Alcohol is the most dangerous drug

In 2009, then Home Secretary Alan Johnson dismissed Professor David Nutt from his role as chairman of the Advisory Council on the Misuse of Drugs.

Why?

Because Professor Nutt had revealed something the government really didn’t want to know.

What was this bombshell information?

That alcohol was more harmful than LSD, ecstasy or cannabis.

Revealing the true dangers of alcohol was always going to be distasteful to a government vulnerable to lobbying by big business and swayed by the tax revenue the drinks industry brings in. But it wasn’t just Professor Nutt’s upgrading of the dangers of alcohol that annoyed the government – it was his criticism of drug classification and how the government measures the impacts of their harm.

This, Mr Johnson said, sailed too close to the realm of policy interference.

Unfazed by his ousting, the scientist (who is currently Imperial College London’s Edmond J. Safra Professor of Neuropsychopharmacology and director of the Neuropsychopharmacology Unit in the Division of Brain Sciences; chair of DrugScience; and president of the European Brain Council) and his colleagues continued their research and, in a study published in The Lancet in 2010, declared that alcohol wasn’t just more harmful than LSD, ecstasy or cannabis.

It was the most dangerous drug of all.

Not heroin; not crack cocaine. Though those two intoxicants did come an unsurprisingly close second and third.

So how did Professor Nutt assess the dangers of the various narcotics? He used 16 different criteria, measuring not just each drug’s harm to the user but also its harm to others and the wider economic impact on society – eg, crimes committed while under the influence, sick days taken off work, etc. Drugs were scored out of 100 points, and the criteria weighted to indicate their relative importance.

Overall, alcohol was found to be the most harmful drug (harm score 72), with heroin (55) and crack cocaine (54) in second and third places. These findings challenged the traditional view that illegal drugs are more harmful than legal ones and sparked a debate on drug policy and the regulation of substances.

Whereas the UN’s drug classification system (which guides UK Government policy) categorises psychoactive substances based on their perceived benefits and harms without considering their actual effects on society (classifying them alongside cocaine and heroin), Professor Nutt’s study found that psychedelic ‘party’ drugs such as ecstasy, LSD and mushrooms were less harmful than tobacco.

And there was alcohol, clearly in the lead at the top of the table, the most harmful and dangerous drug of the 20 analysed.

Which begs the question: why is alcohol still legal, while most other intoxicants are not?

That question was the subject of a 2019 report by the Global Commission on Drug Policy, an independent group of former heads of state and government, other politicians and business leaders. They concluded that current drug laws based on the UN’s drug classification system are arbitrary and lack scientific basis.

This system automatically places drugs without any medical use – LSD, ecstasy, etc – in the most dangerous category, regardless of their actual risks and relative impact on wider society.

But alcohol is deemed a ‘regulated product’ – a food or commodity.

Yet alcohol can not only lead to various health issues, such as alcohol-related brain damage, breast, bowel, mouth or liver cancer and cirrhosis, it is also the foundation for many more deaths caused by, for example, drink driving or domestic violence.

Increasingly sophisticated imaging technologies have enabled CT and MRI scanning to reveal
more and more detailed insights into brain function and into brain structural changes caused by drinking.

Simple x-rays and the nascent MRI scans of the 1970s did not capture how ingesting alcohol immediately and dramatically disrupts white matter development and brain function (Alcohol Change, 2023; Amen 2023). They did not identify the full impact of alcohol use and misuse on brain function or the ensuing alcohol-related brain damage (Alcohol Change, 2023). This is information of which we are now well aware.

The government’s recommendation for ‘moderate’ drinking (approximately two drinks a day for both men and women) can still cause health issues, even exposing drinkers to a heightened risk of seven types of cancer (Wood, 2022). In light of this, the request in 2012 by the alcohol industry to ‘drink responsibly’ seems itself irresponsible (Nutt, 2020).

As for social drinking or drinking for relaxation? Recent meta studies have concluded there are no health benefits of drinking in terms of a person’s psychological health or their longevity. Follow-up reviews of the studies contradicting this view were usually sponsored or funded by the alcohol industry (Amen, 2023).

Many of those who turn to alcohol as a ‘solution’ for their worries or because they see it as a form of relaxation, and then develop an addiction, are doing so because of western society’s love of alcohol. Advertising portrays alcohol in images of camaraderie and fun; of a trouble-free world. Alcohol is the ‘norm’ and it becomes too easy and acceptable to over-imbibe. But, paradoxically, there is a stigma attached to alcohol addiction, and the camaraderie of ‘having a few drinks’ with friends segues into drinking more, and drinking earlier; a closely guarded and shameful secret.

Once an addict is fully subsumed, they struggle with relationships, with their career, with money, even the law.

As Professor Nutt’s study highlighted, it is not just alcohol’s immediate physical impact on the user that is used to measure its potential harm.

The economic, social and psychological harms cannot be understated. The flaws in current drug laws and increase in mental health issues that are leading to an increase in alcohol consumption are also seeing an increase in alcohol-related incarceration and rising prison costs; increased ill health and rising cost to the NHS; an increase in the number of days taken off sick and a rise in sickness benefit claims, and so on.

The Global Commission on Drug Policy has argued that regulating drugs (especially alcohol) in a more meaningful way would make them safer for society, not just the individuals who use them.

But when the UK Government is drawing in a tax revenue of £12bn a year from the sale of alcohol, what would it do to reduce alcohol consumption?

Minimum unit pricing (MUP) was introduced in Scotland by the Scottish Government in 2018. The policy there has seen arguably no reduction in the bottom line for the drinks industry but has seen a degree of ‘social success’. In 2018, The BMJ looked at more than 500 studies and concluded that price-based alcohol policy interventions, such as MUP, were most likely to reduce alcohol consumption, and alcohol-related morbidity and mortality.

And yet the UK Government refuses to consider such policies.

Is it something to do with that £12bn tax revenue? Seems likely? Seems understandable?

Quick sum, courtesy of Alcohol Change UK:

Tax revenue raised by alcohol sales £12bn per year

Cost to society caused by alcohol £27bn per year

You do the maths.