Most kids and adults use alcohol. Prof. Nutt, one of the leading experts on drug use in the UK, wrote:
"MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places."
(He was then sacked from his position advising the government, and then all the other scientists resigned from the committee he chaired.)
While it's good to question the highly dubious criteria to separate legal from non-legal drugs, I think all these studies showing alcohol as the worst drug fail to account for the fact that if used in a responsible way, the harm caused is practically zero.
A person who likes to drink a cup of wine or a beer two or three times a week, and doesn't do so when driving, receives and causes no harm in practice (I know, there are studies about increasing cancer risks due to alcohol, but no more than with meat and other non-drug products). This is not true of cocaine, heroin or even tobacco, where there is no such thing as a harmless dose, and it is controversial in the case of cannabis.
> if used in a responsible way, the harm caused is practically zero.
And yet so many people struggle with using alcohol in a responsible way.
Alcohol is, incidentally, the only household-name drug that can actually kill you from withdrawal. Believe it or not, even though heroin withdrawal is miserable, as long as the person is taken care of and kept hydrated, they won't die from it. That is not true of alcohol; a person suffering from acute alcohol withdrawal can literally die from the direct effects of the withdrawal themselves.
In a pinch, opiates can actually be used to help a person detox from alcohol and mitigate the life-threatening seizures (and the pain). Benzos are much better for this, though, and are more commonly used in medical detoxification scenarios.
I've taken a harmless dose of cocaine: I drank coca tea in the Andes. That this is harmless seems less controversial than either alcohol or cannabis.
It's in any case difficult to separate "responsible" and irresponsible use of drugs when deciding on policy. Either alcohol should be banned, or all the less-dangerous drugs should be legalized.
What puzzles me is that alcohol is available OTC and anxiolytics and psychedelics are not. My 2 uncles died in relation to their alcohol abuse. Both of them mostly due to low availability of psychiatric care after their respective divorces (that happened before they started drinking). We have no infrastructure to help people get up after their lives come apart and the only available drug has zero potential to improve their situation.
Maybe "overall, alcohol was the most harmful drug," but it's because it's the most used one. The "harm to others" score is not by individual, and there is a large difference in the number of users.
It's also the most acceptable and very commonly consumed anywhere and everywhere. People are ridiculously casual about drinking to intoxication then carrying on their business as usual in public.
"MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places."
(He was then sacked from his position advising the government, and then all the other scientists resigned from the committee he chaired.)
http://dx.doi.org/10.1016/S0140-6736(10)61462-6