Alcohol - the worst drug!

By Dr. Ananya Mandal, MDNov 1 2010

A new study shows that alcohol abuse is by far the worst habit to have when compared to other recreational drug habits like that of marijuana, crack or heroin. Neuropharmacologist David Nutt, of Imperial College London who is also a former British government drug advisor and his team rated 20 different drugs on a scale that takes into account the various harms caused by a drug. Drugs are rated on the nine harms a drug causes to an individual and seven harms a drug causes to the society. The scale was developed by a panel of experts called the Independent Scientific Committee on Drugs (ICSD), ranges from 0 (no harm) to 100 (greatest possible harm). It is weighted so that a drug that scores 50 is half as harmful as a drug that scores 100.

Nutt and colleagues write, “The highest and lowest overall harm scores … are 72 for alcohol and 5 for mushrooms… The ICSD scores lend support to the widely accepted view that alcohol is an extremely harmful drug both to users and to society.” Alcohol scores as the most harmful drug to society and the fourth most harmful drug to individual users. Alcohol has been linked to more than 60 diseases say researchers so this is no surprise.

James C. Garbutt, an alcohol researcher of the University of North Carolina at Chapel Hill admitted, “Alcohol does all kinds of things in the body, and we're not fully aware of all its effects… It's a pretty complicated little molecule.”

The study showed that heroin, crack, and crystal meth were the most harmful drugs to the individual, while alcohol, heroin and crack were the most harmful to others. Following the “multicriteria decision analysis approach” alcohol is almost three times as harmful as cocaine or tobacco. Authors conclude that aggressively targeting alcohol harm is “a valid and necessary public health strategy.”

The Nutt study appears in the acclaimed journal Lancet. In an editorial accompanying the Nutt team's report, Jan van Amsterdam of the Netherlands National Institute for Public Health and the Environment and Wim van den Brink of the Amsterdam Institute for Addiction research write, “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.” They add that because the pattern of recreational drug use changes, the study should be repeated every five or 10 years.

Professor David Nutt was sacked last year by then home secretary Alan Johnson after he challenged ministers over their refusal to take the advice of the official Advisory Council on the Misuse of Drugs, which he then chaired. The committee wanted cannabis to remain a class C drug and for ecstasy to be downgraded from class A, arguing that these were less harmful than other drugs when social factors were taken into consideration.

With the help of this report Nutt adds, “…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.” This reclassification would result in tobacco being labeled a class B drug alongside cocaine. Cannabis would also just make class B, rather than class C. Ecstasy and LSD would end up in the lowest drug category, D.

The Home Office in its statement said, “We have not read the report. This government has just completed an alcohol consultation and will publish a drugs strategy in the coming months.” A Department of Health spokesperson also said, “In England, most people drink once a week or less. If you’re a women and stick to two to three units a day or a man and drink up to three or four units, you are unlikely to damage your health…The government is determined to prevent alcohol abuse without disadvantaging those who drink sensibly.”