It’s important not to try and draw false equivalencies. There’s still a difference between heroin and eggnog. Individually, the damage done by alcohol is (at first glance) much smaller than the damage done by drugs like meth and cocaine, which overpower the senses so completely that they lead to addiction more often than other drugs.
But there’s one factor that heavily contributes to the death toll correctly attributed to alcohol: its ubiquity. Alcohol is legal, and available everywhere – and in our culture, it’s common (and even expected) to drink alcohol at least a few times a year, and often in very large amounts.
The fact that it’s accepted and culturally celebrated, and the subject of a respected industry and long-standing series of traditions means that we easily ignore the facts. The facts are that alcohol directly and indirectly leads to more deaths than any other drug (bar tobacco), and that alcohol continues to have a greater negative impact on society than no other substance, due to its effects on the body, on the mind, and on the next generation.
It’s also a little tougher to convince an alcoholic to get help, because alcohol is such an openly accepted and normal vice. You don’t have to hit rock bottom with alcohol to be completely addicted to it, yet it’s less obvious to someone that they have a problem than if they’d find themselves pining for a less legal substance. All addicts understand that their behavior is heavily stigmatized, and that they can’t help themselves – and that that’s a problem. But someone who struggles with an alcohol problem has any number of possible excuses to cling to.
Alcohol is a Dangerous Drug
It’s critical to highlight that, while drugs like heroin and methamphetamine are infamous for the damage they do to individuals, the damage they cause pales in comparison to death toll attributed to drinking. But exactly how is alcohol a dangerous drug?
Consumed by humans since the dawn of civilization (and likely even before it), alcohol is any beverage that contains ethanol, produced by the fermentation of grains and fruits, as well as other sources of sugar (honey, for example). The earliest forms of alcohol used grains such as barley and rice to make beer and wine, and honey to make mead. From the ancient city-states of the Fertile Crescent, to what would eventually become modern-day China; humans all over the world across all periods of history brewed and enjoyed their own brand of drink.
But alcohol’s history does not temper its negative effects on the body, and the brain. Ethanol enters the bloodstream after consumption and leads to what can be generalized as central nervous system impairment. It is what we call a depressant – a drug that slows several functions of the central nervous system, often through interactions with several different neurotransmitters that are responsible for things like motor control and coordination. The neurotransmitters alcohol interacts with include GABA, glutamate, serotonin, and dopamine.
This leads to several things. First, it leads to drunkenness. The state of being intoxicated can be described as a state of lowered inhibition, lowered anxiety, and lowered function. We’re generally slower to react, act clumsily, and struggle with clearly defined speech. Furthermore, high alcohol use begins to have an impact on the body as well. While it’s in our system, ethanol affects fat, protein, and carbohydrate metabolism, causes our immune system to slow in response to infections, leads to slower wound healing, impairs our natural ability to counter shock from blood loss, and so on.
Second, it leads to adaptation. As alcohol use continues, the brain and body adapt by metabolizing it more efficiently. A side effect of this process is that as alcohol use becomes more frequent, the body interprets it as a normal thing – and begins to form a physical dependence. Going sober for too long, then, begins to lead to withdrawal symptoms.
Meanwhile, like other drugs, alcohol becomes a powerful coping mechanism. It’s cheap, doesn’t attract as much stigma as other drugs, and makes you feel either a little better, or a little less worried about your problems. But like any vicious cycle, using alcohol to escape from some problems tends to lead to a host of other issues.
While the body adapts to alcohol use through dependence, tolerance, and withdrawal, it’s important to remember that alcohol is still quite poisonous. Aside from the effects of acute alcohol poisoning, long-term alcohol use is correlated with a much higher chance of developing chronic illnesses such as heart disease, Alzheimer’s, stroke, liver disease, bone disease, and a variety of cancers, from esophageal cancer to pancreatic cancer.
Alcohol also causes deaths and illnesses in others, through alcohol-impaired traffic deaths, homicides, and fetal alcohol spectrum disorders. Like many other drugs, alcohol has a widespread negative effect on individuals as well as society at large. However, it isn’t seen as dangerous – at least not as dangerous as other substances.
When a Problem Becomes Alcoholism
Like any form of drug use, there’s a difference between use and disorder. Only a fraction of people who use alcohol are alcoholic, but there are factors that heavily contribute to the development of alcoholism, including frequent binge drinking, using alcohol to overcome emotional stress, drinking at an early age, and inheriting alcoholism from close relatives.
Problem drinking and alcoholism separate each other by both physical and psychological symptoms. While alcoholics have symptoms of alcohol use disorder – including strong withdrawal and post-acute withdrawal symptoms, also known as detox symptoms – problem drinkers can go weeks or months without drinking, but often binge, and struggle with emotional or behavioral problems while drunk, from increased risk-taking to becoming violent or depressed as a result of their drinking.
As with other forms of addiction, treatment is possible – but it’s important to recognize the potential for alcohol use disorder to be a chronic issue. While it is legal, alcohol is still quite addictive, and those who have become addicted to it face an even greater challenge than many other addicts due to alcohol’s ubiquity and general acceptance in the public eye. Prohibition isn’t the way forward for treating the problem of alcohol addiction – but a good first step in the right direction would be taking the drug more seriously including treatment and rehabilitation.