A comprehensive list of alcohol’s harms and benefits in a cost-benefit diagram

The now defunct Government Cabinet Office Strategy Unit once attempted to capture a comprehensive list of alcohol’s harms and benefits in a cost-benefit diagram

Here it is (click to enlarge)


What I find interesting is that there are 17 above the line costs and only 5 below the line benefits.  Feels like a lot of risk for not a great deal of reward wouldn’t you say?

This graph was included in an article in The Telegraph which ran in January and was looking once more at Professor Nutt’s chemical compounds that have been muted as solutions.

He has finally cracked a chemical conundrum, which has allowed him to develop new drugs that could wean people off alcohol, while allowing them to enjoy the feeling of being “tipsy”.

The first drug, which he calls “alcosynth”, is a drink that mimics alcohol. It a non-toxic inebriant that removes the risks of hangovers, liver toxicity, aggression and loss of control. A benzodiazepine derivative, the substance is in the Valium family, but without being addictive or causing withdrawal symptoms, he claims.

The second is a so-called “chaperone”, which would attenuate the effects of alcohol. Take a pill with booze, and it’s impossible to become drunk to the point of incapacitation. The price point would be set quite high, to stop the drug from being abused, but this “sober up pill” could be popped on the way home, reducing drink-driving accidents, and other alcohol-related incidents and crime.

Both drugs would be available in high-end cocktail bars at first, claims Nutt. The alcohol substitute would be marketed as a companion to a regular tipple and relatively cheap to buy.

The overall cost of alcohol misuse is difficult to calculate because of alcohol’s ubiquity. Its combination with fatty food and sedentary activities make the mathematics tricky: estimates for the overall cost of alcohol to the British economy range from £21bn to £55bn per year.

The Prime Minister’s Strategy Unit has pegged the cost to the NHS of “binge Britain” at £3.5bn – higher than smoking at £3.3bn. Add on the £11bn for crime and £7.3bn in lost productivity from hangovers, absenteeism and poor performance and alcohol increasingly appears economically destructive.

Nutt has been working on synthesising his alcohol mitigation drugs for a decade. The effects of alcohol are devilishly hard to mimic because of its complex effect on the human body.

Ethyl alcohol (C2H6O) is unique in the universe of narcotics. Most drugs operate by hijacking one molecular receptor: tetrahydrocannabinol (THC, the active component in marijuana) impersonates our own endocannabinoids. Psilocybin (the chemical contained in magic mushrooms) mimics serotonin. Cocaine messes with the dopamine networks.

Alcohol uniquely masquerades as a number of neurotransmitters. Booze is the ultimate molecular maverick, which explains why so many of us are hooked. “Alcohol is a promiscuous drug,” says Nutt. It is also called the “dirty drug” because of its capacity to invade every cell in the body.

Nutt has applied for patents on 85 new chemical compounds in the alcosynth and chaperone families, which would be licensed to DrugsScience, and the Beckley Foundation, both independent organisations dedicated to research on drugs and drugs policy research.

Getting alcosynths and chaperones to market will not be easy. Licensing such drugs could take between three and five years, Nutt says – if they pass the UK’s stringent drugs laws at all. He has also courted controversy by working with a chemist, known as Dr Z, who was behind the creation of a mephedrone, also known as “miaow miaow”. That drug that was connected to a number of deaths in the UK last year and was subsequently banned.

“Some see him as the ‘new Shulgin’ [the chemist who gave us MDMA, 2-CB, 2-TI and 200 other psychoactive compounds],” says Dr Nutt. “Others see him as evil incarnate. He polarises people.”

The cost of human trials and legal bills for Nutt’s new chemicals will top £1m, he claims. He is hoping to secure a backer from the big pharma world. Danish pharmaceutical company Lundbeck recently launched Selincro, a drug that reduces the craving for alcohol, proving that there is market interest, he says.

The £1m figure doesn’t scrape the surface of the investment required to change our social and cultural relationship with alcohol. Not to mention our economic reliance on the industry, which generated £39bn for the UK, according to Nielson data.

“If alcohol was treated as a toxic compound in the same manner as benzene or other lethal chemicals, the maximum amount you would be permitted to consume would be one wine glass a year,” says Nutt. “But it is exempt from toxic control measures because we like to drink.”

Nutt says the Government must take drastic action to generate results, as all attempts to mitigate alcohol consumption have so far failed.

“We are incapable of killing alcohol’s allure,” he warns. “This is a battle we cannot win.”

This is an interesting premise and has been discussed by me here and here.  As before I’m not sure that replacing alcohol with a benzodiazepine based product is really helpful and the alcohol attenuator sounds just like Selincro, which I wrote about in these posts here.

What do you think?

PS Am now in the process of organising the next Club Soda Social in Cambridge.  The plan is Sunday 22nd March 5-8pm at Brown’s Restaurant and Laura assures me they have a great mocktail selection 😉

11 thoughts on “A comprehensive list of alcohol’s harms and benefits in a cost-benefit diagram

  1. Interesting development – and… indeed not sure if replacing alcohol with pills is the thing to do. Actually, I personally think I am sure that it is not a good idea. It’s like replacing sugar with aspartaam, sleep with coffee, good food with nutrient pills, attention to children with gifts and tv, peace with armed peace missions. (Where’s the soap box again? 😀 )

    I do like where he comes from: “If alcohol was treated as a toxic compound in the same manner as benzene or other lethal chemicals, the maximum amount you would be permitted to consume would be one wine glass a year,” says Nutt. “But it is exempt from toxic control measures because we like to drink.”

    That’s better than the hypocrite ‘Some people need help and we are here to give it to them and I can become a millionair in the process.’ Let’s see what follows. 🙂

    Thanks again for an interesting article on developments. 🙂

    xx, Feeling

    1. Haha feeling – soap box indeed! He is right and I like him. Not sure about his product ideas though ……

  2. Geez…more moneymaking opportunities for Big Pharma and Big Alcohol….I like the graphic, too; simple and to the point xx

  3. what isn’t included in that graph, and I do think should be, not to excuse inaction on addressing the costs to society and to individuals, but so that we can properly weigh them up – are the ‘economic benefits’ of alcohol.

    these are summed up by the Institute of Alcohol Studies* and comprise:

    – the value of domestic and overseas sales of alcohol
    – the associated tax revenues
    – the number of workers employed in producing alcoholic beverages.

    just looking at the latter for the moment, industry figures in that article give a whopping 650,000 directly employed in the alcohol industry, and indirectly supporting a further 1.1 million jobs. these can be compared with a total 30m currently in work in the UK.

    direct employment in the alcohol industry therefore ranks at about 2% of the total UK workforce, a similar proportion to that of motor vehicle manufacturing **.

    interestingly the tobacco industry figures*** are very significantly lower – direct employment of 5,700 and supporting another 66,000.

    these are big numbers with enormous lobbying and economic power. of course all the people who worked in the tobacco industry in the UK are not sitting on street corners.

    but we cannot ignore the economic arguments as those are what are primarily stopping the blinding obvious required actions taking place!

    * http://www.ias.org.uk/Alcohol-knowledge-centre/Economic-impacts/Factsheets/Economic-benefits.aspx

    ** http://www.thisismoney.co.uk/money/cars/article-2548149/How-booming-British-car-manufacturing-helped-drive-economy-upwards.html

    *** http://www.the-tma.org.uk/~thetma/wp-content/uploads/2012/05/Cogent.pdf

    1. Wow Prim – thank you for that comprehensive response! I agree that this is a massive unacknowledged reason as to why the govt are not keen to pursuit more fully. It didn’t stop them acting on smoking though …… and many of the pub/restaurant trade would be unaffected as they serve food.

  4. Cool infographic. Thing is, most of the benefits, both internal and external, are immediate and nearly guaranteed to occur, while most of the costs are down the road and/or NOT likely to occur. If we redid this graphic so the size of each outcome correlated with the likelihood of its occurrence for the majority of individuals, we’d be looking at a totally different graphic.

    For most people, alcohol has a guaranteed positive payoff with only a small chance of negative outcomes. While it’s certainly a gamble from person to person, those are odds that most people are willing to take.

    1. True enough SC but it was also a case, in my experience anyway, of diminishing returns. The con’s started to heavily outweigh the pro’s and that was some odds I wasn’t happy to play any longer. If I’d kept going how long would it have taken for the costs to have occurred? I’m pretty sure they would have done I just couldn’t say when.

      1. I agree. It’s really a matter of choice. You gotta set a limit when you go to Vegas, because when the slot machine keeps eating your money, only a fool keeps playing because “this quarter is the lucky one.”

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