Alcohol More Lethal Than Heroin and Cocaine!

Perhaps the dumbest study ever published in the Lancet compares the negative effects of alcohol and illicit drugs without controlling for incidence.

I saw the YahooNews headline “Study: Alcohol more lethal than heroin, cocaine” and was naturally intrigued. And suspicious that some serious scientific stupidity was afoot.

Alcohol is more dangerous than illegal drugs like heroin and crack cocaine, according to a new study.

British experts evaluated substances including alcohol, cocaine, heroin, ecstasy and marijuana, ranking them based on how destructive they are to the individual who takes them and to society as a whole.

Researchers analyzed how addictive a drug is and how it harms the human body, in addition to other criteria like environmental damage caused by the drug, its role in breaking up families and its economic costs, such as health care, social services, and prison.

Heroin, crack cocaine and methamphetamine, or crystal meth, were the most lethal to individuals. When considering their wider social effects, alcohol, heroin and crack cocaine were the deadliest. But overall, alcohol outranked all other substances, followed by heroin and crack cocaine. Marijuana, ecstasy and LSD scored far lower.

The study was paid for by Britain’s Centre for Crime and Justice Studies and was published online Monday in the medical journal, Lancet.

Experts said alcohol scored so high because it is so widely used and has devastating consequences not only for drinkers but for those around them.
“Just think about what happens (with alcohol) at every football game,” said Wim van den Brink, a professor of psychiatry and addiction at the University of Amsterdam. He was not linked to the study and co-authored a commentary in the Lancet.

When drunk in excess, alcohol damages nearly all organ systems. It is also connected to higher death rates and is involved in a greater percentage of crime than most other drugs, including heroin.

There’s simply no question that alcohol abuse is more dangerous to society than abuse of all other recreational drugs combined.  The difference, of course, is that alcohol is legal and socially acceptable and therefore widely consumed.   Cocaine, heroine, LSD, ecstasy, and so forth, by contrast, are hardly used at all, comparatively speaking.

Naturally, I have to issue my standard caveat:  I’m relying here on media accounts (in this case, that of AP medical writer Maria Cheng, excerpted above, and similar reports by Reuters‘ Kate Kelland, and Graham Fitzgerald of Sky News) because all Lancet makes available is a summary of findings.

Then again, lead author David Nutt is quoted in some of these pieces.  And the “Methods” are rather dubious to my mind:

Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance.

This is what we in the public policy business call BOGSAT: Bunch Of Guys Sitting Around a Table.  It’s not a study at all!

Oh, and, apparently, Nutt has something of an agenda.

The study was led by drugs expert Professor David Nutt, who has hit the headlines before for arguing that the current approach to regulating recreational drugs is fundamentally flawed.

He was sacked a year ago from his post as the Government’s top drugs adviser for criticising ministers’ decision to upgrade cannabis from class C to class B.

His comment that “you are more likely to die riding a horse than you are by taking cannabis or ecstasy” was widely reported at the time.

Since then he has formed the Independent Scientific Committee on Drugs (ISCD), and is urging ministers to do more to tackle alcohol abuse and change the way recreational drugs are regulated.

So . . . it’s not just BOGSAT:  It’s a committee of people predisposed to find something who sat around talking about the subject in question and, at the end of the day, agreed with their previous position.  Fascinating!

Now, to be clear:  I’m inclined to support legalization of marijuana, although I’ve never used it.  And I fully acknowledge that alcohol has pernicious societal effects, even though I consume it pretty much daily without any.

But, damn, I can’t believe Lancet published this.

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James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College. He's a former Army officer and Desert Storm veteran. Views expressed here are his own. Follow James on Twitter @DrJJoyner.


  1. It doesn’t surprise that Lancet published something like this at all, they’re the ones that originally published the “study” that started the whole vaccine-Autism hysteria and it took them over 10 years to even bother to issue a correction.

    They’re also the ones that who were responsible for the dubious study about the number of civilian casualties in Iraq and have also published an op-ed calling for the total ban on the use of tobacco products in the United Kingdom.

  2. MstrB says:

    MaCallan 12, nice call.

  3. Tano says:

    Well actually,,,,I don’t think the findings are quite as outrageous as you argue (although the BOGSAT point is well-taken – this is not a study, but rather a consensus of a small group of “experts”).

    They do find that heroin and crack are more dangerous to the individual. And for that consideration, one should take into account incidence – obviously. Heroin is absolutely harmless to the individual if you don’t use it – so an assessment of its dangers to individuals must include consideration of usage level.

    But the larger question seems to be a public policy question. What is the effect of these drugs on society at large – presumably leading to the question of what, if anything, the government should do about it. For this question, incidence probably is best considered on the other side of the equation. Yes, heroin is far more dangerous on a per dosage basis, but the very fact that its use is trivial relative to alcohol, means that it has a small overall effect on the public order, and thus may well not rise to the level that would demand government action. And the opposite may be the case for alcohol.

  4. john personna says:

    Boy, I think you missed the target on this one. The correct question after reading this is why we choose legalization (and incidence) the way we do.


    “When considering their wider social effects, alcohol, heroin and crack cocaine were the deadliest. But overall, alcohol outranked all other substances, followed by heroin and crack cocaine. Marijuana, ecstasy and LSD scored far lower.”


    “why does legalization not follow this same pattern?”

    I’m sure we know the answer. Alcohol, for all its risks, has a social history in western societies. Ecstasy and LSD do not. They have not for instance made the leap to the Sacraments in mainstream religions.

  5. tom p says:


    SURELY you know that 12 year old Macallan has never had ANY sort of deleterious effect on any human… quite the contrary, it has been scientifically proven to have nothing but the most soothing effect on the savage soul.

    (good thing you didn’t use a picture of Laphroaig…)

  6. Drew says:

    Sing along.

    “….one bourbon, one scotch, one be-er…..”

  7. PD Shaw says:

    Seems like a lot of ice in that scotch . . .

  8. tom p says:

    “Seems like a lot of ice in that scotch . . .”

    Yeah a sin I neglected to comment on.

    “….one bourbon, one scotch, one be-er…..”

    Drew, I used to live in the great metropolis of Bourbon, MO… They had 3 water towers… I always wanted to do a paint job some April 1. Unfortunately it was more than I could handle on my own and all of my friends had more sense than I…

    Or not as much “one bourbon, one scotch, one be-er…..”

  9. James Joyner says:

    @Tano and @John Personna: Right. But I gather that the authors don’t endorse a return to prohibition of alcohol. And, while I’m sympathetic to legalization of other substances, especially marijuana, the study admits that the individual effects are much more deleterious. So, if we extrapolate to a larger incidence, the society effects would explode.

    tom p: Concur. I’m a Highlands man, myself, with Macallan my current fav. I haven’t ventured beyond the 12, for reasons of fiscal sanity.

    @Drew: I’d prefer two Scotchs. But fine song.

    @PD Shaw: Certainly, for single malt of that caliber. I like a couple large cubes. For blends, such as Dewars and Grouse, more ice can be better.

  10. Ben says:

    James – It was only cocaine, heroin and meth that were more individually lethal than alcohol. OK fine then, lets at least agree to get started on legalizing cannabis, lsd and ecstasy.

  11. Steve Verdon says:

    Scotch with ice is simply wrong. Wrong!!

  12. Drew says:

    “Scotch with ice is simply wrong. Wrong!!”

    Well, Steve V……..alcohol is involved………

    “the clock on the wall says 3 o’clock…….last call, for alcohol……….watchoo want?”

    You suppose it was really lovey-dovey? Oh, yeah? Oh, yeah………

  13. anjin-san says:

    > They do find that heroin and crack are more dangerous to the individual.

    A lot of the negative consequences of heroin are associated with it being illegal. A user does not know the purity of what they are getting on the street and the cost is driven (way) up by the legal environment.

  14. steve says:

    In over 25 years of medicine, mostly at trauma centers, I have never seen someone brought into the ER because they were hit by someone driving while high on heroin, though I am sure it has happened. Alcohol? Nearly every day. Stabbings? Shootings? Same thing. Here is what they say in the article.

    “Heroin, crack cocaine and methamphetamine, or crystal meth, were the most lethal to individuals. When considering their wider social effects, alcohol, heroin and crack cocaine were the deadliest. But overall, alcohol outranked all other substances, followed by heroin and crack cocaine. Marijuana, ecstasy and LSD scored far lower.”

    They explicitly acknowledge the incidence issue.

    FTR, anyone who puts ice in good scotch is in no position to defend alcohol.


  15. James Joyner says:


    But the reason you see it all the time is because of the high incidence of alcohol use and abuse. People don’t take heroin and drive because, well, they’re explicitly planning to be stoned out of their minds.

    I’m with you on soda, which is a very popular scotch additive. But I like a large ice cube or two, both for the cold and the incidental dilution.

  16. G.A.Phillips says:

    What about Koolaid?

  17. Zelsdorf Ragshaft III says:

    I know you people hate an attack on your drug of choice, but facts are facts. I am, by profession, a substance abuse counselor. The information you question is well known among those who treat addictions. Alcohol is second only to tobacco in its fatality rate. There are only two classes of drugs which can prove fatal if one were to stop using. One is alcohol. I am sure several of the people who post here suffer wet brains. More people die as a direct result of alcohol than all other drugs combined. Some scientist you are James.

  18. michael reynolds says:

    I want to add my own voice to those who have protested your use of a completely inappropriate, and frankly obscene photograph showing The Macallan poured over ice. Good God, Man, what if children were exposed to that?

    Kids, if any of you are reading this you are probably reeling in shock and horror and feeling betrayed. Please don’t let this one disturbing image leave a lasting scar on your psyche. Just know that a good single malt — and Mac 12 is a great single malt — may be served neat or with just a few gentle drops of water but must never be assaulted with the brute, numbing force of massed ice cubes this way.

    It’s in the constitution.

  19. matt says:

    Personally I don’t care what drugs are most lethal to the users as it’s their life. That being said the biggest impact on my life by a drug user was when a chronic drunk hit and killed a friend of mine who was a father of two and a husband. The dude got off with a relative light slap on the wrist via a couple years in jail since most of his accidents weren’t reported…

  20. Steve Verdon says:

    Goddamn right Michael….goddamn right!