OBJECTIVES: To assess the prevalence of tobacco and alcohol consumption, and household spending on tobacco, alcohol compared to household health expenditure, across different educational levels and income quintiles. METHODS: The study analyzed two major nationally representative household surveys conducted by the National Statistical Office of Thailand, the Health and Welfare Survey (HWS) for 2001, 2003 and 2006, and the Household Socioeconomic Survey (SES) for 2002, 2004 and 2006. RESULTS: The prevalence of regular tobacco and alcohol consumption among those in the lower educational levels (primary and non-educated) and poorer income quintiles was higher than the highly educated at university level and higher income quintiles. The inequitable index (ratio of prevalence between the first and the fifth income quintiles, and between the lowest and the highest educational levels) of risk exposure to alcohol and tobacco increased over the period of 2001 to 2006, indicating those with limited education and poor socio-economic status did not benefit from government campaigns against tobacco and alcohol consumption. Benefits from the campaigns against tobacco were mostly yielded to the richer and higher income groups, while there was no significant difference of benefits gained from the campaigns between those with different income or educational levels. In addition, household spending on alcohol and tobacco consumption was 4-8% higher than that on healthcare. CONCLUSIONS: Urgent revisit of effective policy interventions for tobacco and alcohol consumption control was proposed. This includes demand and supply side interventions, especially on taxation and price policy due to income and price elasticity of tobacco and alcohol. Control of accessibility to alcohol should include hours of sale, minimum purchasing age, prohibit of alcohol sale and consumption in high-risk situations, and drunk-driving breath testing.