What's galling is how badly this type of person handles it when the inevitable catches up with them. Anyone can break down under the stress of serious illness. But the people who know for a fact that it's a result of their own choices are usually horrible about accepting it. I think in large part because they start out framing it as something with only personal impact.  But life doesn't work like that and neither does terminal illness. When we're dying it's often the people who love us that are hit the hardest. We know that the pain is going to be over fairly soon for ourselves. But we're struck with the realization that whatever we created around us is our final gift to the people we care about the most. And in the case of lifestyle related illness, people see just how much they've hurt their loved ones and know it's 100% on their own shoulders. They find out that their own unwillingness to tackle an addiction, or even just a personal indulgence, will result in mental scars that will last the lifetime of their spouse and kids.  People tend to run from that kind of thing. They can't handle the personal responsibility and try to deflect it on ANYONE. Not just the medical professionals trying to keep them alive. But often times even lashing out at their own families. Whose love makes it so hard to deal with in the first place.  The people who cover their ears and eyes at the doctor when it's about something serious are usually a ticking timebomb for everyone around them.