How not to think about drugs? 🚦💉🍺

Hi There,

When you think about the adverse effects of intoxicants on health, society, and the economy you think about opioids, and whatever the drug cartels are currently busy innovating on or Netflix is about to make a show on. You will be hard-pressed to find alcohol in the list of harmful and banned intoxicants. This is an issue that was picked up by the Global Commission on Drug Policy in 2019, an independent think tank with 26 members who have been in the highest offices of their respective countries. The 2019 report outlined that the current drug laws do not make much sense. The United Nations has a drug classification system which places around 300 psychoactive substances in different schedules based on their benefits, or harms. Morphine is a drug with huge medicinal uses and is categorised as such, but psilocybin is recreational and attracts massive penalties in the real world. Intoxicants or drugs without medical uses are automatically categorised as extremely harmful and attract massive penalties even if they are not very risky or may have potential positives for the users. The fact that this classification system is extremely flawed has been evident for a few decades now.

In 2010 Nature published an interesting paper which tabulated the harms caused by different intoxicants using multicriteria decision analysis (MCDA). This was done by scoring 20 drugs on 16 criteria, nine of which were harm caused to self (user), and seven were harm caused to others. This resulted in creating a harm score for self, and others. The MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to the self. Alcohol, heroin, and crack cocaine were the most harmful to others. However, alcohol was the most harmful drug with an alarmingly high harm score of 72, followed by heroin at 55. The harm caused by alcohol due to drunk driving is a huge personal, emotional, and social cost.

Therefore it is understandable that governments have been trying to control drinking for almost over a century now. With the ending of prohibition (banning alcohol) in 1933 in the United States of America, western countries changed the policy mechanism for dealing with over-indulgence in alcohol. Now with clever taxation, awareness campaigns, and targeted positioning of who can legally buy alcohol and how much. Though countries in Asia, and Africa are still using prohibition as a primary tool for dissuading people from imbibing too much alcohol. The problem is that alcohol is very easy to produce and is extremely popular therefore prohibition does not work in controlling over-indulgence in alcohol. Prohibition in fact ensures that the root cause of the problem largely goes unaddressed. Ergo when prohibition is lifted, the alcohol companies make a silver surfer-like return. So what can be done about alcohol? Can we reduce the number of people indulging in alcohol?

Well if too few people drink less alcohol the industry around it currently valued at US$ 1.47 Trillion might continue to expand operations and revenue like it has in the past two decades. Therefore the industry decided to pitch in and be a part of the solution. Under the aegis of 'responsible drinking,' the industry wants to use an advertisement, and behavioural targetting to get people to drink within limits. What does this mean? According to researchers from the University of Sheffield, and a think-tank the Institute for Alcohol Studies, two-fifths of alcohol in Britain is in excess of the recommended alcohol limit, therefor if the big liquor is sincere in 'responsible drinking' they will have to get people to drink more expensive, fancier tipples the researchers calculate that the per unit costs could go up to as much as 22 to 98%. Is it possible that 'responsible drinking' might not be all that sincere from the companies that depend on over-indulgence to continue to discharge their fiduciary responsibility? Most probably yes. In 1999 tobacco firms had one of the most expensive investments in lobbying groups in the world. From Washington D.C. to Brussels, and beyond. Alcohol firms used to spend around a quarter of their money on lobbying. Today, they spend 31% more than tobacco firms in the United States alone. Today the social norm around alcohol consumption is changing due to factors from the demographic shift, better awareness, better enforcement, social network, and the rising cost of alcohol and stagnating wages.

So alcohol consumption was stabilising and going down. Some of the efforts were useful. Noticeably the campaign around not drinking, and driving has been very successful in getting people to have an assigned driver, therefore reducing the number of injuries and deaths caused due to it. This should have been a good time to reflect on alcohol and see how it could be replicated across geographies. Except fatalities caused due to alcohol came down but alcohol drinking went up. Three economists went looking for the cause. Jacob Burgdorf, Conor Lennon, and Keith Telster found that the availability of ride-sharing apps such as Uber, Lyft, Grab, and Ola have made it easier for people to binge and reach home safely. The arrival of these firms in places with bad public transport increased binge drinking incidences by as much as 20% in some settings, and almost 5% incidence of average drinking. The findings of this study are limited to the United States as the data used is primarily the United States Centres for Disease Control and Prevention's health surveys along with the availability of Uber in different geographies over time. In places such as Portland, Oregon the presence of ride-sharing meant that car accidents due to alcohol came down by as much as 62%. However, the behaviour modification efforts have focused on not drinking and driving therefore with the availability of ride-sharing has meant drinking to an alarming excess.

Alcohol is a case in point of public policy needing a more cohesive and well-studied solution than focusing on the lowest common denominator. The issue around drugs is a case in point of relativism, industry, and regulation coming together to create a chaotic choice architecture,