Is it healthier to smoke weed or drink alcohol?

Alcohol and marijuana are two of the most widely used intoxicating substances on earth. As such, there is no shortage of debate over the ways they help or harm us. The scientific literature highlights a number of health risks secondary to marijuana or alcohol use, from memory loss to liver disease. Still, many health experts tout marijuana as a miracle cure-all, while researchers have found that drinking moderate amounts of alcohol can bring about big health benefits. So, what’s the truth? For those trying to pick the healthiest poison, should they turn to weed or alcohol?  

It’s a tough, complex question because the two substances differ in legality, ingestion methods, and long-term effects. However, with drug policy reform on the horizon in many states as well as increased research in the works, there’s now more clarity on the topic. Here’s a closer look at how alcohol and marijuana compare health-wise.

Marijuana vs alcohol

Marijuana is the most commonly used “illicit” drug in the United States, with a reported use of 12% by people 12 years of age and older. The laws surrounding marijuana use are rapidly changing across the country. Today, recreational use is fully legal in 11 states, while medicinal use is legal in 34.

When marijuana is ingested, most commonly by smoking or eating it, chemicals called cannabinoids are released into the body. One particular cannabinoid, THC (marijuana’s main active ingredient), gets into the brain and attaches to cannabinoid receptors. Once activated, dopamine is released, and the result is a “high” that is associated with impaired thinking and slower reaction time. Effects vary by user, but these may include a pleasant euphoria, altered senses, and changes in mood.

Now that we’ve taken a broader look at marijuana, let’s turn our attention to alcohol. Simply put, alcohol consumption is extremely popular in the United States. According to the 2018 Behavior Risk Factor Surveillance System survey conducted by the CDC, more than half of the US adult population reported having consumed alcohol in the past 30 days.

When someone drinks alcohol, the chemical compound ethanol enters their bloodstream and gets transmitted throughout the body. Alcohol reduces inhibitions and produces impaired coordination and judgement, slurred speech, and blackouts. Like marijuana, alcohol causes a rush of dopamine into the brain. But, just how much a person is affected by alcohol depends on several factors including their height, weight, age, and more.

Short-term and long-term health consequences

According to the National Institute on Drug Abuse, alcohol consumption can harm the brain and most organs in the body, including the heart, liver, and pancreas. It can compromise the immune system, increase the risk of cancer, and puts fetal development at risk. In comparison, the adverse effects of using marijuana include impaired short-term memory, impaired motor coordination, and—in high doses—paranoia and psychosis.

The National Institute on Alcohol Abuse and Alcoholism estimates that roughly 88,000 people die annually from alcohol-related causes, making alcohol abuse the third leading preventable cause of death in the United States. Moreover, it is well established in the medical field that alcohol is attributed to poor mental health and can exacerbate underlying mental health disorders. 

In a cross-sectional population survey published in the European Journal of Public Health, researchers recorded the drinking habits and self-reported mental health statuses of approximately 2,700 Finnish adults. Overall, binge drinking was found to be associated with poorer mental health, specifically a lack of life satisfaction and psychological distress.

Marijuana, by contrast, is nontoxic and unlikely to cause death from overdose. No deaths from marijuana overdose have been reported, according to a 2017 Resource Guide released by the DEA.

But, while the CDC explicitly states that a fatal overdose of marijuana is unlikely, that doesn’t mean it’s harmless. Marijuana use has been associated with altered brain development, especially in adolescent users. In addition, one cohort study showed an association between frequent cannabis use by teens and increased risks of anxiety and depression. Researchers monitored 2 classes of students at random from 44 schools over 6 years. After adjusting for concurrent use of other substances, daily marijuana use among participants was associated with an over five-fold increase in the odds of reporting depression and anxiety.

But, in an interview with the New York Times, Dr. Ziva Cooper—research director of the University of California, Los Angeles (UCLA) Cannabis Research Initiative, and one of the authors of the National Academies of Sciences, Engineering, and Medicine’s comprehensive report on cannabis—refuted the common-held belief that marijuana causes schizophrenia. “We do not yet have the supporting evidence to state the direction of this association,” said. Dr. Cooper. “[The UCLA Cannabis Research Initiative committee] also concluded that a history of cannabis use is associated with better cognitive outcomes in people diagnosed with psychotic disorders,” she added.

Between the two, it appears that marijuana is also much less addictive. According to the criteria for dependence in the Diagnostic and Statistical Manual of Mental Disorders, approximately 9% of those who experiment with marijuana will become addicted. For alcohol, however, that percentage leaps to 23%.   

Which is healthier?

Modern research is increasingly recognizing cannabis as a valuable aid in pain control. According to Peter Grinspoon, MD, author of the memoir Free Refills: A Doctor Confronts His Addiction, marijuana is a safer alternative to opiates in the treatment of chronic pain. “It is impossible to overdose on and far less addictive,” he wrote in an article for the Harvard Health Blog, “and it can take the place of [non-steroidal anti-inflammatory drugs] such as Advil or Aleve.”

As far as cancers go, marijuana gets another win. Alcohol use is overwhelmingly linked to several kinds of cancer, the CDC confirms. On the other hand, a systematic review published in the International Journal of Cancer combined the results of six studies and found no association between lung cancer and habitual or long-term practice of smoking marijuana.

A testament to alcohol’s benefits, The School of Public Health at Harvard University found inverse associations between light to moderate drinking and the risks of heart attack, stroke, and death from all cardiovascular causes. Still, the pervading scientific consensus is that less alcohol is best.

The bottom line

The key takeaway is that, despite all noted risks and benefits, anyone who consumes alcohol or uses marijuana should exercise caution. There is no clear-cut answer for which substance is better for one’s health because both carry several risks to those who use it.

Still, marijuana does not pose the same serious health dangers that excessive alcohol consumption does. Marijuana is less addictive, is unlikely to lead to a fatal overdose, does not cause cancer—at least, according to current evidence. Not to mention, marijuana use does not typically result in the hangover that is most common with drinking.

Considering only the facts, marijuana is the healthier option. But, if deciding between the two strictly for health purposes, the best choice is probably neither.