Alcohol is even more dangerous than illegal drugs such as heroin and crack cocaine – when the ripple effect on society is taken into consideration, according to the study published in medical journal the Lancet today, which will reopen calls for the drugs classification system to be scrapped and a concerted campaign launched against drink.
Led by the sacked UK government drugs adviser David Nutt with colleagues from the breakaway Independent Scientific Committee on Drugs, the study says that if drugs were classified on the basis of the harm they do, alcohol would be class A, alongside heroin and crack cocaine.
The paper is written by Professor Nutt, of Imperial College London, and the Independent Scientific Committee on Drugs, Dr Leslie King, UK Expert Adviser to the European Monitoring Centre for Drugs and Drug Addiction, and Dr Lawrence Phillips, London School of Economics and Political Science.
The new paper updates a study carried out by Nutt and others in 2007, which was also published by the Lancet and triggered debate for suggesting that legally available alcohol and tobacco were more dangerous than cannabis and LSD.
British experts said alcohol was most destructive because it was so widely used and had devastating consequences not only for drinkers but for those around them.
The study evaluated substances including alcohol, cocaine, heroin, ecstasy and marijuana, ranking them based on how destructive they were to the individuals who took them and to society as a whole. It used nine categories of harm to the self and seven to society as a whole.
The ‘harm to self’ categories cover mortality, poor health, impaired mental functioning, loss of friendships and injury. The ‘harm to others’ categories include crime, environmental damage, family conflict and decline in community cohesion.
Researchers analysed how addictive a drug was and how it harmed the human body, in addition to other criteria such as environmental damage caused by the drug, its role in breaking up families and its economic costs, such as healthcare, social services and prison.
Heroin, crack cocaine and methamphetamine, or crystal meth, were the most lethal to individuals. However, 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 modelling showed that alcohol is almost three times as harmful as cocaine or tobacco.
It also showed that alcohol is more than five-times more harmful than mephedrone, which was recently a so-called legal high in the UK before it was made a class B controlled drug in April 2010. Ecstasy, which has had much harm-related media attention over the past two decades, is only one eighth as harmful as alcohol in this new analysis.
David Nutt told the Guardian that the drug classification system needed radical change. “The Misuse of Drugs Act is past its sell-by date and needs to be redone,” he said. “We need to rethink how we deal with drugs in the light of these new findings.”
Nutt told the Lancet that a new classification system “would depend on what set of harms ‘to self or others’ you are trying to reduce”. He added: “But if you take overall harm, then alcohol, heroin and crack are clearly more harmful than all others, so perhaps drugs with a score of 40 or more could be class A; 39 to 20 class B; 19-10 class C and 10 or under class D.”
Don Shenker, the chief executive of Alcohol Concern, said: “What this study and new classification shows is that successive governments have mistakenly focused attention on illicit drugs, whereas the pervading harms from alcohol should have given a far higher priority.”
He continued: “Drug misusers are still ten times more likely to receive support for their addiction than alcohol misusers, costing the taxpayer billions in repeat hospital admissions and alcohol related crime.”
“Alcohol misuse has been exacerbated in recent years as government failed to accept the link between cheap prices, higher consumption and resultant harms to individuals and society,” he added.
“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 but co-authored a commentary in The Lancet.
He said that when drunk in excess, alcohol damaged nearly all organ systems. It was also connected to higher death rates and was involved in a greater percentage of crime than most other drugs, including heroin.
Some experts said it would be impractical and incorrect to outlaw alcohol. “We cannot return to the days of prohibition,” said Leslie King, an adviser to the European Monitoring Centre for Drugs and one of the study’s authors. “Alcohol is too embedded in our culture and it won’t go away.”
Mr King said countries should target problem drinkers, not the vast majority of people who indulge in a drink or two. He said governments should consider more education programs and raising the price of alcohol so it wasn’t as widely available.
But all the experts said the study should prompt countries to reconsider how they classified drugs. “[The] government should now urgently ensure alcohol is made less affordable and invest in prevention and treatment services to deal with the rise in alcohol dependency that has occurred,” said Don Shenker.
“What governments decide is illegal is not always based on science,” said Professor van den Brink. He said considerations about revenue and taxation, such as those garnered from the alcohol and tobacco industries, might influence decisions about which substances to regulate or outlaw.