The illegal use of, addiction to and overdose deaths from opioids, particularly prescription painkillers, is an epidemic in the US, and at least a growing problem in Europe. But alcohol is another scourge that is possibly worse – the more so because it is legal, more readily available, and socially acceptable in most of the world.
Alcohol Deaths in the US and Europe
Despite legality, alcohol is a drug, though it isn’t always labelled as such or always included in lists of drug deaths. Depending on the statistics you use – even the US Centers for Drug Control and Prevention (CDC) seems to offer contradictory data – and how you interpret them, alcohol abuse may account for more deaths in the US than all other drugs combined.
Europe, in general, has even higher rates of alcohol abuse than the US, and some of the highest in the world. The UK has lower rates of alcohol-related deaths than the US, according to the World Health Rankings, according to 2014 World Health Organisation data. Germany, France and most of Eastern Europe have higher, as does Canada and most of Latin America. However, little seems to be done about it.
The Lesson of US Alcohol Prohibition
One thing that shouldn’t be done is outlawing alcohol. The US tried that from 1920 to 1930 with the 18th Amendment to the US Constitution, which established prohibition. It was the only amendment to be repealed by the passage of another amendment. It is estimated that it annually cost the US government $21m in enforcement and $1.25 billion in lost tax revenue. No one should recommend a return to prohibition, or advise Europe to try a similar remedy.
Not only did prohibition fail to end drinking in America – though it did reduce the consumption level by the poor, who could not afford bootleg prices or the charges at the speakeasy bars – it spurred the proliferation of organised crime and its associated violence, which turned otherwise honest citizens into criminals.
The Lesson of the US War on Drugs
Despite that lesson, the US repeated the blunder with its “War on Drugs“, primarily initiated for self-serving political reasons by President Richard Nixon. Europe, by contrast, did learn from the US and taken a more pragmatic approach – rehab treatment, plus harm reduction, such as safe places to shoot up, clean needles and more readily available counselling – and as a result has (at least according to a 2007 article) half the rate of drug use and drug overdoses as the US.
The reduction in incarceration rates compared to the US alone may have saved Europe millions of euros. One estimate says for each euro “invested” in drug education and counselling, Europeans save €15 euros in police and health costs.
Portugal may have had the most dramatic results, with its decriminalisation – for drug possession and use, not trafficking – counselling and harm reduction efforts – including free methadone for heroin addicts – leading to a 75% drop in heroin use and the lowest drug death rate in western Europe – one-tenth of Britain, one-fiftieth of the US. (Not that the latest European news is all rosy: cocaine use in the UK has increased 16% in the past year, which helps explains why it has the highest cocaine overdose death rate in Europe.
What Alcohol Abuse Costs the US
But while no one argues that drugs, legal and illegal, have no harmful effects, alcohol’s impacts are worse. According to the CDC, “excessive alcohol use” was responsible for an average of 80,000 deaths per year from 2001–2005, and to have cost the US $223.5bn in 2006 alone.
The CDC estimates the costs to the American economy was $249bn in 2010, roughly $800 per person or $2 per drink. The worst economic hit – almost three-quarters – was due to lost workplace productivity, followed by healthcare expenses, criminal justice costs and motor vehicle crash costs.
A more recent CDC figure from 2015 indicates that the number of people who died due to alcohol consumption (a more modest 30,000, though that does not include automobile deaths due to alcohol; when they are included, the figure triples) was more than all the heroin and prescription painkiller deaths combined.
Most of that drinking in the US is done by 10% of the population, who average more than 70 drinks per week.
Alcohol and Cannabis
Alcohol not only has worse outcomes than a relatively benign drug such as cannabis, but in combination, it can make things even worse. A study in 2015 found that alcohol increases the concentration of THC – the largest component and main cause of euphoria in cannabis – in the blood.
Also increasing is the number of accidents in which cannabis and alcohol are both present in the blood. That may be why while the number of automobile accidents resulting in death has gone down where cannabis has been legalised, but the total number of accidents has gone up.
Bars are already a form of “safe space” to use alcohol. Alcohol abuse help is even more widely available than opioid abuse help. Reducing alcohol abuse will require a different approach. That approach may mean stronger alcohol control policies.
Alcohol Control Policies in the US
At least that’s one of the findings of a 2017 study by Boston University and Boston Medical Center. Specifically, alcohol control policies, such as sales restrictions and higher alcohol prices, have been shown to reduce the numbers of alcohol-related violence and homicides.
About half the people involved in homicides are alcohol-impaired, either victim or perpetrator. As it happens, approximately half of alcohol-attributable deaths also are attributed to binge drinking – usually reckoned as five drinks at one sitting for men, four for women – as well as three-quarters of the economic costs.
Stronger alcohol control policies, based on the Alcohol Policy Scale (APS) – an assessment of 29 alcohol policies across 50 states and Washington, DC, and the Fatality Analysis Reporting System – seem to correlate with less binge drinking and fewer alcohol-related homicides. Another study in the journal Pediatrics finds that strong alcohol policies can reduce automobile crash deaths involving young people.
Alcohol Control Policies in Europe
The European Comparative Alcohol Study (ECAS), a European Union-financed study of alcohol control policies in Europe, used a similar scale to the APS. Among the factors it considers are:
- Control of production or wholesale: state monopoly or requiring a licence.
- Control of distribution: State monopoly, licence or other special restrictions for retail sales
- Control of marketing: Alcohol advertising restrictions.
- Public policy: A national alcohol education and prevention agency or programmes.
- Social and environmental controls: requiring low blood alcohol content (BAC) limits.
- Personal controls: age limits for alcohol purchases.
The ECAS did not examine the effect of higher alcohol prices, though it acknowledged that they are “one of the most efficient ways” to restrict problems associated with excessive alcohol consumption.
A Moderate Proposal
People abuse alcohol and drugs for the same reason people abuse anything: They can and they want to. Anything – from food to weapons, engineering to chemistry, politics to religion, even language – can be abused. We don’t outlaw it, but we try to prevent its abuse with sensible legislation and controls.
Controlling substance abuse – legal or otherwise – cannot be achieved by absolute prohibition or absolute license. A more realistic and sustainable path is required between the two, with the addition of education programmes to prevent abuse and rehabilitation when such programmes fail. As Plautus (and Hesiod, in almost the same words), said, “Moderation in all things is the best policy.”
More on Health
Home Invasion: Internet of Things, Economics and Health
The Internet of Things (IoT) is now a member of the family. It is a done deal. There is no...
Potential Applications of Blockchain Technology
Technology is reshaping the world thick and fast. Blockchain, IoT, AR, VR, Big Data analytics and other emerging technologies have...
Baby You Can Drive My Car: How Cars and AI May Predict Health
Sedan = Democrat. Pick-up = Republican. The method used to arrive at this conclusion is really more fascinating than the...