When it comes to legal intoxicants, alcohol is still the only game in town. But with a massive pharmacopeia and scientific infrastructure at our disposal, that makes pretty much zero sense.
American painter George Bellows's lithograph 'The Drunk.' Photo via Wikimedia Commons
There is a knot of pain just behind my right eye that throbs in time with my pulse. My eyes feel raw. My mouth is dry. Last night’s booze-induced heroics are a distant memory. In the harsh light of day, I feel simply terrible, and yet, next weekend, I’m liable to do it all over again.
When it comes to legal intoxicants, alcohol is essentially the only choice available. It is the world’s most widely used drug and can be safely deemed toxic, addictive, and linked to violent behavior. As the failed American experiment with alcohol prohibition in the 1920s and 30s demonstrated, the desire for easy intoxication will seemingly always be a part of our society. But with a massive pharmacopeia and scientific infrastructure at our disposal, why do we still rely on such an imperfect means to accomplish that goal?
That imperfection was on display in a study released last week by the Center for Disease Control (CDC). Their researchers have determined excessive drinking to be responsible for the deaths of one in ten working-age adults in the US. In total, 88,000 Americans die every year from alcohol.
The CDC’s research complements a 2010 study for the British government quantifying the harms of alcohol in relation to other intoxicants. Twenty-nine psychiatrists specializing in addiction (as well as experts in chemistry, pharmacology, forensic science, and police services) were assembled. Their mandate was to rigorously assess 20 legal and illegal drugs for harm to the user and to society. Alcohol received a harm score of 72 out of 100—the highest in the study. The runner-up was heroin, with a score of 55.
In order to understand more about alcohol’s appeal, I went to a man whose job it is to dispense the stuff. Bartender Maxime Giordani has more than 15 years of experience mixing drinks in some of New York City’s finest establishments.
“I think a lot of people drink because it’s a way to be social,” he told me. “It’s something you do with other people. Oftentimes, it’s just what's expected. When I ask, ‘Would you like another drink?’ for example, generally people in a group will look at one another first before responding.”
“But most of all,” Giordani continued, “alcohol is an escape from reality. I hear all the stories: bad jobs, broken marriages, or just boredom from the daily routine. A couple of drinks will loosen you up. It’ll relax you. Some people become funny, or more animated. Your shyness is gone. You can say whatever crazy thing you want to the girl sitting next to you.”
The ideal replacement would reproduce as many of alcohol’s positive qualities as possible. It would act as a social lubricant by reducing inhibitions. It would produce feelings of euphoria. Users would be able to control their level of intoxication by limiting their consumption. Finally, it would integrate seamlessly into the existing social structure—served in drink-form at bars and other gatherings alongside traditional alcoholic beverages.
At the same time, the ideal replacement would be nonaddictive. It would be nontoxic and easily metabolized. It would produce no sensory-motor impairment. Better yet, it would come with an antidote that, when consumed, would quickly bring the user back to a normal state of consciousness.
With these criteria in mind, I sat down with psychoactive-drug expert and VICE contributor Hamilton Morris. I wanted to know: Can we find other ways to replicate alcohol’s desired effects?
“The first thing you have to understand is that alcohol has an incredibly complicated pharmacology,” Morris explained. “Primarily it has a GABAergic effect—a Valium-type effect, you could say. But it also behaves as an NMDA antagonist to a lesser extent—a Ketamine-type effect. It modulates so much neurologically that even now we don’t fully understand how it works. There are many other drugs that produce effects similar to alcohol, though, so I do think that a replacement is at least theoretically possible. My main question is: Will people accept it?”
Asked for candidates, Morris’s first thought was benzodiazepines—a class of drugs rated 15 on the UK's drug-harm scale. Taken by millions of Americans in the form of prescription medications like Xanex, Valium, and Klonopin, benzodiazepines mimic alcohol’s primary mechanism of action in the brain.
“Like alcohol, these drugs will produce a euphoric effect and reduce anxiety, but they’re very functional, which is why they’re used therapeutically. You could take a benzodiazepine and go to an important meeting, and at a reasonable dose, you’d likely be fine. You might even do better at the meeting because you would feel relaxed. The data on how benzodiazepines impair motor functioning relative to alcohol is equivocal, but it seems there is potential for benzodiazepines or related compounds to produce relaxation without dramatic loss of coordination. There’s no metabolic burden, no toxic metabolite, and no dehydration, so there’s no hangover. In some ways, though, that actually might be a bad thing. When you lose that toxicity, you also lose a major reason not to use a substance in excess. Benzodiazepines are still addictive, and they still produce withdrawal symptoms after heavy use.”
We talked over a series of additional possibilities: diethyl ether, xenon gas, NSBT, 2-methyl-2-butanol, 1-ethynyl-1-cyclohexanol, oxytocin, khat. Each had its benefits and its drawbacks.
“I suppose if I had to pick the strongest candidate,” Morris mused finally, “it would probably be cannabis. It’s almost entirely nonaddictive, and it provides a lot of the stress relief and disinhibition that people seek in alcohol.”
It’s a disinhibition that, as former Baltimore narcotics officer Major Neill Franklin insists, renders the user docile. “Alcohol and violence go hand in hand,” he stated. “As a cop on the street, in my entire career, I never had an altercation with someone on weed alone. Domestic violence calls—it’s always alcohol.”
That pro-social docility is one of the reasons why marijuana scores so low on the UK harm scale (with 20 points). Still, the drug is not without its problems. Research suggests that it can also lower motivation and cause short-term memory loss, though a recent study found that ibuprofen taken prophylactically may protect against some of the memory problems.
I mentioned my conversation with Morris to another drug researcher, who wished to remain anonymous. He suggested an alcohol substitute of his own: 4-ACO-DMT. The little-known chemical is an analogue of the hallucinogen psilocybin—the substance rated as least harmful in the UK drug study. With a score of six, psilocybin is currently yielding promising results as a treatment for a range of clinical conditions from anxiety to cluster headaches to PTSD.
“I bought a lot of 4-ACO-DMT from a Chinese company years ago,” the researcher told me. “It’s banned under the Analog Act, but you can still technically buy it, as long as it’s not intended for human consumption. It was my social lubricant of choice for years. I would take it and go to bars and just do whatever I was going to do. You take a very low dose, and everything just becomes so beautiful. Everything is slightly crisper than usual and a little bit more present. Everything is just a little bit sparkly and bright. You feel confident. You feel very calm and fully in possession of your mental faculties—totally articulate. I drove on it many times without the slightest problem.”
In my conversations with experts in the drug community, one other drug came up again and again: MDMA. Commonly known as ecstasy or Molly, MDMA produces a state of euphoria accompanied by feelings of intimacy and empathy. Its harm score of 9 in the UK study was so low that the architect of the experiment, Dr. David Nutt, declared it to be safer than horseback riding—a statement that quickly led to his dismissal as a chief scientific adviser to the British government.
Undaunted, Nutt has vowed to carry on research into a safer substitute for alcohol. He is currently testing five unnamed substances for their ability to target specific alcohol-related brain systems. The finished intoxicant will sell as a cocktail and be advertised as “an upmarket product for people who want to drink responsibly.” He hopes to have a prototype ready within the next several years. “It may be,” he suggested in an op-ed for the Guardian, “that by 2030, that's what we'll all be drinking in the pub.”
Roc’s new book, And, was released last year. You can find more information on his website.