Have there ever been any thoughts of adding items based around Isaac trying to smoke or drink? It could tie into the theme of child neglect well. Both could have visual deformities based on the long term effects. For example, cigarettes (the item could be called Pack A Day) could have a hole in his throat, or have him hacking up phlegm, and alcohol (maybe called Mom's Drink) could have jaundicing or stunted growth from fetal alcohol syndrome.

i just dont feel like those things fit into the world of isaac, its hard to explain the humor and theme when it comes to items.. because there are a lot of drug references in isaac, but smoking and drinking just dont feel funny or fitting to me at all… pills and needles yes, cigs and alcohol no.