There is a well-known thinking game played among University students that has failed to dwindle in popularity over the years. ‘Which is worse’ is one title that can be given to this form of entertainment, and its basic rule of choosing between two typically disgusting options admittedly serves as a delightful procrastination tactic. Only a few months ago were we university students given a new subject to consider along the lines of the ‘which is worse’ theme, when The Lancet published a study comparing the overall harm of various drugs. Much to the surprise of many, it was alcohol that was regarded as the worst, significantly surpassing the likes of heroin and cocaine. Admittedly, I hadn’t heard of this issue until last month, when it was fervently debated in one my modules. As it turns out, the factors involved in overall ‘harm’ are far more complex than I had originally imagined – much more challenging than the typical ‘which is worse’ conundrum. The proposition for the debate argued in support of this study, while the opposition debated that the traditional view that heroine and cocaine were worse drugs should be maintained. As a change from my normal ramblings concerning the idiocy of scientific authors, I thought that this particular issue would be worthwhile blogging about.
The physical effect on the individual was the first aspect that both sides looked at. Interestingly, the difference in physiological effects between alcohol and drugs was an issue over which both sides were relatively quick to harmonise. It was relatively uncontested that on an individual basis, cocaine and heroin have a considerable more severe impact than alcohol. Heroine is estimated as 1.5 times more addictive than alcohol, and the severity of withdrawal symptoms for these drugs is far greater than that of alcohol. Yet the proposition was adamant about the importance of not undermining the physiological effects of alcohol. Sudden deaths due to alcohol poisoning are not unheard of, and we’ve learned all too frequently in biology lessons the risk of fatal cancer and liver disease because of its consumption. I don’t think I’m exaggerating when I say I caught smirks among the audience when the proposition spoke passionately of the negative effects of binge drinking. Nor will I deny that it’s these same people that I’ve frequently witnessed on late night drunken strolls through London punctuated by the occasional vomit attack. Nor will I even deny that that was because I was with them doing the same thing. Yet in all seriousness, the proposition’s remarks do hold true: Why is it that we laugh at the token drunkard at a party? Granted, the token drunkard will usually find himself hungover yet generally fine at lectures the next day, but not without having compromised his short term and long term health, not to mention his dignity.
The physical effects of these drugs have a far wider scope than their direct impact however, and this was something that I embarrassingly had not considered before the debate. I choose to interpret this as a representation of my good-girl characteristics as opposed to my naivety. Cocaine is frequently sold in diluted forms for the purpose of cheaper production, leaving consumers unaware of its purity and concentration of other hazardous chemicals, which thereby increases the risk of adverse physical affects. Heroine, taken intravenously, exposes users to a wide range of infectious diseases, most notably HIV/AIDS. That much I did know, let me point out - if not from academic sources or hearsay then because I have watched RENT at least seven times. Nevertheless, alcohol does not have such complications, making its physical impact much less dramatic than that of heroine and cocaine. At least on an individual physical level, it was clear that the opposition had a stronger case.
Overall harm of course, refers to much more than physical effects. As the proposition pointed out, the greater harmfulness of alcohol is due largely to the wider extent of consumption. 90% of the adult population in the UK, they claimed, consumes alcohol, compared to the 2.4% that use cocaine and the mere 0.1% that take heroine. Naturally this means that the effects of alcohol are much further reaching than that of the other two drugs. Although somewhat valid, it was at this point that I allowed myself to be entertained by the fervour of the proposition. That 90% figure after all, is hardly representative of the numbers of people that are negatively impacted by the drink. The opposition happily pointed out that only 0.5% of drinkers known to be alcoholic. Despite potential risks, alcohol is a recreational substance when drank in a controlled manner; far more so than the likes of heroine and cocaine. House parties, dates, and special events are not without their fair share of alcoholic substances, and its characteristic as a social lubricant perhaps even presents alcohol in a positive light. Although I realise that that says much about our society that we need inebriation to get along.
Of course, the proposition did follow up on this statistic with several valid points.
The link to criminal activity was striking: in the UK, 86% of homicide offenders committed their crimes under the influence of alcohol, as did 37% of assault offenders. Indeed, anyone who has seen students at the Roxy, a notorious UCL nightclub, will definitely understand the potential for violence among testosterone-pumped sports men. Domestic violence in particular was framed as an alcohol-catalysed cycle, with abused children being particularly at risk of turning to alcohol abuse and in turn perpetuating the abuse onto their own offspring. No evidence, on the other hand, was found to link heroin or cocaine to domestic violence. Road accidents were naturally pointed to in the proposition’s argument, and indeed the 11,000 road casualties under DUI conditions per year dwarfs the heroine and cocaine equivalent of 248. Alcohol’s cost on society was furthermore asserted as substantial, as costs to the English economy in terms of crime and health amount to 18 to 20 billion pounds per year. The opposition however was quick to come up with a conspiracy-theory-reminiscent point, in that due to taxing of alcohol, the state actually benefits from alcohol consumption.
These were certainly strong arguments by the proposition, yet it was the next point which made the biggest impact, as it did with most of the audience that day. Drugs, the opposition argued, had immeasurable international implications. From crime in the UK between gangs over drug smuggling, violence perpetrated by drug cartels in Colombia, to the fuelling of civil conflict in Afghanistan, heroine and cocaine seemed to bring about devastating international consequences, and the opposition were particularly skilled at drilling this point home. Upon voting, they won with a clear majority, and I left the room with a selfish sense of gratification that I had been on the winning side.
However, I’ve thought about the debate since, and possibly because of my lack of social life I did also manage to look up the original study that postulated the harmfulness of alcohol. If I was forced to vote again, I would probably vote for the same side, but undoubtedly largely because of the rhetorical skills of the opposition. They had obviously researched their position well: they made use of an appropriate selection of statistics, were able to make impressive rebuttals, and being good at speaking to the extent that one of the speakers was particularly intimidating certainly worked in their favour. The proposition did too make good points, yet their awkward use of personal anecdotes and less impressive public speaking certainly did not help their case. Yet when stepping away from this particular debate and looking at the argument in general, I feel that I have established a stance of actually refusing to vote on the matter. Yes, it appears I have turned into one of those annoying people that abstain during important elections. Yet this is due to the realisation that I actually have several problems with this debate; not merely the specific points themselves but the whole concept of the debate in general.
Looking at the original study, the following scores for ‘harmfulness’ were given to the mentioned drugs: 55 for heroin, 54 for crack cocaine, and an obviously significant 77 for heroin. Analysing at the actual break-down of the criteria and the point allocation, it appears that the reason that alcohol scored so highly was because of its high economic and social costs. But more importantly, it was because these economic and social costs were weighted so highly. International effects, this being ‘deforestation, destabilisation of countries, and international crime’, which heroine and cocaine are undeniable catalysts for, was only attributed minor importance compared to all the other factors.
This is understandable of course: your own problems are always horrendously more important than anyone else’s. But this just seems to indicate that the extent of ‘harm’ is completely subjective. Who is to decide which factor is more important than another? Experts can, yes; but being a scientist doesn’t necessarily give you the utmost right to determine what factors are more important than others. This whole concept of one thing being ‘overall’ more harmful than another thus seems somewhat irrelevant and unrealistic. If one is to look at the situation within the UK, getting rid of the ‘overall’ adjective and spitting up the argument into harm to ‘self’ and to ‘others’ on the other hand makes this issue is much more straight forward: Alcohol is evidently the most harmful drug concerning its impact on society, while heroine and cocaine easily top alcohol in terms of personal physical effects. Yet splitting up the issue of harm this way is of course a much less exciting way of looking at it.
A further point which I feel makes the whole argument somewhat abstract, is that the debate does not truly concern the harmfulness of the drugs themselves. By looking at their overall impact on society and on international communities, we are effectively analysing the legalities, social norms, and economic policies surrounding their production and consumption. Are we analysing how awful cocaine is, or we are analysing how awful making cocaine illegal is? Its illegality, one can argue, may be considered an inherent characteristic to heroine or cocaine in general, but I don’t feel that that should be the case. Alcohol for instance, is illegal in some countries and not others, which completely changes the dynamics of demand and consumption. I am by no means an expert on this, but surely making alcohol illegal in the UK would result in substantial black market activity and maybe even an increase in booze related crime? Perhaps it is the scientist in me that only wants to compare substances under strict laboratory conditions, but it feels that the complexities surrounding the different drugs in contemporary society render a general comparison superfluous.
There are of course lessons to be learned from the entire debate, providing that the debate is looked at in the right way. Laughingly stating that cocaine is obviously not that terrible considering that it is actually rated as better than alcohol is not a healthy way to perceive this argument, for instance. Rather, it brings light to the current dangerously blasé attitude towards the consumption of alcohol. As much of a social lubricant that it is, the extent of casualties, accidents, and social problems as a result of alcohol consumption makes it clear that the damaging effects of alcohol are often undermined.
In terms of personally affecting my own behaviour however, this debate has not made much of a difference, - this being because, I am proud to say, I am a very healthy alcohol drinker. And while the whole issue has nevertheless been an appreciated food for thought… I wouldn’t mind reverting back to the more primitive and scandalous ‘which is worse’ subjects for a while.
