Alcohol vs. Heroin: What’s the Harm?

If the headlines are to be believed, a recent paper in the Lancet claims that alcohol is more harmful than heroin. The reaction to this claim by most commentators has been sceptical to say the least: in what possible world could this claim be true?

First, some context. The paper’s lead author, Professor David Nutt, set up the Independent Scientific Committee on Drugs after being sacked from his advisory role by the previous Labour government. He has been a longstanding critic of the government’s approach to drugs and drug policy, arguing that it is based not on scientific advice or evidence but rather political ideology. It is therefore perhaps unsurprising that his latest research aims to undermine the basis of the government’s stance on ‘hard drugs’, in this case by pointing out that in fact the legal drug, alcohol, does far more damage to both users and society at large.

The interesting question (for a philosopher at least) is: what does Prof. Nutt mean by ‘harm’ here? Two distinctions need to be made in order to get a handle on this. Firstly, harm to whom? This is addressed in the paper by distinguishing between harm to the user and harm to others. Heroin, crack and methamphetamine cause the greatest harm to the individual user, but alcohol tops the list for cumulative harm to the user and to others.

This seems counterintuitive: many of us enjoy the odd tipple, occasionally even drinking to excess, without causing harm to ourselves or to others. This is where the second distinction comes into play, and it is not made particularly clear by the Lancet paper itself. This is the distinction between public health and individual health. The paper is concerned with the public health implications of the consumption of these drugs, i.e., its interest lies in the point at which their use becomes an issue for health (and social) services at an epidemiological level: the analysis of harms conducted “rang[es] from the intrinsic harms of the drugs to social and health-care costs.”

Clearly for most of us our drug habits do not concern health services at all. But at the point at which they do, the harm implications of alcohol consumption become much more evident: risks of liver cirrhosis, cardiomyopathy, losing one’s job, family breakdown, criminality etc.

There is no doubt that heroin use causes huge harms to the individual user and to society, but at an epidemiological level, these harms are dwarfed by the scale of the problems of alcoholism in this country. Estimates from the Institute of Alcohol Studies suggest that based on statistics from 2000, around  3 million adults in the UK are alcohol-dependent.

2 factors therefore combine to justify the intentionally provocative conclusion that alcohol is more harmful that heroin. Firstly, the ‘harms’ recorded are those which fall within the domain of health and social services. This excludes the ordinary drinking habits of the vast majority of ‘social’ drinkers. Secondly, as a public health issue, the scale of alcoholism or alcohol dependence as compared to heroin addiction does entail that alcohol causes greater health and social problems than heroin in this country. But I guess with those caveats the headline doesn’t sound as snappy.


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