In nearly half of the United States, all three are legal for those over 21: alcohol, tobacco and marijuana. However, the three substances come with different rules, taxes and — of course — health effects.
We posed the question to three doctors around the country: How do alcohol, weed and cigarettes rank when it comes to your health?
All three doctors agreed on which is best.
First off, they had a few conditions. “It is difficult to conclusively rank them in the order of their risks, since there have been no major randomized controlled head-to-head trials among the substances,” said Dr. Michael L. Glickman, a Washington, D.C. family medicine doctor and weight loss expert. He added that the amount you consume of each substance also greatly impacts your risk of bad effects.
Dr. Anand Akhil, a behavioral health doctor with Cleveland Clinic, also pointed out that each individual has their own risk factors based on family history, pre-existing conditions and more.
But when it comes to generalizing for the average person, Akhil said alcohol was the worst, followed by tobacco.
“Alcohol use is linked to over 200 health conditions and diseases, damaging every organ system in the body,” said Akhil. “Depression, anxiety, dementia, cancers, heart and liver disease, and bone disease can all result from alcohol consumption. Similarly, tobacco use is largely connected to serious cancers, chronic obstructive pulmonary disease, and cardiovascular diseases.”
Dr. Kevin Most, chief medical officer at Northwestern Central DuPage Hospital, agreed.
“I would certainly rank alcohol No. 1,” Most said in a recent interview with WGN Radio. “I’m going to say that alcohol in moderation is OK, but too much alcohol is going to have impact on many illnesses.”
The harms of consuming tobacco, Most said, could be largely reversed when people stop smoking earlier in life. “If people understand the the risk of lung cancer, based on how many years you’ve been smoking and how much you’ve been smoking, if you stop that smoking at an early age … your lungs can reinvigorate and get back almost to normal.”
But Glickman disagreed, and ranked tobacco as worst due to the fact it has no proven health benefits.
“Tobacco I would argue is the worse substance of the three, given it has no conceivable benefit even in light amounts, and considerable risks. Tobacco has been linked to increases in heart disease, cancers, and premature mortality, among others,” Glickman expalined. “Alcohol on the other hand, could have benefits at light or moderate amounts, but then risks with large amounts.”
He said red wine in particular contains antioxidants, and pointed to studies showing up to one glass per day can reduce inflammation in blood vessels.
But all three doctors agreed on which ranked least harmful to the average person’s health.
“I would put marijuana third, mainly because we know that there’s a lot of medicinal uses for marijuana and used in the right format and in the controlled environment is fine,” Most said. He said chemotherapy patients often credit cannabis as the only thing keeping their appetite up, allowing them to get nutrition they need.
Glickman said evaluating cannabis’ healthfulness and harmfulness is more complicated than the other two.
“The available evidence suggests that cannabis could be of benefit when medically supervised as part of a treatment plan for certain conditions such as chronic pain, anxiety, trauma, insomnia, and muscular disorders, among others,” he said. But Glickman went on to say cannabis use could make certain mental health issues worse, as well as impair memory and concentration.
He said the data suggests there is an extra risk to young adults whose brains aren’t fully developed.
Plus, Akhil noted, while the U.S. Department of Agriculture and Health and Human Services have guidelines on how much alcohol adults can consume in moderation (up to two drinks a day for men, one drink for women), there are no such guidelines for safe cannabis or tobacco use.
“I think negative health consequences could be possible for all of the three substances, even in moderate amounts, depending on the person and situation,” Glickman said. “There is no foolproof vice.”
All three experts emphasized each person is unique, and you should always talk to your doctor about your specific situation.