Harmful Substances

Reducing our exposure to toxic or harmful substances or behaviours is sometimes characterised as the ‘negative’ Lifestyle Medicine pillar. This probably stems from Lifestyle Medicine’s emphasis on eliminating these substances from our lives – or at least reducing their use. While the other Lifestyle Medicine pillars focus on doing something positive – eating healthily, being more active – this pillar is all about not doing something.

The risks associated with harmful and toxic substances – such as alcohol, tobacco or recreational drugs – are well known. Few of our patients are unaware of the damage which excessive drinking, smoking or drug use can do to their health. However, as with many aspects of our lifestyle, having the knowledge of unhealthy behaviours is only the start. Achieving positive behaviour change is the difficult part – and this is perhaps most challenging when it comes to harmful substance reduction or cessation.

A quick reminder of some of these harms is however useful …

Smoking and heavy drinking in particular are key behavioural risk factors associated with many chronic physical and mental health conditions. They are among the main causes of preventable deaths.

Smoking kills more than five million people globally each year, while drinking too much is associated with a greater risk of chronic liver disease, some cancers and heart disease. Smoking is, of course, the biggest risk factor when it comes to developing cancer – especially cancers of the lungs, mouth and throat. Smoking also harms your immune system and puts you at greater risk of heart disease.

Drinking too much alcohol can also place us at greater risk of death and injury from accidents – and even violence. And it’s important to note that alcohol and tobacco misuse also often go hand in hand. Having a problem with one, increases our likelihood of having a problem with the other.

Lifestyle Medicine facts: harmful substance misuse

  • 24% of adults in the UK regularly drink over recommended guidelines
  • Alcohol is responsible for 4% of disease globally. Contributing to more than 60 different medical conditions
  • Smoking kills five million people worldwide every year
  • 16% of all accidental deaths involve alcohol
  • 7/10 people in professional occupations drink over guidelines compared to 5/10 of those in manual occupations

The British Society of Lifestyle Medicine therefore advocates for a non-judgemental, supportive and compassionate approach to this important pillar of Lifestyle Medicine.

As Lifestyle Medicine doctors, professionals and practitioners, supporting patients to achieve meaningful change in this area is perhaps our greatest challenge. When unhealthy behaviour such as excessive alcohol consumption, smoking or drug use have become ingrained habits they can become very difficult to unpick.

However, the good news is that the tools and techniques of Lifestyle Medicine can have a positive impact. Lifestyle Medicine can offer real hope to people experiencing difficulties in this area of their lives – and BSLM advocates for its wider use in harm reduction and prevention strategies in this area.

Approaches and techniques used in Lifestyle Medicine include motivational interviewing, health coaching, screening, readiness assessments, brief interventions and extended interventions.

The Lifestyle Medicine approach advocated by BSLM emphasises …

  • A non-judgemental, supportive approach based on replacing unhealthy habits with healthy ones.
  • Listening to patients without criticising or blaming and establishing and removing individual barriers to change.
  • Replacing harmful – and largely ineffective – ways to “feel good” and reduce stress with healthy alternatives such as physical activity, connecting with nature, sleeping well, eating healthy food, meditation, listening to music and improved social connections.
  • Referral to support services where appropriate – e.g., alcohol treatment services.

More recently, BSLM has also advocated for a broadening out of the definitions of harmful substances, toxins and behaviours to include other areas of our modern lifestyles. This now encompasses excessive internet or social media use, gambling and even the harm which can be caused by excessive or inappropriate use of prescription drugs.

Further reading and learning

Watch BSLM regional director Dr Sue Smith’s webinar presentation on reducing harmful substance misuse (BSLM members only).

Listen to the BSLM podcast on creating healthy habits