Girlfriend takes 3 to 4 500mg vicodin a day for permanent chronic pain. sural nerve removed. drinks 6 beers a day and cigarettes. is health at risk?

Absolutely: Your girlfriend is slowly killing herself. There is a good chance her pain problems are going to get worse and worse and she may already be addicted to pain meds.

Absolutely: Lets focus on the current issue. Alcohol use of this degree is associated with rebound anxiety and pain exacerbation which is increasing the need for the pain meds. Pain need use of that regularity will also be associated with mild withdrawal between doses and subsequent anxiety. This drives the need for alcohol. However the use of these substances keeps her regularly on the edge of withdrawal.

Serious risk: The combination of heavy drinking and cigarette use has a synergistic effect, making the combo much more unhealthy than either alone ( which of course are not great by themselves). She should seriously considered counseling to get all 3 habits under control and at the same time seek a pain specialist.