Which is More Harmful: Alcohol or Marijuana?

by | Apr 20, 2021


Happy 420 Day

Today is April 20th and informally is associated with marijuana. The association began back in the 1970s when a group of teenagers in San Rafael, California would meet at 4:20pm to hunt for abandoned cannabis plants in the nearby forests. Over the ensuing decades “420” became slang for cannabis and thus April 20th (or 4/20) became the day among marijuana proponents to celebrate cannabis usage.

The Spread of Marijuana Legalization

While marijuana is still illegal federally, legalization for medical and recreational purposes has spread across most states over the past decade. California was the first state to make marijuana legal for medical purposes back in 1996 and in 2012 Colorado legalized weed for recreational purposes. Currently (as of April 2022), 18 states and D.C. have legalized recreational marijuana and 37 have made medical marijuana legal. Here’s a link to a current list.

Here’s a map of the current status of marijuana legalization (updated as of Feb. 2022):


Which is More Harmful, Alcohol or Weed?

Back in 2014, I listened to a Freakanomics podcast that explored this question:

Imagine a fantasy world that’s exactly as the world is today except that two things are missing: alcohol and marijuana. And then imagine that tomorrow, both of them are discovered. What happens now? How are each of them used – and, perhaps more importantly, regulated? How would we weigh the relative benefits and costs of alcohol versus marijuana?

It’s a really interesting question to ponder. Alcohol is socially accepted, and for most of the US population, an important part of our social lives. Sharing a bottle of wine or a few beers with friends is super enjoyable as the alcohol tends to lubricate the social interactions and helps the conversation flow (of course, there’s a tipping point the other direction . . . ). But alcohol has huge negative effects on our health and society:

  • Health-wise, alcohol is bad for you. There is no safe amount of alcohol. While low to moderate levels of alcohol have cardiovascular benefits, any consumption of alcohol increases the risk of cancer and other diseases that more than offset its health benefits. Read more about that here.
  • Alcohol use is associated with violence: “Of the 11.1 million victims of violent crime each year, almost one in four, or 2.7 million, report that the offender had been drinking alcohol prior to committing the crime. Among the attacks that were committed by current or former intimate partners of the victims, two out of three of the offenders had been drinking prior to the attack.” Source. Additionally, about half of homicide offenders were under the influence of alcohol at the time of their crime.
  • Drunk-driving deaths and crashes are a huge problem. According to the NHTSA, “Approximately one-third of all traffic crash fatalities in the United States involve drunk drivers (with BACs of .08 g/dL or higher). In 2018, there were 10,511 people killed in these preventable crashes. In fact, on average over the 10-year period from 2009-2018, more than 10,000 people died every year in drunk-driving crashes.”
  • Then there are the hangovers . . . a study from the CDC found that excessive drinking costs the US economy around $250 Billion annually in lost worker productivity.

So, alcohol has a lot of downsides. What about marijuana? In most of the areas where alcohol is problematic, marijuana scores better:

  • Pot and violence. Years ago, I heard the story of a rally supporting cannabis legalization that was held in Denver on 4/20. Hundreds of thousands of people were expected to attend. Local law enforcement was concerned about so many people in one spot who might be consuming marijuana. So, the state police were called in to help regulate the rally in case things got out of hand. But, nothing happened; while that many people drinking would likely spark fights and bad behavior, the people at the rally just got stoned and chilled out. This is a huge difference between alcohol and pot: there is no association between marijuana use and increased violence (except those with certain mental disorders such as schizophrenia).
  • Driving while high. While marijuana impairs driving skills, there is no evidence that driving while high results in increased crashes. A 2015 study from the NTSB found that drivers under the influence of marijuana were significantly less likely to be involved in a crash than those under the influence of alcohol. According to the NTSB, “At the current time, specific drug concentration levels cannot be reliably equated with a specific degree of driver impairment.” Here’s a chart summarizing the data from the NTSB study by the Washington Post:
  • Pot has lower addiction risk than alcohol. When it comes to dependency, marijuana is less of an issue as studies have shown that while it can be addictive, it is less so than alcohol. Here’s a chart from a study showing the relative addictiveness of various substances:
The way to tread this chart is that of people who smoke pot, 9% will become addicted compared to 15% of alcohol users. Smoking cigarettes is hugely addictive. Though not in the study, I’ve also personally found that tofu is addictive.
  • Marijuana provides some medical treatment benefits including control of nausea and vomiting for those undergoing chemotherapy as well as chronic pain management. A move from opioids to pot to combat chronic pain likely will be a huge societal benefit and reduce the number of opioid-related deaths in the future.
  • No overdoses. There has never been a documented case of a marijuana overdose. The below chart from VOX based on CDC data tallies direct deaths from various substances (meaning indirect deaths such as car crashes aren’t included).

Of course, marijuana has its own set of issues, including:

  • Marijuana use affects the brain and is associated with memory issues and brain development. Marijuana use in teens and young adults “may reduce attention, memory, and learning functions and affect how the brain builds connections between the areas necessary for these functions. Marijuana’s effects on these abilities may last a long time or even be permanent. This means that someone who uses marijuana may not do as well in school and may have trouble remembering things.” Source CDC.
  • Lung health. Smoking marijuana is harmful to the lungs as it contains many of the same toxins found in cigarettes. According to the CDC,” smoked marijuana, in any form, can harm lung tissues and cause scarring and damage to small blood vessels.”
  • Social issues. Drinking a few beers together can enhance sociability while getting stoned together often decreases social interaction. When I’ve been at parties and a few people have gotten high they have tended to be less social and harder to interact with.

Thought Provoking?

My goal with this post is not to suggest that marijuana is good for you or that everyone should toke up a fatty on a regular basis, but rather to provide some thought-provoking facts about alcohol vs marijuana. Both drugs have issues, but the data indicates that alcohol causes more harm. As marijuana legalization spreads, replacing alcohol with marijuana may be a net benefit.

I’ll leave you with a final study out of the U.K. which looked at the harm to ourselves and others across a variety of drugs. It found alcohol to be the most harmful. Here’s a chart summarizing the study:



  1. Growing up as a teen in the SF Bay Area during the ‘70’s was an enlightening experience, yet controversial. There were many other drugs that were being used and marijuana was looked at as the “Gateway to the rest” (pun intended). Once the gateway concept was slowly disproven, marijuana began the process of proper scrutiny as your article aptly points out! Working in healthcare (both in Missouri and Northern California, I have had the benefit of deep discussions with the doctors who administer care to the poor. Unanimously, their experience and foundational knowledge supports your article. I had many discussion with my children during their teen years about the consequences of both, never promoting either, but giving them an opportunity to discern the pros and cons. Today, my son has chosen a path that gives him opportunities that he may have not had if those discussions had never occurred. Thank your for the objective presentation of this societal issue that is leading to enlightenment!!

  2. This is a very complicated topic. I wonder what US stats would look like if there was zero tolerance for alcohol and driving like in Europe, notably Scandinavia, notably Finland of which I have personal knowledge via family. Violations bring very strict penalties, unlike in US. THC definitely affects brain development and that’s why it is dangerous for kids. We’re probably all aware that brain development isn’t complete until the early 20s. I suspect the same holds true for alcohol. The shame is how both have infiltrated into younger and younger age groups.

  3. too much of anything kills, moderation is the key to satisfaction and the meaning of pleasure…

  4. “I’ve also personally found that tofu is addictive.“
    Haha good to know. What are the health risks of too much tofu?

  5. “I’ve also personally found that tofu is addictive.“
    Haha good to know. What are the health risks of too much tofu?

  6. Interesting but intuitively I find it hard to believe that marijuana use and driving “high” doesn’t cause any driving impairment.

  7. Interesting but intuitively I find it hard to believe that marijuana use and driving “high” doesn’t cause any driving impairment.

    • Agreed. It does seem counterintuitive and driving while high should be avoided IMO. Maybe greater amounts of data will shed more light in this.

  8. Love this article!! I learned a lot. I always thought 420 was a police code, but now I know that was false news!!


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