Alcohol – The Under-Appreciated Killer


I just saw the great movie “White Irish Drinkers” and it got me thinking. Global deaths from smoking are almost twice alcohol-related deaths – 5.4 million versus 2.5 million annually. And yes, it is also true that nearly half of all heavy smokers will die because of the “sticks”. But there are many other ways drugs can kill. It turns out that the damage resulting from excessive alcohol consumption dwarfs that from cigarette smoking.

Smoking and Drinking “Externalities”

Heavy smoking/drinking causes health problems for the individual smoker/drinker – like death!  But aside from secondary smoke, the side effects/externalities of smoking are quite limited. You can work (even if you have to go outside periodically for smokes), you can drive to and from work, and you can be a good parent. If anything, smoking allows people to relax and focus more on the task at hand. And with the growing global obesity epidemic, smoking is a plus – weight control. As I have noted in an earlier piece, people who stop smoking normally gain 5 to 15 pounds.

The side effects of heavy drinking are just the opposite. Brain functioning is impaired resulting in:

  • Driving under the influence-caused deaths;
  • Poor performance at work/job loss and, most importantly;
  • Physical violence and other damage to family/friend relationships – who of us has not observed a nasty and violent drunk in action?

In what follows, more detail on these points from a report just released by the World Health Organization (WHO).

Disability-Adjusted Life Years (DALYs)

DALYs are a new measure of the cost of illnesses such as drinking or smoking – DALYs. It measures years lost due to:

  • a premature mortality and
  • years of life lost due to time lived in less than full health.

DALYs for the ten leading risk global factors for the age group 15-69 are presented in Table 1. Alcohol leads the list with tobacco third behind unsafe sex (mostly AIDS-related). However, it also is notable that high blood pressure, high blood glucose, high cholesterol, and physical inactivity are related to being overweight and obese. As I have reported, there is a global obesity epidemic.

Table 1. – DALYs Lost Globally: The 10 Leading Risk Factors, 2004

Source: WHO

The causes of alcohol-related DALYs are given in Table 2. Note that these data do not include the destruction to families and friends resulting from drinking. From the table, it is clear that far more of alcohol-related DALYs are generated by men and that a far greater portion of women’s problems come from alcohol-induced diseases.

 Table 2. – DALYs from Alcohol-Related Problems, by Gender

Source: WHO

The Heaviest Drinkers

It appears that weather affects drinking. In colder climes more alcohol is consumed. More specifically, when total alcoholic consumption per capita is regressed on latitude (absolute value), the coefficient is positive and significant.

Table 3 gives data on the 20 countries that drank the most alcohol in beer, wine, spirits and other beverages on a per capita basis (ages 15-59) in 2008. It appears that a region comprising Russia and most of Eastern Europe drinks the most.

 Table 3. – 20 Countries that Drank the Most – 2008

Source: WHO

Alcohol Epidemics in Muslim and African Countries

But Table 3 does not tell the whole story on heavy drinking. In part, the figures are high because for most of the countries listed, a very large portion of the population drinks. But WHO also has a 2005 database for drinkers only. These data for men are provided in Table 4 for the 20 countries with the highest consumption.

Table 4. – Annual Alcohol Consumption, Males, 2005 (liters/year)

Source: WHO

These countries are strikingly different than those in Table 3. They are populated by African and Muslim countries. Apparently, drinking males in these countries drink heavily.

To give some perspective on what these numbers mean, 40 liters annually is equivalent to daily consumption of 6.2 cans of beer (12 oz. can) or 1.1 bottles of wine (.75 liter) or 6.8 shots (40 ml per shot) of whiskey. On assignments to Africa, I have witnessed such heavy drinking among senior government officials. Many of these officials work day and night under tremendous stress. I worked with two such officials – one in Ghana, one in Lesotho. They were the “technocrats” in their finance ministries that did all the work. Both dead at 45 from stress and heavy drinking.

Policy Issues

We know that for addictive killers, outright bans/prohibitions do not work: addictions create markets. Bans provide criminals with lucrative income sources, drugs that are expensive and low-quality, and gang warfare killings. As I have suggested earlier, what has been done with cigarettes is about all you can do. Tax them heavily, require warning labels and run publicity campaigns.

Alcohol is a more complex issue. Unlike cigarettes, there are numerous studies indicating that alcohol consumed in moderation has positive health consequences. At one point in US history, alcohol was banned (1919-1933), but “The Noble Experiment” did not work. It did not work because the demand was still there and it was satisfied by “criminal” producers and distributors.

Food is another example of a product that if used in moderation is good for you. Addictions are the problem. Overeating as an addiction is just beginning to be noticed. It was just a couple of years back that the UN conceded that there were more obese children in developing countries than undernourished children. Major educational campaigns are being launched, e.g., see promoting better eating habits and exercise.

There are 33 million DALYs lost annually from alcohol and 23 million lost from smoking. How about illicit drugs? Table 1 indicates that 6 million DALYs are lost from illicit drugs. How does that compare to the lives lost in gang warfare and the billions the US spends on drug eradication? As I have written elsewhere, illegal drugs fit perfectly the profile of what happens when a product for which there is a significant demand is made illegal. The product is still supplied but by a criminal element making tremendous profits. Since 1996, the US government has spent in excess of $150 billion trying to eradicate drugs. Has any of this worked? No.

The United Nations Office on Drugs and Crime reports there are vibrant markets throughout the world for cannabis, opium, heroin, cocaine, and amphetamines. Statistics from the US Office of National Drug Control Policy show that drug production has increased and prices in the US have fallen over the last decade.


Drinking has greater costs than cigarette smoking. What should we do about it? Probably a little more should be spent educating people about the dangers of alcohol addictions. And physical abuse by men in homes should be aggressively investigated and prosecuted. But that’s all. Addictions create their own demand and bans don’t work.

Banning drugs is a horrible mistake. A lot more people die in efforts to eradicate drugs and gang warfare than the additional numbers that would die if they were legalized.

“We dig our own graves.”

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