A new study suggests alcohol is more harmful than heroin or crack | Hacker News Reader

A new study suggests alcohol is more harmful than heroin or crack

economist.com

46 pointscammsaul52 comments

This seems to me like a really simple-minded article--who is surprised that the most available, legal, inexpensive, socially-acceptable drug has the largest impact? By this measure walking down a flight of stairs is more dangerous than mountain climbing.

Ive never thought about it like that, thanks.

Are stairs more dangerous? No. Is the sum of all accidents on the stairs more costly to society than all accidents mountain-climbing? Probably.

There's a reason the occasional mandatory workplace-safety education sessions you have around your office focus on things like ladders and picking up packages: people actually do those things.

Postscript: Also, auto accidents cause kill more people in the US than terrorism. :P

That was sk5t's point.

Funny you should mention workplace safety.. where I work there is a campaign to have people take the stairs instead of the elevators, a typically busybody approach to improving employee fitness. However an employee is far more likely sustain an injury by using the stairs compared to riding in an elevator, and particularly as they were encouraged by the employer to do so, they would have a pretty clear worker's compensation claim.

> However an employee is far more likely sustain an injury by using the stairs compared to riding in an elevator, and particularly as they were encouraged by the employer to do so, they would have a pretty clear worker's compensation claim.

With or without encouragement by their employer, they would have a pretty clear worker's comp claim, as the injury is "in the course of employment."

Also, I would imagine that the company promoting usage of stairs has had an actuary do the cost-benefit analysis of the potential health-care savings versus the potential worker's-comp payouts.

We have a similar campaign where I work. I think the suggestion was instigated more by an "incentive" from our health insurance company than any strong desire by my employer.

Forget stairs, at one job my safety training included training on how to walk safely. And, while it felt silly, they were right to give it some thought (given that it was a repair job likely to involve being at unfamiliar places).

Indeed. If everyone were using shrooms like they drink beer, highway driving would be an adventure.

Doing this sort of analysis "right" (trying to determine which drugs are least-bad, quantitatively) would be a daunting challenge.

People have at least tried, however: http://upload.wikimedia.org/wikipedia/commons/thumb/9/9c/Rat...

From the original study:

"Many of the harms of drugs are affected by their availability and legal status, which varies across countries, so our results are not necessarily applicable to countries with very different legal and cultural attitudes to drugs." (1)

And I'm still confused - are they weighting for per-user, or overall?

Under a per-user model this is interesting.

Under an "overall" model this is obvious (legality of alcohol)

Since neither the linked article or the original study make this clear, I'm voting by clicking "flag"

(1) Source: http://www.chanvre-info.ch/info/en/IMG/pdf/drug-harms-in-the...

Unfortunately, it seems that it's an "overall" model -- see under "Study Design" in the "Methods" section of the paper.

There are "individual harms" that take account the harm done to the user himself or herself.

But, "the extent of individual harm is shown by the criteria listed as to others take account indirectly of the number of users"

(emphasis mine)

Unfortunately, parts of the study are well-thought, but others, not so much.

>to rank 20 drugs (legal and illegal) on 16 measures of harm to the user and to wider society, such as damage to health, drug dependency, economic costs and crime

What I don't understand about these studies is what mathematical basis they use for comparing the relative impact of these various factors. I would assume that these would all be completely different, and as a consequence, incommensurable. However, studies like this seem to have found appropriate relative weights for these factors, and were able to add them all together. I would be interested in knowing if it's really possible to do this without producing a figure that's totally bogus, and if so, how.

They explained it pretty simply - they asked the experts in the field to rate the harm on various factors, and they aggregated and compared those ratings.

Drugs and the harm they cause to an individual and others is highly subjective and contextualized within a culture/society. There is not going to be some math formula to give you the answer.

If you wanted to know the best web application framework to build your next REST API, would you build a mathematical theory for deducing it, or find out what the relevant experts in the field think?

"they asked the experts in the field to rate the harm on various factors"

IIRC they asked psychiatrists and not pharmacologists.

>Drugs and the harm they cause to an individual and others is highly subjective and contextualized within a culture/society. There is not going to be some math formula to give you the answer.

I disagree. I am a psychiatrist and participated in some clinical research. Step 0 is quantifying. It's not always perfect, but if you don't know what you are measuring, your measurements are useless.

The fact that you can quantify a thing by a given metric doesn't change the subjectivity of the choice. You can measure the amount a drug causes the average user to miss work, or die sooner, or number of missing teeth, or anything, but any combination of these will still always be: a) missing other relevant metrics b) representative of one perspective on what is valuable to measure, and what constitutes harm

The idea that any one set of metrics and measurements have more intrinsic truth-value than simply aggregating the internal mental weights of all the relevant experts in the field is just like, your opinion man.

If you want to present an alternate, mathematical model for drug harm and explain and argue for the validity of the choices you make for how to measure harm and how the data was gathered over what time period, etc etc - no one's stopping you.

But there's a bar graph! What more could you possibly ask for? Units? Definitions? Those just add visual clutter and make the bar graph less pretty. Beauty is truth, after all.

> and they aggregated and compared those ratings

Well, see, that's the tricky bit right there.

I wouldn't ask experts about application frameworks, I'd ask the people who use them. Similarly, drug experts, despite their profession, are not in a position to know the aggregate harm levels of various drugs. It's a misapplication of expertise and statistics, which apparently is the sort of thing the lancet has a fondness for.

If you wanted to make a legitimate measure of the harm of various drugs despite the inability to build a mathematical model, you could do a survey asking people about how often they use various drugs and their opinion of the harm they've been caused by various drugs (as user or non-user). You'd get systemic bias from peoples imperfect ability to judge harm but at least you'd have something instead of nothing.

Probably no mathematical basis at all. Asking drug-harm experts to rank them is thoroughly unscientific, unless the topic of study is the opinion of drug-harm experts and nothing else.

tl;dr If you want to be healthier, switch from drinking wine to huffing butane.

I've posted this before, but since I can't seem to find it in the search I'll just copy paste the explanation of why this is propaganda rather than science:

- The full methodology isn't actually published anywhere.

- The rankings are created by combining a lot of different factors that don't have anything to do with each other, e.g. by combining harm to the user with harm to society. This means that drugs like coffee end up being more dangerous than drugs like heroin, simply because more people use coffee than heroin so the total social costs are greater.

- The harms for drugs are measured as they are typically used, rather than correcting for things like differences in demographic and route of administration. This leads to drugs like heroin looking more dangerous than they are, because people who have drug abuse problems tend to gravitate toward drugs like heroin. (Whereas people who use, say, Khat tend not to be the worst of the worst as drug abusers go.) This is especially problematic since how drugs are typically used depends on the laws that exist to encourage or discourage their use. E.g. when drugs like tobacco and coffee used to be illegal, they were used more similarly to how crack and heroin are typically used today. So the idea of using these rankings, which are meaningless to begin with, as an argument for setting public policy is completely nonsensical.

- The harms of the drugs caused by prohibition are not accounted for. (E.g. they are counting people using dirty needles and impure/unknown/fake drugs as being a harm that stems from heroin, but they aren't counting using dirty needles and fake Starbucks as being a harm that stems from drinking coffee.)

-The way they assess the harms is by doing a survey of mainly psychiatrists and just asking their opinion. It's not scientific at all. If the people they were asking for their opinions were experts this wouldn't be scientific, but the people they're asking aren't even experts.

-The idea that some drugs are more harmful than others is anti-scientific to begin with, since the dosage makes the poison. E.g. there is no way to say whether weed or heroin is more harmful, since it's all about patterns of usage. Same for the idea that some drugs are more addictive than others.

- They're not accounting for the benefits of drug use, only the harms.

The absurdity of that "research" can't be explained better.

In fact the study ommits the most dangerous drugs, that is those which are used to fight cancer. They are very, very dangerous... and so what.

I grew up in a drinking culture, and damn we loved to party. Nothing was funnier than a drunk friend doing something stupid.

Twenty five years later: four of my school friends are dead from alcohol. Fuck - that kind of takes the fun out of it - I loved those people.

Most people can handle drugs and alcohol just fine. But a lot of people can't.

Wow. How old were they when they died, and what were their drinking habits like throughout the years, if you don't mind sharing. If you don't feel like providing the details, understood.

My friends died in their late thirties / early forties. I don't know all the details. One guy's liver gave out - another got into pills and I'm not sure what else. I don't know what killed the others, just that alcohol was contributor.

Stories like these are not uncommon. CDC says alcohol kills 80K people annually.

I always wondered why alcohol didn't get the same restrictions that cigarettes got: sure you can still buy marlboros anywhere, they are not banned and the police wont throw you in a cell for carrying a pack, but ads for tobacco are seriously curtailed if not outright forbidden in most places and the boxes themselves are full of health warnings.

Why don't do the same with alcohol? Where I live ads for beer, wine and other drinks are literally EVERYWHERE, and the way the ads are made is plain manipulative, something even Don Draper would consider going too far. It doesn't takes a psychologist to see alcohol ads much like the cigarettes go for the exact opposite of what an addict's life is like, and just like marlboro told men they could be cowboys and go into adventures beer ads say you can party hard 24/7 and nail all the chicks you want/see by being pissing-in-your-pants drunk.

Ironically the most realistic beer ad I ever saw was Pißwasser's in GTAIV.

beer ads say you can party hard 24/7 and nail all the chicks you want/see by being pissing-in-your-pants drunk

Hilarious. This was been the exact opposite of my experience in my younger days. If anything, alcohol tipped the odds against me in situations, in sober retrospect , would have went my way had I not been drinking. They should use celibate monasteries as a backdrop for alcohol ads.

Too late to edit: The grammatical errors in the parent post may lead one to think that I was inebriated prior to typing. I assure you this was totally due to poor editing rather than alcohol. :)

"I always wondered why alcohol didn't get the same restrictions that cigarettes got"

It did, and worse. See:

https://en.wikipedia.org/wiki/Prohibition

Did you even read that article? the prohibition was the BAN of alcohol, they didn't limit the ads or forced companies to put warnings on the label, they BANNED all drinks and beverages containing alcohol meaning if they catched you with a beer box it had the same results than walking around with a bag of marijuana today: jail.

I think that this chart (sourced from Figure 4) is rather telling. I changed the order to reflect the cumulative weight of each of the factors, then added in whether the study considers each item to be a harm to others, or a harm to the user.

Economic cost (CW 12·8) - others

Injury (CW 11·5) - others

Crime (CW 10·2) - others

Family adversities (CW 8·9) - others

Drug-related mortality (CW 6·4) - users

Dependence (CW 5·7) - users

Drug-specific impairment of mental functioning (CW 5·7) - users

Drug-related impairment of mental functioning (CW 5·7) - users

Drug-specific mortality (CW 5·1) - users

Loss of tangibles (CW 4·5) - users

Loss of relationships (CW 4·5) - users

Drug-specific damage (CW 4·1) - users

Drug-related damage (CW 4·1) - users

Environmental damage (CW 3·8) - others

International damage (CW 3·8) - others

Community (CW 3·2) - others

Expanding on an point by grimtrigger, is this related to damage per user, or overall damage? If governments no longer controlled heroin, and the number of users spiked to be the same as the number of users of alcohol would the graphs change.

I suspect that because of dependency, strong drugs would still lead to increases in crime, since they would still cost something, and their users would still not be in a position to productively earn to feed their habit especially as they got deeper into the addiction.

You suspect wrong on both accounts. Many governments have legalized Heroine. Doing so has always lead to marked decreases in use. Lower use means lower demand means less drug related crime.

Additionally, when money saved on drug enforcement is appropriated for needle exchanges and rehab centers, the price of a days worth of heroin drops to 0 for the user. Areas with decriminalized heroin and needle exchanges see the greatest reduction in use and drug related crime.

" Many governments have legalized Heroine. Doing so has always lead to marked decreases in use." Source?

Is this chart adjusted for number of users? For example if not a single person in the UK used alcohol, would it drop to the bottom of the list?

If not, it makes very little intuitive sense.

Where does the societal harm from anabolic steroids come from? Is it because anabolic steroids have an illegal black market? Why don't LSD and mushrooms have that same black market induced societal harm then?

And how does harm to self from anabolic steroids come under harm to self from cannibis? Has anyone ever killed their liver with cannibis? Anabolic steroids can do that, and much more, to your body.

This whole thing seems very bullshitty to me.

> Where does the societal harm from anabolic steroids come from?

I think the argument for this would be similar to the argument for using models with less atypical body types. If all the guys I saw on TV when I was a kid were super jacked, I'd probably feel more pressure to be that way and possibly use anabolic steroids to get there.

Considering that we have an obesity epidemic, I wonder if more jacked people on TV might actually do us some good.

Step one, well before dosing up, is diet and exercise. Anyone wishing to imitate the muscleheads on TV would have to go through that distinctly self-improving step first. I suspect that anyone who continues on to use steroids after that would be well offset by all those who dropped out before reaching the point where self-harm becomes involved.

> This whole thing seems very bullshitty to me.

I agree however

> Has anyone ever killed their liver with cannibis?

Liver damage from steroid abuse only applies to use of oral steroids. And even that is "only" comparable to drinking alcohol. Looking as to how professional bodybuilders utilizing steroids tend to lead a vastly more healthy lifestyle (diet, workout) than most people it'd assume it somewhat reduces overall health risk. Assuming the fictional situation where I would have to pick between option

a) a friend starting to use steroids, cleaning up his diet and working out most days of the week

or b) smoke pot every day, play video games and eat Ben and Jerrys

I would pick option a) by a wide margin.

Personally I have smoked pot in the past and while casually smoking a little weed is all good and fun (like having a few beers), repated use has a zombifying effect on me which is very strong. For me it's as if my whole brain is slowed down. I've seem people who still get along just fine smoking pot regularly but I've also seem people whose personal development just completely stopped and their social life is centered around smoking bud as the result of regular pot use. I am all for legalization but don't make the mistake of assuming that just because delta 9 THC is a chemical that occurs in a plant it is a drug without any negative consequences or addiction potential for anyone.

Certainly steroids can be used safely, and to be clear, I think that the healthy lifestles lived by users of steroids should more than make up for any aggragate negative impact steroid use may have. I fully support the use of anabolic steroids, they are a-okay in my book.

However to say that pot can be dangerous because it's users often adopt fatass lifestyles seems a bit disingenious. You could similarly start attributing sports injuries to anabolic steroids (clearly sporting injuries would never catch up with fatass injuries, but anyway..), though that would be similarly disingenious. I think the only reasonable way to compare the drugs is to compare the harm that the substances themselves are capable of inflicting when taken in dosages that are logistically feasible.

In your fictional situation I think I would choose the unstated option c) clean up my diet, smoke pot occasionally, and go to the gym almost every day. Hmm.. come to think of it, that is already what I chose...

> However to say that pot can be dangerous because it's users often adopt fatass lifestyles seems a bit disingenious. You could similarly start attributing sports injuries to anabolic steroids, though that would be similarly disingenious.

yes, you are completely right. I just wanted to make the point that you shouldn't promote THC as a completely harmeless wonderdrug without potential to worsen your life. I wrongfully assumed that you might fall into this camp.

> In your fictional situation I think I would choose the unstated option c) clean up my diet, smoke pot occasionally, and go to the gym almost every day. Hmm.. come to think of it, that is already what I chose...

sounds like a reasonable choice :) more power to you

Wait, how is methamphetamine use not harmful to others? Doesn't methamphetamine use specifically lead to erratic behavior?

Very very rarely. For most methamphetamine users, you can't even tell when they're using.

Markedly different from alcohol, which frequently causes erratic and even extremely dangerous behaviour.

There is a high degree of confirmation bias in observation of meth users. Most are docile but when someone has a violent reaction it is usually extreme.

Unless you mean perhaps the erratic behavior/decision making caused by long-term addiction?

I dare say that alcohol is more harmful than Americans' owning assault rifles. Thus, by extrapolation, the gun-control proponents should also be clamoring for increased control of alcohol if they were truly concerned about "protecting the children."

Pdf: http://www.chanvre-info.ch/info/en/IMG/pdf/drug-harms-in-the...

Reading the study, this poll/index-based study actually did rank Crack Cocaine more harmful than Alcohol in terms of "harm to others". On that axis, they claim the worst in terms of "harm to others are, in order: 1. Crack Cocaine, 2. Heroin, 3. Metamfetamine and 4. Alcohol.

Alcohol ranked #1 in terms of "harm to yourself". In order for "harm to yourself" they found: 1. Alcohol, 2. Heroin, 3. Crack Cocaine.

There are many issues with this study, obviously. Dosages / use can significantly differ between drugs, etc.

So why is cannabis so high? Especially "to others". Why did researchers rank it so high, so often? I have to wonder what the "harm" was that they were thinking of so frequently.

Given that we've established that this study is invalid as a matter of methodology, are there any legitmate attempts to compare harm caused by various drugs? A graph like this would be really interesting if it were backed by actual evidence.

So, despite the title, this is not new at all (2010). On an unrelated note it's very shoddy speculation, not based on life outcomes of alcohol users versus crack users or anything remotely meaningful.

"A new study..."

"Nov 2nd 2010"

Reply on news.ycombinator.com