Earlier this week, a report was published claiming proof that alcohol causes more harm than heroin or crack.
I believe it is wrong.
But I’m no professor so best listen to the expert first (source: BBC News)
It’s all well and good using multi-criteria-decision-analysis and other long phrases that academics favour. But the judgements appear to be based on the assumption that the societal effects are unique to alcohol and would otherwise not occur. Take the following quote:
Crack cocaine is more addictive than alcohol but because alcohol is so widely used there are hundreds of thousands of people who crave alcohol every day, and those people will go to extraordinary efforts to get it – Professor David Nutt
Aside from not providing the evidence to confirm we have hundreds of thousands of alcoholics (not sure if that’s just the UK or globally), does he honestly think people who go to extreme lengths to acquire alcohol would not switch to alternatives if alcohol became as difficult to source as heroin? And people who need alcohol for the courage to be abusive, violent and the other societal dangers that led to this judgement are unlikely to live the rest of their lives in a saintly manner without it.
Here’s the chart showing the breakdown (source: BBC News)
It appears the ‘harm’ score is influenced by the number of people who use each drug – I can’t believe the score for the likes of methadone wouldn’t change if everyone who currently uses alcohol switched to it on the basis of this chart suggesting it is a much safer option. This is a classic example of how statistics and data visualisation can mislead.
A better chart would be one showing the effects per 100 people who use each drug to excess, i.e. what is the cost to the individual and society of 100 alcoholics vs 100 heroin addicts vs 100 heavy smokers etc. That would offer more practical information when it comes to policy decision-making. Using the Professor’s approach, you might as well add chocolate and chips to the list.
References:
- Alcohol ‘more harmful than heroin’ says Prof David Nutt – BBC News, 1st Nov 2010
Joining Dots 
I’m fairly confident the “hundreds of thousands” figure is a UK one and to be honest I’m more surprised that the figure is so low. “Alcoholic” doesn’t just mean “homeless tramp clutching a two-litre bottle of cider,” it also means all those well-to-do middle class people who can’t contemplate getting through a day without at least one drink (ie they have developed a dependency), or who regularly and repeatedly binge to the point of making themselves sick or otherwise harming themselves and those around them (ie they are unable to control the impulse to drink despite being aware of the consequences).
The societal effects ARE unique to alcohol because of the unique position of alcohol as a legally-available and socially acceptable (sometimes downright socially required!) psychoactive substance. This position means that the alcoholic demographic don’t need to have any criminal connections to begin, develop and pursue their habit – how many of us were offered our first glass of wine by parents who wanted us to be able to drink it properly at social functions? – and in the early stages, an alcoholic’s drug use is not seen as a problem. The freaks in our society are the ones who choose not to indulge, and in many circles it’s considered acceptable to berate, criticise and even spike the drinks of people who prefer to stay sober.
Someone who shoots up heroin twice a week is a junkie. INTERVENTION! Someone who has a bottle of wine twice a week is a perfectly normal member of society who will be offered another glass. Even people who get completely blitzed twice a week – no one’s quite sure where the line should be between “I think you’ve got time for one more,” and “I think you’re drinking a bit too much these days.”
I feel that the most harmful part of alcohol is the way that it’s the one drug towards which we have a generally positive societal disposition.
Alcohol isn’t the only drug we consider socially acceptable. So is caffeine and cocoa. People who feel the urge to eat chocolate on a regular basis or can’t leave the house before having their morning cuppa could equally be classified as addicts. So yes, with that definition the numbers probably are low. But the quote seems to be referring to those will take extreme measures to acquire it, which suggests theft and/or abuse.
Alcohol-related violence and illnesses are problems. As is a culture that marginalises people who choose not to drink and encourages regular binge drinking. But a report suggesting alcohol in general is more dangerous than heroin offers easy headlines and no solutions. You could make the same case against food, given the rising cost of treating obesity-related issues.
We can’t be sure what counts as an “extreme measure”. Mugging little old ladies, that’s extreme, but past that… Making your own slightly shonky [drug of choice] at home? Travelling to a foreign country to obtain [drug of choice] at a cheaper rate? Using [drug of choice] while responsible for young children, even though you know it impairs judgement? As a society, we won’t be too bothered by the insertion of “booze” into those sentences but say “heroin” and no one will hesitate to call it extreme.
Granted, caffeine and cocoa are also addictive drugs over time, although I think it’s relevant that you would need to ingest an awful lot to experience a short-term change in your psychological state. But then, that was part of the point of the research that got Prof Nutt sacked from government work – that the effects of drugs are not in proportion to their hazard perception or their current legality. There are some Class A drugs which are less dangerous than some Class C drugs. As you say, the easy headline is “ZOMG alcohol more dangerous than heroin!!!1one!” and everyone will home in on it because just about every adult in the country will have imbibed alcohol at some point – but it wasn’t the full point of the research. The Lancet paper *did* focus on the differences in availability for various drugs, scale of usage, harm to individual vs society, and possible approaches to solving the issues. The intention of the research is to enable drug policymakers to try and find appropriate solutions based on evidence rather than anecdote.
From what I’ve read and seen on Trainspotting, heroin gives an instant ‘high’ that several drinks would fail to achieve. You can’t have a shot equivalent to one drink, it’s all or nothing. That makes it extreme and yes, I’d be a lot more worried about someone using heroin whilst responsible for young children than if they were drinking a single glass of wine.
But I’m focusing on this more from the use of data visualisation to present statistics than arguing the case for or against alcohol. The chart provided by The Lancet report is misleading because it suggests if you have the choice of a glass containing alcohol or a syringe containing heroin, the latter is a safer option. No context is provided. Is it a like-for-like comparison or based on total consumption? And if it is the latter, proportions should be included. If the ratio for alcohol vs heroin use is 100:1, it will take a lot more resources to lower the harm score for alcohol vs the harm score for heroin. And if the side effect of that effort drives just a small fraction of those alcohol users over to heroin, the net result will be greater harm overall. Comparing totals to calculate a scale can be a risky strategy for decision-making. Using that method, swimming would be considered more dangerous than riding motorbikes or horses based on annual deaths. Insurance premiums suggest otherwise.
Assuming the chart isn’t a like-for-like comparison, the chart title should be amended to include ‘based on total consumption’ and add a scale to show how many people are considered to be using each of the drugs listed to (in total and to harmful effect). That would present a more accurate picture and doesn’t reduce the argument for tackling what is clearly a big problem within society.
BTW, think you’re spot on with with questioning the numbers regarding alcoholics. Was mooching through stats and came across one that said there are 12 million smokers in the UK and approx 500,000 die each year. That seems like a huuuge number so maybe hundreds of thousands was low.
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