but you'd never know from the headlines
Mainstream media tend to report more stories about illicit drugs than alcohol.
Stories about illicit drugs are also more negative. The media is more likely to frame illicit drugs as dangerous, morally corrosive and associated with violent behaviour, while it frames people who use illicit drugs as irresponsible and deviant.
In particular, the media is more likely to link illegal drugs with violent crimes, sexual assaults and murders than alcohol. This is despite one study finding 47% of homicides in Australia over a six-year period were alcohol-related.
Coverage of the recent Rainbow Serpent Festival in Victoria is one example of how the media have linked illegal drug use with violence. There were reports of alleged sexual and physical assaults at the festival, held over five days including Australia Day. But we'd argue there were no more than any alcohol-related violence and sexual assaults expected at a similarly large gathering on Australia Day.
Considering media reporting plays an important role in shaping people's opinions, this might lead people to believe illicit drugs are more likely to lead to violence than alcohol. This is because of a type of cognitive bias or "mental shortcut", known as the availability heuristic, which leads people to form opinions based on the most recent information they receive.
So what does the evidence say about whether alcohol or other drugs is more likely to lead to violence? And are some drugs worse than others?
What does the evidence say?
Most violence linked to alcohol and other drugs in Australia is due to alcohol, with 26% of Australians reporting they have been affected by alcohol-related violence compared with 3.1% who reported being affected by violence related to illicit drugs.
Despite rates of alcohol consumption remaining relatively stable in Australia between 2003 and 2013, there was an 85% increase in alcohol-related family violence over the same time period. While some drugs such as methamphetamine ("ice") have been implicated in a recent royal commission with an increase family violence, the degree to which it plays a role is not clear.
How does this happen?
In understanding how alcohol and other drugs mediate violence, we need to consider how they work in the body.
As people drink alcohol, they experience reduced functioning of the pre-frontal cortex of the brain, a part that plays an important role in how people regulate behaviour and make decisions. When people drink, they tend to make poor decisions and are more likely to react emotionally to situations in which they might normally respond with more reason and reflection. When people drink they are also less likely to consider the possible consequences of their actions.
MDMA ("ecstasy") works in a different way. It leads to a release of serotonin in the brain so people tend to become empathetic towards others and emotionally open. So, MDMA is rarely associated with violence. That's the case unless people take it with other drugs such as alcohol or stimulants, or they take what they think is ecstasy but really is a new or otherwise harmful drug.
LSD ("acid") is a psychedelic drug that binds to certain serotonin receptors in the brain. So, LSD can lead to significant changes in consciousness and perception that are therapeutic in clinical settings. But people can become overwhelmed by the changes in perception caused by LSD at festivals, leading some people to become distressed and occasionally unaware of their actions. There are no studies showing a clear link between the use of LSD and violence.
Anecdotally, we have rarely seen people become violent as a result of their distress after taking LSD at festivals. However, as with ecstasy, there is no quality control of the illicit drug market in Australia and some people have had violent reactions or self-harmed as a result of unintentionally consuming NBOMe drugs sold as LSD.
So, it would appear alcohol is far more likely to be associated with violence than MDMA or LSD.
Drugs such as methamphetamine have also been associated with violent behaviour and psychosis in hospital emergency departments, particularly in association with extended sleep deprivation.
We are not aware of any data that compares emergency department presentations due to alcohol-related violence with amphetamine-related violence. But we know the total number of presentations to emergency departments due to amphetamines (the class of stimulants to which "ice" belongs) pales in comparison to those involving alcohol.
Widespread use of alcohol
A key factor in this situation, of course, is that alcohol is arguably the most widely accepted social tonic in western society. The most recent data show that about 80% of Australians aged over 14 drank alcohol in the past year, with 6.5% drinking it daily.
While most people consider its risks to both personal health and community safety manageable, research suggests its widespread use makes it the most harmful drug due to the impact it has on others in terms of violence.
But most illicit drugs are recent arrivals in western society and have been subject to widespread prohibition rather than regulation. So, it is hardly surprising that fewer people use them.
The most recent data show that about 7.2% of Australians aged over 14 consumed "ecstasy" in the past 12 months, 2.1% had used methamphetamine and 1.3% had used a psychedelic drug, such as LSD, in the past 12 months.
What we'd like to see
Ultimately, we need more research to confirm, despite the acknowledged risk of other harms, that drugs like MDMA and LSD have a low potential for causing violence compared with alcohol.
The media should be more responsible in how they report on alcohol and other drugs, particularly given the consistently high rates of alcohol-related violence compared to violence linked with other drugs.
People who use illicit drugs are also a minority and it is important the media does not further marginalise this group by using stigmatising language.
Without such changes there will still be limited opportunities to discuss implementing evidence-based drug policy. Rather, Australia will continue to fall behind other western nations in implementing harm reduction measures such as pill testing.
The authors are board members of Psychedelic Research in Science and Medicine. They volunteered at the recent Rainbow Serpent Festival with DanceWize to provide festival goers who were feeling distressed with a safe space to process their drug-induced experience.