Analysis: Alcohol Is America’s Biggest Drug Threat

America’s communities are besieged by a highly dangerous, addictive drug. Its users can become agitated and violent, harming themselves and family members. It’s incredibly toxic and even lethal at high doses. Many people who start abusing it are unable to quit. It’s responsible for nearly 90,000 deaths each year. And in a new survey, more than three-quarters of Americans identified it as a serious problem in their community.

I’m talking, of course, about alcohol.

In a new survey by the AP-NORC Center for Public Affairs Research on American attitudes toward substance use and abuse, 76 percent of respondents named alcohol as a serious problem in their communities. That’s higher than the percentage who named any other drug. More people are worried about alcohol than are worried about painkillers. Or cocaine and meth. Or heroin. And marijuana? That’s at the bottom of the list.

Part of this is a simple reflection of the relative prevalence of each drug. Many more people drink than use heroin, for instance. So compared to heroin, the typical American is more likely to see the negative effects of alcohol in their daily lives.

But the survey results also underscore one of the central problems with drug policy as we’ve practiced it over the last 40 years. Our state and federal bureaucracies consider alcohol separately from other drugs, like cocaine and marijuana. This split is evident even in the names of the agencies that craft drug policy. It’s why the NIH has a National Institute on Alcohol Abuse and Alcoholism along with a separate National Institute on Drug Abuse. It’s why the Bureau of Alcohol, Tobacco and Firearms stands apart from the Drug Enforcement Administration.

These distinctions are useful from a legal standpoint — after all booze is legal, while other drugs aren’t. But from a scientific standpoint, they’ve never made much sense. The abuse of alcohol and other drugs often go hand-in-hand. Among adolescents, the use of alcohol often precedes the use of other substances, licit and illicit.

Alcohol, in other words, is a drug. It’s a psychoactive substance that people ingest in order to produce an intoxicated state. And like other drugs, the use of alcohol carries any number of risks.

Recent federal research indicates, for instance, that drunk driving carries a much higher accident risk than driving while under the effects of many other drugs. The difference between an “effective dose” and a “lethal dose” of alcohol (e.g., the difference between “buzzed” and “dead”) is small compared to a number of illicit substances, like marijuana, LSD, meth and ecstasy. Nearly 90,000 people die of alcohol-induced causes each year, making it second only to tobacco on the list of America’s deadliest drugs.

But for decades, policymakers vigorously prosecuted a war on less-dangerous illicit drugs while basically giving booze a free pass. From a public health standpoint, this doesn’t make a whole lot of sense. For some time now, researchers have been calling on lawmakers to shift public health resources “towards alcohol and tobacco rather than illicit drugs,” as one paper put it last year. After all, tens of thousands of lives hang in the balance.

The survey results above suggest that Americans are currently one step ahead of lawmakers when it comes to understanding the threat of alcohol abuse relative to other drugs.