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.