Alcohol is Most Harmful Drug?

A famous David Nutt figure included in an article of his in The Lancet.

I mostly write about rocks here, but as a skeptic I was very intrigued by this recent news story. A panel of scientists led by Prof. David Nutt in England have named alcohol the “most harmful” drug.

I believe their labeling- if only because alcohol is one of the most widely-used and socially acceptable drugs. The drug is also capable of great physical harm. Many families have been affected in very bad ways by alcoholism, my own included. My own parents rarely drink (half a beer and my mom is *very* drunk), but we have other family members who are alcoholics or recovering alcoholics. No one in the family talks openly about the problems with alcohol these people face, but everyone whispers about it. One family member has serious health problems as a result of many years of drinking. Personal stories aside, however, I am very happy to see someone take a scientific approach to understanding drugs and the harm they do. There should be more scientific research on this, in my opinion. There should be more scientific debate and dialogue between various researching groups. Perhaps there already is- anyone work in this field and know more about it?

Personally, I think we should follow science- not social convention and socially-impregnanted prejudices- when it comes to tackling drugs and their regulation (or lack thereof). As David Nutt infamously said in one of his papers, taking the drug ecstasy is statistically less-dangerous than horseback riding.

Drugs and their legality are a major topic of discussion these days. For instance, yesterday California voted against legalizing marijuana.

Personally, I am a scaredy-cat goody two-shoes when it comes to drugs. I drink alcohol occasionally- no more than 3 or 4 drinks a month, generally- and I’ve been drunk maybe 3 or 4 times. Once was after I went on a wine tour without having breakfast and ended up drunk by 11am. I have since learned to eat breakfast before wine tours and not to drink all the wine just because it’s “free.” However, I find it funny that as a goody two-shoes I actually regularly use the most harmful drug of all. Also, I have never tried ecstasy (or any other drugs aside from alcohol), though I did take horseback riding lessons for several years.

Actually, most of us regularly use the “most harmful” drug… at least once a month at Skeptics in the Pub. According to Nutt and his research team, perhaps we should be organizing monthly cannabis or khat events, rather than monthly drinking events. Might be better for our health, if illegal most places in the world.


Evelyn is a geologist, writer, traveler, and skeptic residing in Cape Town, South Africa with frequent trips back to the US for work. She has two adorable cats; enjoys hiking, rock climbing, and kayaking; and has a very large rock collection. You can follow her on twitter @GeoEvelyn. She also writes a geology blog called Georneys.

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  1. Personally … I think the study is a load of crap and a huge exercise in how to lie with statistics.

    Imagining that the harm caused by alcohol is any way comparable to that caused by crack-cocaine is just fucking insane.

  2. It may or may not be a conflict of interest, but according to some sources, Nutt is developing his own ‘safe’ alternative to alcohol, a fact not declared in most coverage of his research.

    Thought it worth mentioning in case you wanted to do some digging.

  3. There are so many ways to measure harm that it isn’t very difficult to show evidence that any moderately harmful drugs are the MOST harmful. I think one of the keys to declaring alcohol the most harmful is that you have to look at harm to other people. Drunken driving probably easily causes more death and damage than any other substance’s harm, even on a per person basis. It also helps that alcohol is probably the most widely used drug so cumulative damage is quite high if you don’t average it by user or doses among the population.

  4. Interesting article, Evelyn. I hope it will fuel a lively debate.

    I know this is not the point of the original article, but I can easily believe that alcohol is the most harmful drug based strictly on the number of people it as harmed both directly and indirectly. I like it, however, both for the yummy beverages its in and for it’s effect on me. Plus my wife and I have crazy fun conversations while splitting a bottle of wine. One of the many advantages of not driving is not having to think about drinking and driving any more.

    I think it is good to be aware of the dangers of the drugs in our life and pass these lessons on to our families. For decades the number one cause of accidental poisoning in children was aspirin because most parents didn’t properly understand the danger. Child-resistant caps mostly solved this problem.

  5. I imagine this article will cause much debate… that’s why I posted it. Nutt is a controversial figure with controversial opinions.

    I don’t know what I believe on the matter, really… nor am I an expert in this field, nor have I actually read the scientific article (reading a CNN article is not enough to base an opinion on). However, I am very intrigued by it…

    Also, I agree that the “most harmful” classification is perhaps far from scientific. What is the best way to scientifically classify harm? If cannabis were legal, would its use be more widespread and thus would it become more harmful? There is clearly much to discuss…

  6. @NoAstronomer

    Official statistics released today showed there were 235 deaths linked to cocaine abuse in England and Wales in 2008, compared with 197 people in 2007. The figures include deaths related to crack cocaine.

    Alcohol related deaths in the UK rose to 9,031 in 2008, up from 8,724 the previous year.

    I realise that just measuring the number of deaths is a fairly blunt way of ascertaining the cause of the greatest harm, but I think it’s a fairly strong argument.

    I believe Nutt’s reasoning is mostly based on the fact that alcohol use is far, far more widespread in the UK than any other drug, and a large proportion of violence is alcohol-related.

    Bit more info on the alcohol alternative touched on by Tracy King:

    Interesting article on the consequences of legalisation:

  7. Total mortality and health issues related to alcohol as well as fetal alcohol issues worldwide would be way more of a problem than all other drugs combined in my estimation and as shown by Supertec above. A quick google of some government and private organizations show the following.

    2009 US Alcohol related traffic fatalities: 33,808
    Annual US alcohol related cause of death approximate: 85,000
    Annual US illicit drug related deaths approximate 17,000
    Annual US tobacco related deaths approximate 435,000

    And from my perspective in dealing with child protection issues alcohol abuse often presents more risk to children, due to the associated car accidents and violence, than most illegal drugs.

  8. This goes to show that social conventions are more powerful than scientific information in many ways. In the U.S. we gladly put into force laws that restrict drug use but do that with alcohol and people get upset. Look at what happened with the 18th amendment. (Prohibition for those who aren’t familiar with U.S. history.)

    A lot has been said about the “war on drugs” and how it’s a dismal failure. In a purely academic sense I’d like to see what would happen if instead of making drugs illegal if we regulated them in much the same way we regulate alcohol and tobacco. (This is not to say we’re entirely successful with that.) I think it would mean more money for the government since the stuff would be taxed like crazy.

    The big thing is that it all comes down to responsibility. Is it fair to those who can responsibly use alcohol if alcohol were removed from the market? (We’ve seen what happens when we do that.) What about other drugs such as marijuana? How should we regulate drugs which have a high level of addictiveness? Can such drugs as heroin and cocaine be used responsibly?

  9. I am not surprised at the results because alcohol is, by far, the most widely used drug and therefore more people misuse it. However, what would happen to the results if the study was controlled for population? I have no idea how this would be done, but my guess is it would look different as a result.

  10. Here’s a pretty good breakdown of some of the faulty criteria used in Dr. Nutt’s paper:

    A snippet from there: Dr. Whelan was further troubled that the researchers categorized alcohol as the most dangerous drug based on its more profound societal effects, not individual health effects. “This is a matter of dose, and the study presupposes that everyone who drinks alcohol is abusing it, when in fact moderate alcohol consumption can actually increase longevity.”

    I loved Dr. Nutt’s ecstasy vs equasy comparison, but this recent evaluation does seem a bit… off.

    I’d like to see a study some day that includes the GOOD that drugs can do. Frankly alcohol as a social lubricant and relaxation aid would win it more than a few points.

  11. @SkepticalWooBot: Thanks for sharing that link. I read the abstract for the study the other day, but couldn’t read the full article, and I was really curious about the methodology. It sounds like Dr. Nutt made up an arbitrary set of criteria, then got a few people (presumably experts on these matters?) to rank drugs based on those criteria. It seems very subjective. You could put a different group of people together and give them the same criteria, and they may come up with completely different results.

  12. It’s harder to tell when someone is drinking a little more than usual, whereas someone doing a line or hitting a crack pipe would likely raise a red flag because it is not as socially acceptable. Since alcohol is socially acceptable we might overlook some of the warning signs of serious use. People might go on for years developing habits that they would otherwise have to hide. It is also easier to remain in denial that a socially acceptable drug is causing problems compared to a drug that might carry a stigma.

  13. @SkepticalWooBot: I’d like to see a study some day that includes the GOOD that drugs can do. Frankly alcohol as a social lubricant and relaxation aid would win it more than a few points.

    You are an idiot and have absolutely NO IDEA WHAT YOU ARE TALKING ABOUT!!! I’ve tried alcohol and it was USELESS!

    KY Jelly worked much better.

  14. BBC journalist Mark Easton has a nice summary and comment on the report. The article also links to another paper looking at the decriminalisation of hard drug possession in portugal.

    I would comment myself that Nutt and his collaborators explicitly acknowledge the value judgements that go into this. It is part of the idea of looking at drugs from the point of view of harm prevention rather than prohibition.

  15. @davew: COTW

    Just looking at my own family (never tested but I’m assuming we have a strong genetic predisposition to addiction) the damage that can be caused by alcohol vs other drugs becomes very apparent. I can’t count on my hands the number of family members that have struggled with alcohol consumption issues, including 2 that are currently killing themselves with their drinking. The impact of this goes well beyond just the drinkers and impacts or damages many of the familial relationships. In some cases children of these family members have turned towards alcohol abuse as a way to deal with their parent’s problems.

    The family members with addictions to other drugs have similar problems but not nearly on the same scale. They cause similar damages to others but since they are much harder to get it’s been controlled.

    I know this is totally anecdotal but taking a measure in terms of the total damages caused it makes sense to me given these experiences.

  16. Everyone in my extended family has one or more vices: gambling, religion, alcohol, marijuana, or tobacco (some have more than one). It is ironic that the only prohibited activity in that list (smoking weed) is the only one that hasn’t resulted in financial, legal, medical, and social problems for at least some of them. I realize that this is anecdotal, and the plural of anecdote is not data, but I have 80+ cousins, aunts, uncles, and step-relatives; and based on my experience and first-hand observation, I try to avoid gambling, cigarettes and religion entirely; consume alcohol in moderation; and I’m not worried about the effects of marijuana use in the slightest. (Of course, I live in Canada and I am unlikely to face legal repercussions for casual use.)

  17. Go into a city centre on a Friday night, or a casualty department any evening, and you’ll soon start to get an idea of the harm that alcohol can do. Drunken-ness, antisocial behaviour, alcoholism – we’ve all had experience of these.

    Heroin is consumed by many fewer people. And even then, it’s dangerous mostly because people have to buy dirty, contaminated stuff off the street, and can’t be sure what dose they’re taking. Medical quality diamorphine (that’s its medical name) is very safe as long as you don’t overdose – it can cause respiratory suppression. Even then, there’s an antidote…

  18. Hi there!

    As I’ve SO intelligently said on my friend’s Facebook post about this study …

    Isn’t saying that alcohol is a more dangerous drug than heroin because it KILLS more people exactly like saying that dogs are much more dangerous than Komodo dragons because more people own dogs than have ever even SEEN a Komodo dragon?

    I have no doubt that more people are killed by dog bites every year than by Komodo dragon attacks.

    If we legalized Komodo dragon ownership, would that cause a ton of Komodo dragon related deaths, or are most people intelligent enough to NOT OWN A KOMODO DRAGON?

    Well, they are kinda cute, though …

  19. I don’t understand the high “physical harm” rating for heroin. Yes, someone can die of an overdose, but other than that opiates are pretty easy on the body (from my understanding, correct me if I’m wrong). There are secondary dangers like dirty needles causing disease, getting stabbed by another sketchy addict, etc. but these are mostly a consequence of the legal status of the drug, not the drug itself.

    I saw a special (BBC?) a little while back that seems to have gotten it’s info from the same data. I remember thinking it was wildly flawed and the rankings seemed either arbirtrary or designed to provoke controversy (ecstacy as the least harmful, alcohol near the top, barbituates listed higher than alcohol despite extremely low incidence of use and very few deaths), it’s just very sloppy science that doesn’t really give anyone any useful information.

  20. and for you boozers that love your goof juice, yeah alcohol is harmful. It does more long-term harm than most drugs, doing damage to your liver and cardiovascular health among other things. I have also never felt as bad from any intoxication experience as I have during my worst hangovers. Many of the other drugs on this list don’t do the kind of damage that alcohol does, despite the fact that they are more demonized.

  21. Inhaling solvents does even worse damage than does alcohol. The “problem” is that there is a lot of redundancy in the target organ (the brain), so by the time that redundancy is used up and the loss of it becomes noticeable, you are completely fucked with irreversible brain damage. You need that redundancy for learning new stuff and for later in life.

    It is sort of like autoerotic asphyxiation, but worse. You have to induce the near death metabolic state to get the rush of euphoria, but when you do that with solvents, you necessarily do irreversible damage.

    All of the other drugs can be used in “moderation” (pretty much, not sure about ecstasy and ketamine), where you can get effects without doing serious irreversible damage. You can’t do that with solvents. I am not saying the others are benign, they aren’t, there is a tremendous pull to use them to excess where there is serious damage. The reason there is that tremendous pull is that the physiology that invokes the feelings of euphoria is only triggered in a near death metabolic state, the state you enter when you are running from a bear and your physiology induces euphoria so you can escape from the bear or run yourself to death, which ever happens first.

    Induce that physiology pharmacologically, and you can “run yourself to death” while sitting on a sofa spacing out. It is the diversion of physiological resources away from life-support and toward immediate consumption (the running from the bear) that does that. That is what happens in the hyperpyrexia of ecstasy and ketamine. The fever comes from your physiology mobilizing all available ATP generating capacity and then dissipating it as heat because your muscles aren’t using it.

  22. A review of the actual study or source document rather than the media reports reveals a different emphasis. Specifically, the study’s conclusions assert that heroin, crack, and crystal meth were the most harmful drugs “to the individual,” while alcohol, heroin and, crack were the most harmful “to others.” These weightings are detailed in the Physical Harm image above; the British adore colorful graphics.

    As a result, alcohol becomes the most harmful drug when the qualifier of “harm to self AND others” is referenced. In this light, it’s a bit difficult to disagree with the validity of the study’s conclusions, using either empirical data or anecdotal accounts. Regardless, Mark Twain said it best with, “Too much of anything is bad, but too much of good whiskey is barely enough.”

  23. There’s also the fact that much of the danger from drugs like heroin are actually a result of their illegality.
    – You’ll probably need to consort with some very dodgy types to get it.
    – It’s likely to be cut with who-knows-what and you have no way of knowing how pure or impure the drugs is, so each time you shoot up, it’s pretty much a game of russian roulette
    Both of those problems would go away if it were decriminalized.

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