to inflammation when consumed regularly

• Interferes with some medications

• Can become a coping mechanism that prevents addressing underlying issues

Patients who reduce alcohol consumption often notice improved sleep and reduced inflammation—both of which affect pain.

Harm reduction for alcohol:

If you're not ready to quit or don't believe you need to:

• Track your consumption honestly

• Set limits before drinking and stick to them

• Alternate alcoholic drinks with water

• Have alcohol-free days each week

• Avoid drinking for emotional regulation

• Know your personal patterns and triggers

Other Substances

Cannabis:

Cannabis is increasingly legal and widely used. The research is evolving, but current understanding suggests:

• Some therapeutic applications exist (certain types of pain, nausea, seizure disorders)

• Smoking cannabis carries respiratory risks similar to tobacco

• Regular use affects memory, attention, and motivation in some users

• High-THC products may increase mental health risks in vulnerable individuals

• CBD products are generally lower-risk but also have less robust evidence

If you use cannabis, be honest about whether it's helping your health goals or interfering with them. Consider consumption method (smoking vs. edibles vs. topicals). Be aware of effects on motivation, sleep quality, and mental health.

Caffeine:

Caffeine is so normalized we often don't think of it as a drug. For most people in moderate amounts, it's fine. But consider:

• Caffeine consumed after noon affects sleep for most people

• High doses increase anxiety and stress hormones

• Tolerance develops, requiring more for the same effect

• Withdrawal causes headaches and fatigue

• Energy drinks combine caffeine with other stimulants in concerning ways

If you're addressing sleep or stress, caffeine is worth examining.

Prescription and over-the-counter medications:

Not all medication use is problematic, but some patterns warrant attention:

• Chronic opioid use for non-malignant pain

• Regular use of sleep medications

• Excessive NSAID use (ibuprofen, naproxen)

• Long-term benzodiazepine use

If you're depending on medications to manage symptoms that might respond to lifestyle interventions, there may be room for change. This doesn't mean stopping medications—it means exploring whether lifestyle factors could reduce need over time.

Harm Reduction Philosophy

Harm reduction means meeting people where they are, not where we think they should be. It means:

Pragmatism over ideology. What actually works to reduce harm, rather than what feels morally correct?

Incremental progress. Reducing use is better than failing at abstinence. Safer use is better than unsafe use.

Removing barriers. Making it easier to make healthier choices rather than adding shame and punishment.

Individual agency. Respecting people's right to make their own decisions while providing honest information.

Context matters. Understanding why people use substances, not just that they do.

This approach is the opposite of how many healthcare providers address substances. It's also more effective for most people.

Questions to Ask Yourself

Rather than rules about what you "should" do, consider these questions:

About any substance:

• Is this serving my health goals or working against them?

• What would change if I significantly reduced or eliminated this?

• What need is this substance meeting? Could I meet that need another way?

• Am I in control of my use, or is it in control of me?

If honest reflection suggests a problem:

• What support would help me make changes?

• What barriers have stopped previous attempts?

• What smaller step could I take right now?

What I Can Help With

As part of lifestyle medicine consultations, I can:

• Provide honest, non-judgmental assessment of how substance use affects your health goals

• Support harm reduction approaches where appropriate

• Refer to specialized treatment resources when needed

• Address lifestyle factors that often underlie substance use (stress, pain, sleep, connection)

• Monitor progress and adjust approaches

This isn't about lecturing you about your choices. It's about helping you see clearly and make decisions aligned with what you actually want for your health and life.

Series Conclusion

Over the past seven weeks, we've explored all six pillars of lifestyle medicine:

1. Nutrition

2. Physical Activity

3. Restorative Sleep

4. Stress Management

5. Social Connection

6. Avoiding Risky Substances

These pillars work together. Better sleep improves stress resilience. Reduced stress supports better food choices. Social connection provides motivation for movement. Addressing substances improves sleep. It's all connected.

The most important insight isn't any single pillar—it's understanding that sustainable health transformation happens through lifestyle, not quick fixes.

Your Next Step

If you've been following this series and want to take action, here's where to start:

Pick one pillar. The one that resonates most or where you see the biggest opportunity.

Start small. One change, practiced consistently, beats an ambitious overhaul every time.

Get support. Accountability and guidance make success more likely.

Book a Lifestyle Medicine Consultation and let's create a personalized plan for your sustainable transformation.

Thank you for following this series. My mission is healing as resistance, care as liberation. I hope these posts have given you tools for your own journey.