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Research Summary

Societal and Individual Harms from Specific Substances of Abuse

The equitable allocation of resources toward the prevention and treatment of substance use disorders requires an accurate assessment of the individual and societal harms caused by specific substances. To address this, researchers convened a 1-day expert consensus panel to score 20 substances on 16 criteria related to harm to others* or harm to the individual user.† For each criterion, substances were scored on a scale from 0 (no harm) to 100 (most harmful). Each criterion was weighted to reflect the importance of the specific harm.

  • Alcohol (harm score [HS], 72), heroin (HS, 55), crack cocaine (HS, 54), methamphetamine (HS, 33), cocaine (HS, 27), and tobacco (HS, 26) were rated most harmful overall.
  • Anabolic steroids (HS, 10), khat (HS, 9), ecstasy (HS, 9), LSD (HS, 7), buprenorphine (HS, 7), and mushrooms (HS, 6) were rated least harmful overall.
  • Alcohol (HS, 46), heroin (HS, 21), and crack cocaine (HS, 17) were rated most harmful to others.
  • Crack cocaine (HS, 37), heroin (HS, 34), and methamphetamine (HS, 32) were rated most harmful to the individual user.
  • Socioeconomic costs accounted for much of the harm from alcohol, heroin, and tobacco.

*Injury, crime, environmental damage, family adversities, international damage, economic cost, harm to community.
†Substance-specific and -related mortality, damage and impairment of mental functioning, dependence, loss of tangibles, loss of relationships.


This sophisticated consensus-scoring process found alcohol causes greater overall harm than other substances of abuse, a finding that might be at odds with the substance-control policies of many countries. Although these scores reflect harms from substances in the UK, the findings may be of interest to policymakers in other countries who wish to conduct similar assessments or re-examine their own allocation of resources to reduce substance-related harm. Kevin L. Kraemer, MD, MSc


Nutt DJ, King LA, Phillips LD. Drug harms in the UK: a multicriteria decision analysis. Lancet. 2010;376 (9752):1558–1165.