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1. Substance Use Disorder (SUD) ["addiction"] is an unusual consequence of the use of any drug.

Below are the number (mn = million) of people estimated to have ever used four prominent drugs followed by the government estimate of the number and percentage who met the definition of abuse or dependence (A or D) in 2009.

Alcohol 220 mn 18.6 mn 8%
Cocaine 37 mn 1.1 mn 3%
Heroin 3.7 mn 0.4 mn 11%
Marijuana 104 mn 4.3 mn 4%

 


(further discussion)


"Among year-before-last initiates of specific substances, over two thirds of crack cocaine, inhalant, and heroin initiates did not use the drug in the past year."

Quit use entirely within one year of first trying

Crack 76 %
Heroin  69 %
Stimulants (meth) 59 %
Cocaine (not crack) 57 %
Pain relievers 57 %
Marijuana 42 %
Alcohol 24 %

 

http://www.oas.samhsa.gov/2k8/newUseDepend/newUseDepend.htm

2. Substance use disorder (SUD) or "addiction" is dominated by alcohol use disorder (AUD). About 68 percent of current cases are alcohol alone and 12 percent are AUD comorbid (simultaneous) with other drugs. Another 13 percent have a previous history of comorbid AUD. Alcohol is a major factor in about 95 percent of all cases of SUD. The drug effects of alcohol are the worst of any drug in terms of many important effects on others, including the victims of alcohol induced violent behavior, damage to the fetus and the loss of mental and physical control that contributes to so many rapes, assaults and accidents.

In 2010 the National Institutes of Health (NIH) said that alcohol is just another drug, quite similar to prohibited drugs. Alcohol causes the most problems and is most closely linked to brain and organ damage, violent and uncontrolled behavior and damage to the fetus. They declared their intent to unify the study of alcohol and other drugs.

" ... similar risk factors are associated with use and abuse of drugs and alcohol, and similar behavioral therapies and prevention strategies can be employed regardless of substance ... [separation] perpetuates the misconception, especially among youth, that alcohol is not really a drug. Therefore, one benefit of [unified study] is to develop a clear public health message that alcohol has similar detrimental effects on the brain and body as illicit drugs."

The full report includes input from NIDA and NIAAA.

REPORT ON SUBSTANCE USE, ABUSE, AND ADDICTION RESEARCH AT NIH

In 2009, an estimated 8.9 percent of persons aged 12 or older were classified with abuse or dependence  in the past year.

Total 22.5 mn % of total
Alcohol 18.6 mn 83%
Cocaine (includes crack - 2%) 1.1 mn 5%
Heroin 0.4 mn 2%

Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2009

In 2009, an estimated 22.5 million persons aged 12 or older were classified with substance dependence or abuse in the past year (8,9 percent of the population aged 12 or older).

-15.4 million were dependent on or abused alcohol but not illicit drugs. [68  percent  of 22,5 million]

-  3.2 million were classified with dependence on or abuse of both alcohol and illicit drugs [14 percent]

-  3.9 million were dependent on or abused illicit drugs but not alcohol [17  percent]

(DPFT  note: However,  of the 3,9 million not currently abusing or addicted to alcohol, about  3.3 million had a previous history of alcohol abuse or addiction.


DPFT note: "Illicit drugs" includes prescription drug abuse. Excluding marijuana, prescription drug abuse is greater than the abuse of all prohibited drugs.


Many people addicted to illegal drugs (SUD) have concurrent alcohol addiction (AUD)

Cocaine disorder 79 %
Amphetamine disorder 63 %
Opioid disorder 58 %
Cannabis disorder 58 %


(from NESARC Tab 3):
Comorbidity between DSM-IV alcohol and specific drug use disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions
(NESARC) 2001-2002  survey by NIAAA  

Table 3. Twelve-Month Prevalence of DSM–IV Alcohol Use Disorders Among Respondents With and Without 12-Month Drug Use Disorders

Percent Of People With Other  Drug Use Disorders
Who Also Have An Alcohol Use  Disorder (AUD)
(From Table 3 )
 
   
Any drug use disorder 55 %
Sedative use disorder 40 %
Tranquilizer use disorder 58 %
Opioid use disorder 58 %
Amphetamine use disorder 63 %
Hallucinogen use disorder 79 %
Cannabis use disorder 58 %
Cocaine use disorder 79 %
Solvent/inhalant 60 %

Figure 7.1 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2013

"In 2011, an estimated 20.6 million persons aged 12 or older were classified with substance dependence or abuse in the past year (8.0 percent of the population aged 12 or older) (Figure 7.1). Of these, 2.6 million were classified with dependence or abuse of both alcohol and illicit drugs, 3.9 million had dependence or abuse of illicit drugs but not alcohol, and 14.1 million had dependence or abuse of alcohol but not illicit drugs."
"In 2009, an estimated 22.5 million persons aged 12 or older were classified with substance dependence or abuse in the past year (8.9 percent of the population aged 12 or older) (Figure 7.1). Of these, 3.2 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.9 million were dependent on or abused illicit drugs but not alcohol, and 15.4 million were dependent on or abused alcohol but not illicit drugs."

Prevalence of lifetime alcohol use disorder (AUD) among individuals with selected lifetime substance use disorders (SUD)
[current SUD numbers are in bar graph above]

From NIAAA / NESARC graph p. 9 at
http://www.apa.org/about/gr/science/spin/2009/10/nih-suaa.pdf 

 

Figure 7.2 Dependence on or Abuse of Specific Illicit Drugs in the Past Year among Persons Aged 12 or Older: 2013

Figure 7.3 Illicit Drug Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2013

"Alcohol is the only psychoactive drug that in many individuals tends to increase aggressive behavior temporarily while it is taking effect." - The Panel on the Understanding and Control of Violent Behavior,  National Academy of Sciences, 1994  (more at CRIME and DRUGS)

"Throughout almost 20 years of research, none of us has identified a recognizable condition, syndrome or disorder that should be termed 'crack baby.' This is in contrast to Fetal Alcohol Syndrome, which has a narrow and specific set of criteria for diagnosis." -  30 medical and psychological researchers (more at "Crack Baby Myth)".

Alcohol is more intoxicating than other drugs. Intoxication  is the loss of mental or physical control and "crazed" behavior.  This helps  explain the frequent presence of alcohol "intoxification" in driving and boating accidents. Compare Addictive Properties of 6 Common Drugs, NIDA  includes comparative intoxification.

High-Risk College Drinking Consequences Every Year: students between the ages of 18 and 24

Death: 1,825 alcohol-related

Injury: 599,000 unintentionally injured under the influence of alcohol

Assault: 696,000 assaulted by student who has been drinking

Sexual Abuse: 97,000 victims of alcohol-related SA or date rape

Sex: 400,000 had unprotected sex

Sex: 100,000 too intoxicated to know if they consented

3. Age is a critical factor in SUD. SUD peaks at age 21 at over three times the normal rate. About half of SUD is gone by age 26. There are very few new cases of problem use after age 30. No policy can produce any significant increase in adult drug abuse. Policy must focus on the period from birth to 21. 

National Survey on Drug Use and Health (NSDUH). Data  for  2010 :
Age Group Percent SUD
12 to 17 7.3 %
18 to 25 19.8 %
26 or older 7.0 %

"From 2002 to 2010, the rate decreased for youths aged 12 to 17 (from 8.9 to 7.3 percent) and for young adults aged 18 to 25 (from 21.7 to 19.8 percent). For adults aged 26 or older, the rate remained stable from 2002 to 2010."

Table G.20 – Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month, by Detailed Age Category: Percentages, 2005 and 2006

 

Table G.20 – Alcohol Use, Binge Alcohol Use, and Heavy Alcohol Use in the Past Month, by Detailed Age Category: Percentages, 2005 and 2006
Age Category TYPE OF ALCOHOL USE
Heavy Alcohol Use
2006
12
*
13
0.5
14
0.7
15
1.7
16
4.5
17
6.7
18
12.8
19
14.4
20
14.0
21
19.5
22
17.3
23
17.2
24
16.1
25
13.2
26-29
11.9
30-34
8.4
35-39
7.3
40-44
6.7
45-49
7.0
50-54
6.7
55-59
4.6
60-64
2.7
65 or Older
1.6

Extract. For full chart see Charts, Table G.20



Figure 2.5 Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: 2010 and 2011
4.  Recovery from  abuse and dependence is normal. There are dramatic increases in abuse and dependence from ages 18 to 21 and  dramatic rates of recovery from 21 to 25.  Despite over 7 million new drug  users each year, rates of  abuse and dependence have been stable for at least the eight years from 2002 through  2009.

Despite some 3 million new illicit drug users (includes prescription drug abusers) each year  the rates of  abuse  do not change much. The same is true of the 4.3 million new users of alcohol each year. 

" ... a striking and unexpected finding from NESARC is that 72 percent of people who develop alcohol dependence in their lives have a single episode lasting 3 to 4 years on average, after which it goes away and does not recur (Hasin et al. 2007). " http://pubs.niaaa.nih.gov/publications/arh40/55-63.htm

National Survey on Drug Use and Health (NSDUH). Data  for  2005 :

"There were no changes between 2002 and 2005 in the percentages of persons with dependence on or abuse of illicit drugs (3.0 percent in 2002 and 2.8 percent in 2005) and dependence on or abuse of alcohol (7.7 percent in 2002 and 7.7 percent in 2005).

The overall rate of current illicit drug use among persons aged 12 or older in 2005 (8.1 percent) was similar to 2002 (8.3 percent)." 



5. Illegal [prohibited] drugs have been readily available to any teen who wanted them  for over  30 years. Except for  marijuana, almost  all refuse to use them.  

This may be the most important single fact.  It defines the total failure of a central purpose of our policy, to limit the supply and availability of drugs to teens.                                          

Availability is defined as "easy to get" by 12th graders.  
<http://www.monitoringthefuture.org/data/06data/pr06t13.pdf>
      
Use figures are approximate 5 year averages for two age groups from 2002-2006. The 18 to 25 age group has much higher use rates than the group age 26 or older (not shown). 

The figures below show that only a very small fraction of those who say the drugs are "easy to get" actually use the drugs.   "Availability" is generally higher now than in 1975 but even a huge decrease in supply would have left  far more drugs available than was needed to meet the demand. 

  Availability   Use In Past Month 2002 - 2006
         
  1975 2006 age :  12 to 17 18 to 25
         
Marijuana 88% 85% 7.5% 16.5%
Cocaine 37% 47% 0.5% 2.2%
Heroin 24% 27% 0.1% 0.2%

 


It is obvious that even if  "Availability" was much lower, any teen interested enough to ask a few fellow students  could easily get the drugs.

Prohibition has made the drugs more available to teens than would  a reasonable system of regulated supply to adults by tempting over a million teens into drug sales. Incarceration of low level dealers only facilitates that process by creating job openings which are filled almost instantly. 

"In 2003 ... more than 900,000 (3.6 percent) youths [ages 12 to 17] sold illegal drugs, and more than 900,000 (3.6 percent) youths carried a handgun during the past year."   
"Alcohol Use and Delinquent Behaviors among Youths" <http://www.oas.samhsa.gov/2k5/alcDelinquent/alcDelinquent.cfm>


This problem received the attention of the National Academy of Sciences (NAS) in 1982, "An Analysis of Marijuana Policy:

"The advantages of a policy of regulation include the disappearance of most illegal market activity ... The possibility of illegal markets selling to young people remains, but today's kind of illegal market for marijuana would probably shrink greatly under a regulatory system in the same way that illegal alcohol distribution systems have become so scarce. ...  Such a development would make marijuana selling a less profitable and status-producing occupation among the young." 

NAS also pointed out  the market "gateway" of prohibition:

"Another major cost of attempts to prohibit the supply of marijuana is related to the fact that many illegal sellers of marijuana also sell other illegal drugs, e.g., PCP, amphetamine, and barbiturates (Blum, 1971). It is likely, therefore, that prohibition of the supply of marijuana increases access to and use of other illegal drugs through the creation of an illegal marketing system for all drugs." ... "It is clear, however, that there are many small-scale marijuana dealers, that many sellers service only their friends and acquaintances, and that those who sell marijuana are thereby more likely to come into contact with users and sellers of more dangerous drugs, to use such drugs, and to make them available to their clientele (Blum, 1971)." 

"Moreover, there is reason to believe that marijuana sellers may become socialized into other illegal activities."

http://www.druglibrary.org/schaffer/library/studies/nas/markets.htm

"We believe, further that current policies directed at controlling the supply of marijuana should be seriously reconsidered. The demonstrated ineffectiveness of control of use through prohibition of supply and the high costs of implementing such a policy make it very unlikely that any kind of partial prohibition policy will be effective in reducing marijuana use significantly below present levels."

http://www.druglibrary.org/schaffer/library/studies/nas/conclusions.htm


An Analysis of Marijuana Policy

National Research Council of the National Academy of Science, 1982

http://www.druglibrary.org/schaffer/library/studies/nas/AMPMenu.htm

6. Among teens who do choose to use prohibited drugs, nearly all use is experimental and quickly stops. Prohibition dramatically increases the risks.

The major point here is that most youthful drug use will end  quickly and voluntarily but prohibition makes this  brief period of experimentation much more likely to turn teen curiosity  into  a disaster - possibly death -  because the drugs are unregulated and thus made far more dangerous. What is the potency? Does it contain other drugs or dangerous contaminants? Is it possibly some other drug entirely? With prohibited drugs  a user will seldom know. 

The data demonstrates mythology. There is talk of "instant addiction" to drugs that most people in fact give up within a year. Often these drugs are used only once or twice ever.
Among year-before-last initiates of specific substances, over two thirds of crack cocaine, inhalant, and heroin initiates did not use the drug in the past year (Figure 1). Alcohol and marijuana were the only substances for which the majority of year-before-last initiates used the substance in the past year

Figure 1. Percentages of Year-Before-Last Initiates Not Using the Initiated Substance in the Past Year, by Substance: 2004-2006

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The majority of those who have ever used a specific  illicit drug report using that drug ten or fewer times in their lifetimes. Even the vast majority of those who used an illicit drug more than 10 times have not used that drug 200 times in their entire lives. Use of a drug more than 200 times in a lifetime does not define abuse or dependence(addiction). All figures are for people age 25 and older who are able to look back at their drug use.



[Methamphetamine is a typical "Stimulant"] 

                       Marijuana       Cocaine       Stimulants
# times used   
 
    1 or 2               27 %             25 %             16 %

    3 to 5               14 %             17 %              16 %
     
    6 to 10             13 %             15 %              15 %
     

*1 to 10 totals       54 %             57 %             47 %

    11 to 49            14 %            18 %              21 %

    50 to 99              9 %             10 %               9 %
     
    100 to 199          5 %               6 %               8 %
    
** % late stops      61 %             79 %              72 %


200 +                    18 %               9 %              15 %

   

* Percent of users who tried a particular drug but never used it more than 10 times in their lives. 
** Percent of users who used a particular drug more than 10 times in their lives but stopped before using it 200 times. 

Data from NHSDA, 1993 is cited by The Drug Policy Project of the Federation of American Scientists. FAS, Issue 3, "How Prevalent Are 'Very Light' Drug Users?" by Jonathan Caulkins http://www.fas.org/drugs/issue3.htm#2

 

7. Whether a drug is legal or illegal appears to have little impact on its use.


Teen drug use occurs at an age when all drug use is illegal. It also occurs when all drugs are readily available (see 5. above) and the first try is likely to be free.

First use appears in no particular order and seems to depend on cost and convenience. Inhalants and pharmaceuticals are found in abundance in most homes. Friends may share. Cigarettes are easily pilfered and concealed and their  continued use seems to be the best indicator  of later use of other drugs. Sometimes alcohol or marijuana is easily obtained.    

The fact that over 80 percent of teens break the law to use alcohol indicates how little the laws deter use. Ironically, alcohol abuse peaks around age 21 and then goes down sharply by age 25 just about the time it has become legal to use. (see Table G.20 at 3. above ) Many experts believe that "forbidden fruit" actually makes drug use more appealing to those groups of teens who are most curious, rebellious or thrill seeking.

The striking figures in 1. above show that 90 percent of cocaine users refuse to use heroin (About 70 percent also refuse to use crack.) The same is true of some 96 percent of marijuana users, 65 percent of whom also refuse to use cocaine. If currently prohibited drugs were to become regulated, it is not credible that those who have never used cocaine and heroin would begin to use them at rates anywhere near as high as those who have already broken the law to use some other drug. Any change at all would be no more than marginal. Moreover, any increases would likely be offset by less use of alcohol.

This also applies to the young as seen below..


A Day in the Life of American Adolescents: Substance Use Facts <http://www.oas.samhsa.gov/2k7/youthFacts/youth.htm> (Cigarette, Alcohol, and Illicit Drug Use) is a  report from SAMHSA that says on an average  day, about 631,000 Americans aged 12 to 17 drink alcohol, and 586,000 use marijuana 13,000 use cocaine (including "crack"), and 3,800 use heroin. Compared to alcohol, this means that there is 93 percent  as much use of marijuana but only two percent for cocaine and  less than one percent ( 0.6 %) for heroin. Yet marijuana is the most easily detected by smell or test and thus most subject to punishment. Moreover, arrests for marijuana have steadily risen from 30,000 per year to over 800,000 per year  in 40 years while use has bobbed up and down for no apparent reason beyond faddish behavior.   

Despite ready availability, teen choices about whether or not to use marijuana, cocaine or heroin show dramatic  differences and - since all are illegal - the choices are obviously driven by other factors.  This also is true for the population as a whole. 

Age 12 or older  (percentages ) as of 2005 [ NSDUH 2006]

                         ever used              used over 25 days in past year 

Marijuana            40.0  %                           5.6  %        

Cocaine              13.7  %                           0.8  %

Heroin                  1.4   %                          0.0  %  *

*  The figure of  0.0 for heroin reflects use lower than 0.05 %

The National Drug Threat Assessment of 2005 reported that all drugs are readily available throughout the country. Fortunately, very few of us are at all interested in using them and are therefore blissfully unaware of how easy it is to obtain them.

http://www.usdoj.gov/ndic/pubs11/12620/index.htm

8. Marijuana has an especially vital and unique place in discussions of drug policy. 

The importance of marijuana prohibition is about a great deal more than the drug itself. Some 100 million users combined with inflated prices  have produced an enormous market. 


Key Points:

a) Marijuana is the backbone of the illegal drug trade. This  increases our vulnerability to violent crime. Most is grown in the US.  (more below)

 b) Marijuana enforcement places an enormous burden on our courts and police reducing their effectiveness and misallocating resources. This too increases our vulnerability to violent crime. (more below)


c) There are major financial losses in taxes spent and in taxes not collected. See  500 Economists Ask President Bush for Open and Honest Debate 

d) Marijuana's economic role - not the drug -  accounts for the "Gateway"  and  facilitates the spread of other illegal  drugs via an established distribution system. (See 5. above) 

More at Gateway

 e) Marijuana as a drug is discussed at
This examines  the inherent hypocrisy of prohibiting a drug clearly less dangerous than alcohol, the exaggerations about potency and more. 

In Charts: Types of Illicit Drug Use in the Past Year among Persons Aged 12 or Older: Percentages, 2002-2009 we see that marijuana is used far more than all other prohibited drugs combined. 


"... the prevalence of marijuana use among [adolescents] was still considerably higher in 2003 than in 1991... Use among young adults increased overall since 1991, not peaking until 2002."

"The steady supply of and demand for marijuana overall and the strong, stable market for its distribution often allow for the financial stability of drug traffickers, many of whom traffic marijuana to bankroll other criminal activity, such as producing or distributing other illicit drugs like methamphetamine and cocaine. ... In many areas, drug distributors sell marijuana along with other drugs such as methamphetamine, crack cocaine, and heroin."

The future appears to be bleak.

"The market for marijuana is strong and stable throughout the United States and should remain so given the drug's wide appeal to users and consistent profitability for distributors as well as producers."

"Marijuana production levels appear to be increasing despite continuing eradication efforts in this country and abroad."

Over  half of the marijuana is probably  grown in the US. Some estimates call it our number one cash crop. <http://www.drugscience.org/Archive/bcr2/cashcrops.html>

"Demand is higher for marijuana than for any other illicit drug ... Such a sizable user population, encompassing persons of wide-ranging ages, both genders, and diverse origins residing in areas urban to rural, equates to steady profits."

"Preliminary interagency estimates suggest that anywhere from 12,000 to 25,000 metric tons of marijuana, including domestic and foreign, were available in the United States in 2002, up from an estimated 10,000 to 24,000 metric tons in 2001. These estimates are speculative. While current estimates are not precise, these ranges nevertheless underscore the magnitude of marijuana's availability in the United States and indicate that the amount available is increasing. ... production in the United States could range from 6,000 to 19,000 metric tons annually."

"Marijuana production within the United States should increase as DTOs and criminal groups continue to establish or expand large-scale domestic cultivation operations."

Moreover, distribution increases our vulnerability to violence: 

"Midlevel marijuana distribution is dominated less by large trafficking organizations and more by criminal groups, street gangs, local independent dealers, and OMGs [outlaw motorcycle gangs]." 

b) Marijuana enforcement places an enormous burden on our courts and police reducing their effectiveness and misallocating resources. This increases our vulnerability to violent crime. 

The overwhelming burden of marijuana on law enforcement is evident in the relative quantities estimated to be used in the US each year: 

Marijuana                          25,000    tons
Cocaine                                  300    tons
Heroin                                      20    tons

This raises the question of how we can possibly criticize foreign countries for failing at a much more difficult task than the one we ourselves have so obviously failed to accomplish for decades. 

Growing arrest numbers alarmed The  National Commission on Marihuana and Drug Abuse in  1972 : 

"Another consequence of marihuana possession laws is the clogging of judicial calendars. President Nixon has noted that one of the major impediments to our nation's efforts to combat serious crimes is the fact that the judicial machinery moves so slowly." 

"Swift arrests, prosecution, trial and sentence would significantly improve the deterrent effect of law. Yet the judicial system is overloaded with petty cases."

The Commission noted with horror that "marihuana"  arrests had  grown from 19,000 in 1965 to 189,000 in 1970; in 2006 the number had soared to 830,000, 739,000 for simple possession.  As marijuana arrests grew to exceed arrests for all violent crime combined, clearance rates for violent crimes have plunged to all time lows.

Moreover, these arrests do not  deter use except to  a minor  extent among the more casual  users.

See: Comparisons of Dutch and US marijuana policy

and 

Deter

Prisons

9. Comparisons of other drugs with alcohol provide a vital missing dimension in discussions of drug policy.

U.S. officials are determined to avoid comparisons with alcohol, which is arguably the most dangerous of the drugs. This deprives the public of their most logical basis for assessing other drugs. Alcohol is always readily available and most  who are  dependent on prohibited drugs are already dependent on alcohol too. In view of 2. above, it seems clear that a policy that does not emphasize alcohol abuse (and teen age vulnerability, 3. above)  cannot have any significant impact on drug abuse and dependence. 

Alcohol also provides an example of the wide range of responses that occur among different users of the same drug. Defining what a drug "does" or "is" relies heavily on the dosage, the individual user, and the social setting surrounding use. This is true of all drugs, contrary to the  mythology dominating discussions of drugs. 

One point in the comparison below  is that it is "intoxification," that defines the degree to which a drug causes the user to lose mental and physical control. Alcohol is a  leading candidate for "worst drug" in this respect.


Two Independent Studies Of Drug Addiction:  Henningfield, National Institute on Drug Abuse, and Benowitz [B], University of California at San Francisco, Ratings  [Lowest number = most serious effect]    

 

  Withdrawal Reinforcement Tolerance Dependence Intoxification
           
Heroin
2
2
1
2
2
B
2
2
2
2
2
 
Alcohol
1
3
3
4
1
B
1
3
4*
4
1
 
Cocaine
4
1
4
3
3
B
3*
1
1
3
3
 
Nicotine
3
4
2
1
5
B
3*
4
4*
1
6
 
Caffeine
5
6
5
5
6
B
[5]
5
3
5
5
 
Marijuana
6
5
6
6
4
B
[6]
6
[6]
6
4

* = shared rank with another listed drug 

[#] = ranking adjusted by DPFT to reflect lower shared rankings  

DPFT Note: Other than some variations in the tolerance rankings, the two studies produced virtually identical results. The studies were cited in presentations to the Senate-House Task Force on National Drug Policy in 1996.  

Withdrawal: Presence and severity of characteristic withdrawal symptoms. 

Reinforcement: A measure of the substance's ability, in human and animal tests, to get users to take it again and again, and in preference to other substances.  

Tolerance: How much of the substance is needed to satisfy increasing cravings for it, and the level of stable need that is eventually reached.  

Dependence: How difficult it is for the user to quit, the relapse rate, the percentage of people who eventually become dependent, the rating users give their own need for the substance and the degree to which the substance will be used in the face of evidence that it causes harm.  

Intoxication: Though not usually counted as a measure of addiction in itself, the level of intoxication is associated with addiction and increases the personal and social damage a substance may do.  


The evidence in this entire section helps explain the ratings  below:

The French National Institute of Health, INSERM, consulted with experts from other countries and rated drugs by their danger in 1998 at government request. They established 3 groups: 

[a] "most dangerous" - heroin, alcohol, and cocaine 

[b] "next most dangerous" - tobacco, amphetamines, and others 

[c] "least dangerous" - cannabis [marijuana], since it has "low toxicity, little addictive power and poses only a minor threat to social behavior," and others 

-- from "Alcohol as bad as heroin and worse than pot," Reuters, 6-16-98 

 
ALCOHOL Rated As Most Dangerous Drug 


The Lancet, Volume 375, Issue 9716, Page 724, 27 February 2010

The ‘overall harm’  table: 

1 alcohol 72
2 heroin 55
3 crack 54
4 crystal meth 33
5 cocaine 27
6 tobacco 26
7 amphetamine/speed 23
8 cannabis (marijuana) 20
  <snip>  

 

Heroin, crack and crystal meth were the most harmful drugs to the individual.

Alcohol, heroin and crack were the most harmful to others.

Further analysis showed alcohol is almost three times as harmful as cocaine or tobacco.

More at 

Marijuana And Alcohol Compared 

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