Is alcohol a drug?

To a pharmacologist, that question is a little bit like “Is water a liquid?” Alcohol is not just a drug, but the archetypal drug: the drug most widely used and the drug that causes the most addiction, disease, and violence.

But in ordinary usage, the word “drug” does not include alcohol. If I told you that someone was a drug dealer, you’d be surprised if I meant only that he was a bar owner. If I said that an incident of unplanned sex was due to the use of a date-rape drug, you’d be surprised if what I meant was that the victim was drunk. The National Institute on Drug Abuse does not study the abuse of alcohol, which has an institute all its own.

That linguistic distinction is both an effect and a cause of the fact that “drug” (meaning intoxicant) has been given a strongly negative connotation. A drinker told that he is a “drug user” will be offended as well as puzzled.

Calling alcohol a drug has two great practical advantages, in addition to its accuracy. It would remind drinkers that, when they take a drink, they’re interacting with something that could be dangerous. And by reminding drinkers and non-drinkers alike that “drugs” and “drug use” are familiar rather than exotic, and potentially dangerous rather than inherently evil, it would somewhat soften the negative emotional valence now attached to “drug use.” There’s nothing wrong with smoking pot, any more than there’s anything wrong with drinking beer. The question is always one of time, place, person, quantity, circumstance, intention, and behavior.

All of that connects to a debate about both ideas and tactics going on among proponents of cannabis legalization. The debate concerns what to say about alcohol.

One faction wants to ally with the alcohol industry under the banner of “We’re all anti-prohibitionists together.” That ducks a possible fight with a powerful financial and political force and allows pot advocates to piggy-back on the only partly true but politically potent idea that “Prohibition was a failure.” Apparently at least some of the booze folks are willing to go along, at least passively.

The other faction wants to make alcohol the target. “How can you possibly support banning pot when the alcohol you use is so much more dangerous?” That argument puts legalization advocates on the right side of the “drug abuse” issue, and has great surface plausibility, though neither of the missing premises – that current alcohol policy is appropriate for alcohol or that legal cannabis will reduce problem drinking – is supported by evidence, and the first of them is absurdly wrong. But making that argument runs into the problem that most voters drink, and many of them would be put off by criticism of their favorite drug.

As an anti-culture-warrior, I rather dislike the “Your drug is nastier than mine” argument, even though on almost every dimension save familiarity alcohol is indeed much nastier than cannabis. On the other hand, anything that brings our emerging policy toward legal cannabis closer to our current unsatisfactory policy toward alcohol strikes me as a thoroughly bad idea, and I’d rather see the power of the emerging pot industry fighting the power of the established alcohol industry rather than allied with in opposition to rules to protect public health and safety.

Asking the question “What claim, if accepted by the voters, would lead to the best policy toward alcohol and cannabis?” rather than the question “What claim, if persistently made, would most advance the cause of cannabis legalization?” I would answer:

Alcohol and cannabis are both intoxicating and sometimes addictive drugs. Alcohol intoxication has greater behavioral risks, especially of violent crime and reckless sexual behavior; alcohol is more physically toxic; and alcohol addiction is both more common among drinkers than cannabis addiction is among cannabis-smokers and, on average, harder to recover from. Users of either drug – and, even more, users of both drugs in combination – ought to be aware of those risks, which the sellers of those drugs will do their best to minimize. Public policies ought to make both drugs available for responsible adult use while strongly discouraging problem use with high taxes, marketing restrictions, and (at least for alcohol) temporary bans on sales to, and use by, people convicted of drunken driving or drunken assault.

Of course, trying to take the Manichaean tendency out of American politics is like trying to take the white out of snow. The desire to divide everything into categories of “good” and “evil,” with no room for “possibly beneficial but risky,” is among our national vices, and it’s a vice far more addictive and destructive even than cigarette smoking. It leads, for example, to the idea that any drug – or, for that matter, any commodity or activity – not dangerous enough to prohibit must therefore be safe enough to sell without limit and promote without restriction. In reality, nothing is absolutely and ineradicably evil save boiling vegetables and voting Republican.

Whether fighting Manichaen thinking is good political tactics I can’t tell you. But I can tell you it’s pious work.

Comments

  1. Stephen says

    Alcohol may well be associated with a higher incidence of “problem” behavior under the current legal regime but that doesn’t necessarily mean that it would be in a world in which cannabis were similarly unrestricted. Alcohol can be legally consumed in public places. That means that drinkers are often a car ride away from home and in crowded rooms full of similarly intoxicated strangers (and thus at risk of driving drunk and getting into bar fights). Because cannabis is verboten though its users (on average) tend to consume much more frequently in their own home (and thus have no need to drive under the influence) or in friends’ homes (and thus have less chance of getting into an altercation). Legalize pot use and 20 years from now you’d expect to see people smoking up in bars before driving home or fronting their fellow bar patrons. And on the drunk driving front specifically I’d point out that under the current legal and cultural norms cannabis is much more popular among people in urban settings and the young than is booze. Thus its consumers drive fewer miles in general. Controlling for mix is a bitch.

    Your point about addiction risk is of course correct though.

    I’m not sure about the point around sexual assault risk. Again – in a world in which cannabis could be consumed in bars and college parties as openly as is booze I’m not sure that it would continue to be associated with a lower incidence of such behavior.

  2. Ken Doran says

    It doesn’t go to the heart of your point, but I think you sell your fellow citizens short on today’s prevailing level of understanding of alcohol. I believe that a reasonably clear understanding of alcohol as a dangerous, mood-altering drug/substance that happens to be mostly legal is more widely held these days than you suggest. Abiding by the all-too-well-established “alcohol or drugs” language convention does not contradict that. Also, I ran a Google search on the phrase, “alcohol and other drug abuse”, and got 199,000 hits.

  3. Anderson says

    Drug, schmug. The word is in-toxic-ation: humans are such crazy animals, we poison ourselves because we like how it feels.

  4. paul says

    There are some examples of treating things as “beneficial but risky” in US politics — perhaps the two most obvious are automobiles and air travel. Policy surrounding the safety of both of those entities has been mediocre, but not for the most part surrounded by moralistic grandstanding. Both also (for much of the policy) involve relatively small numbers of players.

    • Fallibilist says

      Nuclear Power is arguably another example. The U.S. currently gets about 20% of its energy from nuclear. Although I would prefer French levels of generation (~80%) in order to combat greenhouse gas emissions, this 20% number has been steady for quite a while. There has never been a death from a civilian nuclear accident in the U.S. While the loudest voices in the nuclear debate do come from the extreme anti, the elites in power have a more measured view.

      The good (but not perfect) safety record of nuclear power in the U.S. is in large part a credit to tight regulations administered by the experts involved in dedicated government bureaucracies. Good for them.

  5. Stephen says

    Anderson:

    Poison Shmoison. Moderate alcohol use is associated with significantly better health outcomes than abstention. Heavy alcohol use is not.

    Eat enough tuna and the Mercury will kill you. Eat a normal man’s amount of tuna and you get a lot of delicious and healthy meals.

    “Toxicity” is a function of a substance’s effects relative to your body’s ability to effectively metabolize the quantity you are ingesting.

    • rachelrachel says

      >Moderate alcohol use is associated with significantly better health outcomes than abstention.

      Yes, but it’s not at all clear that these better health outcomes are attributable to the alcohol.

      Here are some other well-attested factors that come into play:

      The “sick-quitters” phenomenon. People quit drinking because of health problems. These people are included with the abstainers.

      Reformed alcoholics who have stopped drinking after years of abuse. This could be considered a subset of the above.

      Income level. For various cultural reasons, poor people are more likely to abstain than the better off.

      Ethnicity. Blacks are far more likely to abstain from drink than whites.

      Lifestyle. People who are moderate in their drinking tend to be moderate in other areas of their life. On average, they tend to eat moderately and are more likely to exercise. Moderate drinkers are less likely to be cigarette smokers than nondrinkers.

      When studies control for these confounding factors, the picture is much less clear.

      • James Wimberley says

        “People who are moderate in their drinking tend to be moderate in other areas of their life.” That’s not an independent variable. Alcohol confronts people young with the challenge of moderation versus excess. If they succeed, moderate habits – resisting temptations to excess – are reinforced in other areas.

  6. says

    On the other hand, anything that brings our emerging policy toward legal cannabis closer to our current unsatisfactory policy toward alcohol strikes me as a thoroughly bad idea, and I’d rather see the power of the emerging pot industry fighting the power of the established alcohol industry rather than allied with in opposition to rules to protect public health and safety.

    If we were talking about cocaine or heroin, sure, I’d agree. But marijuana is SO harmless that it’s consumption is basically a positive good– people get a lot of pleasure and they don’t run very serious risks (and certainly don’t THROW risks on other people like drunk drivers and drunk wife beaters do, which is really what you need to show to justify stopping people from enjoying themselves).

    In other words, a policy that might be unsatisfactory regarding alcohol (but at least respects people’s freedom to enjoy intoxicating themselves) is perfectly satisfactory regarding marijuana because consumption of pot is basically recreation that does little harm to society.

    • prognostication says

      Stoned drivers aren’t dangerous in a similar way to drunk drivers? I would like to see cites on that.

      • says

        “The answer seems to be that driving stoned isn’t as dangerous as driving drunk.” – Marijuana Legalization: What Everyone Needs to Know, by Jonathan P. Caulkins, Angel Hawken, Beau Kilmer, Mark A.R. Kleiman.

        • says

          “The drunk driver speeds through the stop sign without seeing it.
          The stoned driver stops and patiently waits for it to turn green.”
          - Guitherisms

      • says

        Also, if you’re going to use stoned driving as evidence that marijuana is harmful, then you should do the same thing and say that cell phones are harmful, eating fried chicken is harmful, and being tired is harmful, since all of those activities are potentially harmful if done while driving.

        • prognostication says

          I don’t know why I dive into these threads, I really don’t. I was responding to a claim that alcohol is harmful because driving drunk is harmful that included the implication that marijuana is not dangerous because driving stoned is not harmful. Please read for context.

          And as far as those citations, “not as dangerous” is not the same as “not dangerous.” Driving at 0.05 is not as dangerous as driving at 0.1 is not as dangerous as driving at 0.2, but they are all more dangerous than driving sober. How does driving stoned compare? I also looked at the study above, and their evidence on whether MMJ laws actually affect accident rates seems mildly suggestive of what the legalization advocates believe, but still pretty weak. Having been a passenger of drivers intoxicated by either substance, I would agree that my observation was that stoned people are not nearly as bad as buzzed/drunk people. But they also do have slower reaction times and are prone to distraction, which are not really ideal qualities in a driver. But that is just anecdotal observation, still interested in further empirical evidence.

          • Freeman says

            You’re going off the deep end here, Prog. You asked for citations to the effect that “Stoned drivers aren’t dangerous in a similar way to drunk drivers”. And now that you’ve gotten a few, you want to move the goalposts to “not dangerous” at all? All driving is dangerous to some extent, and as Pete pointed out there are many, many things sober drivers commonly do which are much more dangerous than driving while stoned.

            You asked for help and you got some. If you’re not satisfied that the citations provide enough empirical evidence to answer “How does driving stoned compare?”, then maybe you should do your own damn research instead of whining at people who tried to help you out.

          • prognostication says

            The first study, posted by Fallibilist, doesn’t actually respond to my question at all. It addresses a loosely related question, which is whether medical marijuana legalization creates additional traffic accidents, and it finds some evidence that is weakly suggestive that doesn’t. Surely I don’t need to explain to you the numerous reasons why that is not terribly convincing. The second “study” isn’t really a study so much as a quote, and the context in the book seems to basically be saying that it’s probably not as dangerous as drunk driving (which is really dangerous! there are things we ban people from doing while driving that are not as dangerous as driving drunk) but there isn’t really conclusive evidence on how dangerous it actually is. Those are the only two citations.

            I believe that the onus of proving an assertion is on the person making the claim.

  7. Frank says

    This is a great post Mark. I guess I would be down for more restrictions of alcohol, most notably higher taxes, in exchange for a lower drinking age and less restrictions on alcohol licenses. Drunk driving is clearly a problem, but so is “sleep driving”, “cell phone driving”, etc. The common denominator is a car and hopefully automated driving will come sooner rather than later…

    Also Mark, which society has come closest to your Platonic ideal of alcohol policy? I am not trying to say that your ideal would not work because it has never come close before, but I am just curious if you have any examples…

    Frank

    • Mark Kleiman says

      Typical PoMo b.s., trying to define a problem out of existence with pseudo-cleverness.

      Yes, “drug” is ambiguous. In this context, it means “psychoactive drug”: a chemical or combination whose ingestion influences the mind other than by its sensory properties or by providing nutrition. A subset of psychoactives are intoxicants: drugs that so influence mental function as to markedly impair some measurable aspects of cognitive function and cause some subjects to make choices under the influence that they would not make otherwise and predictably regret afterwards.

      On that definition, there are borderline cases (e.g., nicotine, which can be an intoxicant if used in high doses by someone not habituated to it) but no actual difficulty figuring out that neither penicillin nor lettuce is an intoxicant, while alcohol and cannabis both are.

    • Nick says

      The fact that there is no unambiguous definition of a chair does not stop me from buying one at IKEA or from being displeased when they deliver me a table instead. And that despite the fact that it has four legs and one can sit on it.

  8. H. Beaver says

    I’m not convinced that the use of alcohol and marijuana together are more dangerous than alcohol alone (in general). In my experience, the use of marijuana first, reduces the desire the to drink to excess. If you are already drunk, the alcohol still overpowers it, however marijuana does seem to allow you to become alert to the fact that you are intoxicated. It gives you back that fear of the future that alcohol seems to take away. This can be a good thing, as you may become aware of your inability to drive, or change your mind about that unprotected sex you are about to have.

    I don’t think marijuana will ever become as popular as drinking. It just isn’t as fun, especially for young people. The recklessness that alcohol can conjure up, is a benefit not a cost to many young people. If you are a young male, looking to for a successful night out with a girl, are you going to take her to a traditional bar, or a marijuana cafe (if they are allowed)?

    Last, I don’t like the idea of higher taxes on alcohol to curb overall drinking. It seems unfair to make all drinkers collectively responsible for problem drinkers and very close to declaring all alcohol inherently evil. There needs to be that separation between good and bad drinkers. Punishing all blurs that line. It would also hurt the expanding craft brew market. However, I think minimum pricing would be the most tolerable form of higher taxes.

  9. Mike says

    “Public policies ought to make both drugs available for responsible adult use while strongly discouraging problem use with high taxes…”

    I guess whether that will work or not depends on one’s definition of “high.” If you mean like those already imposed on beer, I don’t see a problem. But if one is talking about the tax rates already scheduled to be imposed in CO and WA on cannabis, then yes, there is a problem. How are you going to undercut the blackmarket when your target prices end up in much the same territory?

    BTW, the “high taxes” of the blackmarket seem to have done little to stem the tide of “abuse” so far. I don’t see how the government getting to clean out the cash register at night, instead of, say, the Zetas, will change much of anything.

    And by high taxes, if you mean the state “deserves” or “by necessity” should price its taxing scheme based on what’s charged in the blackmarket, I’d argue people will see that as exploitative and a problem to be solved by their own means. After all, there seems to be a convenient amnesia that marijuana is a crop, not an industrial product like alcohol. Trying to stamp out cultivation on an individual basis is an untenable policy now — and it won’t be any different under legalization. I strongly suspect Dr. Kleiman has little to no agricultural experience in his background. Growing isn’t rocket science — or even as complex as a homemade still. The idea that high taxes will be effective in offering an alternative to displace the very system he hopes to replace is naive — and assumes that levels and tactics of enforcement activity will continue to be tolerated by the public against what would then be a legal substance…

    Very unlikely to happen.

    Then there is the logical disconnect between a call for high taxes on a legal product and efforts to stamp out a highly profitable blackmarket. It sounds to me like there is an expectation that the government will and should learn nothing from decades of failed prohibition and will simply repeat that failure with prohibition-lite. And apparently all those SWAT teams, GPS tracking units, DEA helicopters, etc will then be redeployed to act as the tax man…if they’re pointless now, that won’t change.

    Dr. Kleiman, may I respectfully suggest that you can have high taxes (by which you mean apparently far higher than imposed on alcohol) _OR_ a you can have a legalization policy that defeats the blackmarket. Try to get both on your plate at the public policy debate buffet and you’ll most likely have a messy accident on the way back to the table.

    Then there is the fact that marijuana legalization should not be held hostage to the problems of alcohol, regardless of the issues alcohol causes. That’s the sort of false equivalence you should call on yourself — or at least offer a better explanation of how you plan to get 10 pounds into a five pound bag than the contradictory internal logic of positions like you’ve drawn above.

  10. marcel says

    Voting for vegetables and boiling Republicans, on the other hand …

    Incidentally, I don’t think the problem is voting for Republicans so much as electing them: like polluting, it is not a problem if only a few do it, but becomes a problem only when too many are involved in the activity.

  11. Freeman says

    The phrase “drugs and alcohol” has always struck me as redundant, like saying “liquid and water” as if water has some special property that separates it from the liquid category.

    • Ralph says

      It’s pretty obvious to me that “drugs and alcohol” is an anachronism. The phrase is used to to distinguish two categories. In this this case, “drugs bad” whereas “alcohol not bad, perhaps problematic, but definitely not bad, otherwise it wouldn’t be legal”. Then time passes and folks get educated and realize that “bad” has many aspects and that a strong case can be made for alcohol being “badder” than MJ. IMO (given the rate of action on legalization) the phrase “drugs and alcohol” will disappear in the next decade.

      Years ago pharmaceutical companies invented the term “ethical pharmaceuticals” to mean “good drugs that we make that should never be confused with bad drugs”. Language reveals a lot.

  12. Ken Rhodes says

    I don’t boil my vegetables. I grill them, I saute them, I eat them raw by themselves or in salads.

    But my wife boils kale. Thereby demonstrating Rhodes’ Rule: “No rule is absolute.” (Yes, the self-referential paradox is intentional.)

    • Fallibilist says

      Boiling kale should get your wife an audience of judges at the Hague. (Other than that, I’m sure she’s a fine lady.)

      For excellent kale, merely de-vein and stir-fry in olive oil. It’s about 1 million x tastier than popcorn and the stratospheric nutrient density will allow you to live forever.

      • Brett Bellmore says

        I certainly hope they’re not all that strict about boiling kale; I like it in soup. ;)

  13. Sebastian H says

    “On the other hand, anything that brings our emerging policy toward legal cannabis closer to our current unsatisfactory policy toward alcohol strikes me as a thoroughly bad idea, and I’d rather see the power of the emerging pot industry fighting the power of the established alcohol industry rather than allied with in opposition to rules to protect public health and safety.”

    I’ve seen this thought repeatedly from you, though rarely so clearly, and I suspect it is the core of our disagreement. It confuses the non-ideal with the bad.

    If our cannabis policy were transformed from their current evil into an exact replica of our alcohol policy, that would be a thoroughly great thing. The negative effects of the drug war are enormous, hit strongly on racial lines, and are orders of magnitude out of line with the negatives of cannabis.

    That case is so obvious that denying it requires very strong unstated assumptions. The anti drug warriors use: drugs are evil. I’m wondering if you are using something like: some form of legalization is going to happen, so all we have to do is wrangle over the details.

    It is the only thing I can come up with. But it isn’t true. The anti-drug warriors still have huge amounts of pull all over the country, and reinstating a federal policy to quash the states is extremely possible.

  14. says

    I think the “cannabis is “‘safer’ than alcohol” argument is usually an effort to put cannabis into context. Given that society is relatively blasé about alcohol ( pharmaceuticals, sports injuries and junk food) why the hysteria over cannabis? It isn’t an exceptionally dangerous herb *, so why the extreme response?

    I am not sure how the “safer” argument implies that there isn’t room for improvement in our alcohol regulations.

    Granted, the typical prohibitionist response to the “safer” argument is “With all the problems we have with alcohol, why would we add another mind-altering drug to the list?” as though we were arguing about whether or not cannabis should exist, rather than debating what might be the optimal (not utopian) regulatory model for minimizing the harms and maximizing the benefits of cannabis cultivation and consumption.

    Is possible confusion and misinterpretation on the part of an audience and argument for not making an argument? Perhaps in a soundbite environment, where one does not have the opportunity to clear up such confusion. The same case has been made against using the term “legalization.” OTOH, I think it helps to use and define the term “legalization” when one has the opportunity, and thus make it possible for others to use the term without having to define it. The equivalent to the “safer” argument is to go on to explain that one is not arguing for alcohol prohibition, nor suggesting that there isn’t room for improvement in our alcohol regulations.

    Yes, the substitution effect is often mentioned in the same argument, but I maintain that the scientific evidence supporting it are stronger than Mark seems willing to concede. http://mapinc.org/url/KRYtgxAQ http://www.biomedcentral.com/content/pdf/1477-7517-6-35.pdf

  15. John Hilfer says

    I quit eating potatoes or my bird's feathers ever since I found out they were drugs. :/

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