[2023] Any way to make the game actually be survival?

I reduce the loot setting; it really makes a difference on accumulating too much food/ammo/meds. Also, where you reside makes a difference, with living in the snow, the wasteland, and/or the city being (in broad strokes) more challenging with more enemies. But I sympathize that some areas of survival, e.g. surviving the elements, are underdeveloped.