Background: We examined the relation of tobacco and alcohol consumption after total laryngectomy with overall survival (OS). Methods: Tobacco and alcohol consumption was assessed at 5 time points after total laryngectomy. Patients were followed up for survival until December 31, 2014. A multivariate Cox regression was fitted to test for differences in OS. Results: Three hundred fifty-nine patients were included in this study. Compared to former smokers, never smokers had hazard ratios (HRs) of 0.88 (95% confidence intervals [CIs] = 0.50–1.59), and continuous smokers 1.31 (95% CI = 0.87–1.96). Constantly high alcohol consumption after total laryngectomy had an HR of 2.19 (95% CI = 1.30–3.67). Duration of smoking (HR = 1.00; 95% CI = 0.99–1.01) and last known status of alcohol consumption (HR = 1.00; 95% CI = 0.76–1.33) was not related to OS. Conclusion: Patients who smoke after total laryngectomy have a 30% higher risk of dying than people who gave up smoking, and constant high alcohol consumption is also a strong risk factor for dying.