Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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Which Causes More Harm: Alcohol, Crack, or Heroin? One Study Says Alcohol
Posted in Alcoholism by Dr. Sharon Orrange on Nov 10, 2010
Which substance causes the most harm to the individual and to society? The winner is alcohol according to a report published in the Lancet that is receiving quite a bit of attention. Alcohol does the most harm, followed by heroin and crack.

Alcohol use represents an unusual paradox for physicians because people have used it safely and enjoyably forever, and moderate alcohol consumption may actually improve health.

However, some alcohol drinkers develop catastrophic complications related to its use, and I have witnessed this over and over again. Many times, I have been at the bedside of patients dying from alcoholic liver disease, or in full delirium tremens struggling for their lives. I have also seen the quick destruction meth and heroin cause to addicts and their families and I often wonder: which is the most destructive substance?

We know drugs including alcohol and tobacco products are a major cause of harm to individuals and society, so how do we assess their harm?
In this study, nine criteria of harm ranging from harms of the drug to the individual to health care costs were assessed. These harms are clustered into subgroups representing physical, psychological, and social harms.

The nine categories in harm to self are drug-specific mortality, drug-related mortality, drug-specific damage, drug-related damage, dependence, drug-specific impairment of mental function, drug-related impairment of mental functioning, loss of tangibles, loss of relationships, and injury. The harm to others categories are crime, environmental damage, family conflict, international damage, economic cost, and decline in community cohesion.

Overall, results showed that alcohol was the most harmful drug, with heroin and crack in second and third places. Heroin, crack, and crystal meth were the most harmful drugs to the individual, whereas alcohol, heroin, and crack were the most harmful to others.

The other drugs assessed followed in this order in terms of overall harm: Crystal meth, cocaine, tobacco, amphetamine/speed, cannabis, GHB, benzodiazepines (eg valium), ketamine, methadone, ecstasy, anabolic steroids, and LSD.

When you look at harm to the individual and society and grade it on a scale, alcohol is almost three times as harmful as cocaine or tobacco! Finally it is intriguing to note that the two legal drugs assessed-- alcohol and tobacco-- score in the upper segment of the ranking scale, indicating that legal drugs cause at least as much harm as do illegal substances.

Thoughts?

Dr O.


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8
Great post! My husband and I talk about this all the time. If they werent making money hand over foot it would be banned. I think people dont realize that alcohol creeps up on you. You think your just having fun partying through high school, then college, then business drinks..etc. Before you know it you have 15 yrs under your belt.
By LG73  Dec 22, 2010
7
Thanks for the comments...its great to hear from all perspectives.
By DrOrrange  Nov 28, 2010
6
While it is true that other drugs are more lethal but they kill you quicker. Alcohol can kill you but over a rather long period of time.

If we measure it in a time lapse, then alcohol wins hands down in the longest and agonizing death rivaled only by nicotine. But that's just my opinion.
By wolfiepa  Nov 21, 2010
5
sounds logical , but i think there might be a little flaw in the conclusion as alcoholics outnumber i would guess heroin and crack users by many folds .....
By ADDbuster  Nov 15, 2010
4
I do not buy it. I spent a year and a half in rehab.My drug of choice WAS alcohol. I watched people die. They did not die by taking another beer, they died from taking another hit or another needle. Whomever made these judgments probably never sat in a crack house watching the show, or walking into a heroin den. They assume it is alcohol because it is LEGAL. If you legalized crack and heroin, then you would see the real story. Get REAL people!
By BrazenG  Nov 14, 2010
3
As a user of all in the past I agree they are all harmful, I disagree that Alcohol is the most harmful to others, what I guess they mean is harm to others, drunk driving, relationship being torn apart abuse etc. In my opinion they are all harmful to others what about the person that uses crack or herion when they can not support their habbit in the inner cities crime taking of lives etc this is just as important not to mention you can commit suicide, I have Cirosis ( how ever you spell it ) and Hep C
By Eaglelandads  Nov 13, 2010
2
But looking at the overall damage done by substances, alcohol takes the most from society as a whole. It wreaks the most havoc on the human body, and it hurts the innocent more than any other substance. I sat alone and shot heroin at home, but that's not how most people use alcohol, whether casual drinkers or alcoholics. I see "social" drinkers leave restaurants and get behind the wheel of a car constantly. Who knows how many people that person might kill? Someone who's not even an alcoholic is going to risk allowing alcohol to take the lives of innocent drivers or pedestrians. It happens EVERY DAY. Alcohol takes far more lives than heroin or crack or meth, the so-called "hard drugs." They all produce terrible addictions, but alcohol KILLS people who didn't even consume it. It's just fact.
By JenniferRose  Nov 11, 2010
1
I have to disagree with the first comment. As a FORMER heroin addict (who also used crack occasionally- yes, just OCCASIONALLY, when it was around), I have to agree with the results of this study. Alcohol has the greatest and most damaging societal costs. I think an addiction to any substance- from alcohol to marijuana to heroin- can do the same amount of harm to the individual addict- any addiction can steal your soul, your entire life, devastate your family. ANY substance you're addicted to is a substance that you NEED- alcohol actually has the most dangerous problems arising from physical dependence- a deadly withdrawal syndrome. One use of any drug doesn't hook you for life though- I know hundreds of addicts and alcoholics, including myself, who now have long-term sobriety.
By JenniferRose  Nov 11, 2010
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