The Global Statistics on Alcohol, Tobacco, and Illicit Drug Use: 2017 Status Report found a quarter of a billion hours of healthy human life are lost each year because of smoking and drinking, ten times more than is lost to illicit drug use.
The study measures the impact in “disability adjusted life years”, which factors in the years lived with cancers, respiratory disease or cardiovascular disease alongside the lives cut short by things like overdoses.
The harm from smoking and alcohol is largely down to markedly higher prevalence: globally, one-in-seven adults smoke – the single biggest health harm globally – while one-in-five drink alcohol.
It notes that death rates per 100,000 people were three times higher for smoking (110.7 deaths) than alcohol (33). Illicit drugs only accounted for 6.9 deaths per 100,000.
“Smoking and alcohol are always well ahead [of illicit drugs], there’s nowhere that it even comes close,” Professor Robert West of University College London and one of the report’s authors told The Independent.
The report, published in the journal Addiction, also found that Europe is a world leader in these bad habits.
In 2015 the regions with the highest alcohol consumption were Eastern, Central and Western Europe, with 11.98 litres, 11.61 litres, and 11.09 litres of pure alcohol consumed per person over 15 years old, each year.
This compared to the global average of 6.42 litres, and heavy drinkers accounted for 40 to 50 per cent of these.
These regions also had the highest smoking rates, with Eastern Europe leading with 24.2 per cent of the population being smokers.
Western sub-Saharan Africa had the lowest smoking rates (4.7 per cent), while North Africa and the Middle East had the lowest per capita alcohol consumption, at 0.91 litres.
“We think of ourselves as bastions of civilisation, but on this particular area we’re doing worse than the developing world,” Professor West said.
“It’s a bit of a wake-up call, for me anyway, let’s stop congratulating ourselves that we’ve got smoking prevalence in Britain down to around 16 per cent – that’s only down to the global average.
“If we’re going to make the impact we really want on death rates, we need to address the cultural normality of it all.”
Use of illicit drugs was less common. Globally fewer than one in 20 are estimated to have used cannabis in the past year, while amphetamines, opioids and cocaine are much lower.
The US and Canada have some of the highest rates of cannabis and cocaine dependence, in addition to opioids which are currently at epidemic levels and caused 42,000 deaths in the US alone in 2016.
Australia and New Zealand were the biggest consumers of amphetamines, nearly 500 people in every 100,000 have used them in the past year.
Professor West added that the report, looking at illicit drug use and harms as laws were strengthened and relaxed, showed just how ineffective prohibition policies have been.
“We think of legislation and drug laws being an important weapon in the armoury,” he told The Independent, “But if you took an evidence-based approach, you’d see there is no evidence. Yet it is something politicians love to do.”
The report does acknowledge there are gaps with the data collection, particularly for illicit drugs and in countries where data collection is not as good, such as in parts of Africa, Latin America and Asia.
In absolute numbers China, India and Indonesia have the largest numbers of smokers, with higher death rates among those who do drink.
Nevertheless, the report represents the most up-to-date audit of the state of addictive substance use and its harms today.
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