"It's Legal, So It Can't Be That Bad": When the Law Becomes the Standard

The logic is simple: if it were really dangerous, they would ban it. Beer is sold in supermarkets. Cigarettes carry warnings but are available on every high street. Online gambling has advertisements during football matches. The law, by permitting these things, seems to vouch for their safety.

The law is doing no such thing.

What legality actually reflects

The legal status of a substance is determined by a complex mix of historical precedent, economic interests, public opinion, the practicality of enforcement, and political will. Health evidence is one input among many, and it is rarely the decisive one.

A multicriteria decision analysis published in The Lancet asked an expert panel to score twenty drugs across sixteen criteria for harm, both to the user and to others. Alcohol scored highest overall. Heroin and crack cocaine scored highest for harm to the individual, but alcohol’s combined score, including harm to others, placed it above both [1].

This finding was striking because it placed a legal, culturally normalized substance at the top of a harm ranking that included illegal drugs. The ranking did not argue for alcohol prohibition. It argued that legal status is a poor proxy for harm.

The global burden

The numbers are large. A Global Burden of Disease analysis of tobacco estimated that smoking was responsible for 7.69 million deaths worldwide in 2019 [2]. A separate analysis of alcohol estimated that 2.84 million deaths were attributable to alcohol use in 2016, and concluded that from a population health perspective, the level of alcohol consumption that minimizes harm is zero [3].

Both substances are legal in most of the world. Both are among the leading preventable causes of death and disability.

A fictional example

The following is an illustrative example, not a real person’s story.

Jake drinks four pints most evenings after work. When his partner raises it, his first response is: “It’s legal. I’m not doing anything wrong. You can buy it in Tesco.”

• What he thinks: “If this were a real problem, the government wouldn’t let them sell it everywhere.”
• What he feels: Righteous irritation at being questioned about something ordinary.
• What he does not consider: The UK’s Chief Medical Officers recommend no more than 14 units per week [5]. Four pints of typical-strength beer is roughly eight units. Jake is consuming about 56 units per week, four times the guideline.

Jake’s drinking is legal. It is also four times what health authorities recommend. These facts coexist without contradiction, because legality and safety are separate questions.

Why the law is not a health guideline

Several factors explain the gap between legal status and health evidence:

Historical entrenchment. Alcohol and tobacco have been part of human culture for centuries. Banning them is politically impossible in most societies, as American Prohibition demonstrated. The substances were normalized long before their health effects were understood [6].

Economic interests. The alcohol, tobacco and gambling industries are significant contributors to tax revenue and employment. Policy decisions about regulation are made in the context of these economic realities [4].

The limits of prohibition. Even when a substance is harmful, banning it can create worse problems: black markets, criminalization of users, inconsistent enforcement. Regulation, not prohibition, is the pragmatic response for widely used substances.

Industry lobbying. Industries that profit from legal substances actively shape the regulatory environment. A comprehensive review of alcohol policy documented how industry actors influence research funding, marketing regulation and policy debates [4].

A more useful yardstick

If legality is the wrong measure, what should you use?

1. National health guidelines. These are based on health evidence and are revised as evidence changes. They are not perfect, but they are closer to a health-based benchmark than the law.
2. Your own data. Track your actual consumption, its effects on your sleep, mood, finances and relationships, and compare it to guidelines.
3. Your doctor’s assessment. A clinical assessment of your personal risk, taking into account your health history, genetics and consumption patterns, is the most relevant standard.
4. The behavior test. Can you stay within guidelines comfortably? If not, the question of whether the substance is legal is irrelevant to whether your relationship with it is working.

For the related thought that normalizes the behavior by pointing to other people, see “Everyone does it”. For the version that uses absence of consequences as proof of safety, see “It’s not that bad”.

When to get more support. If you are consuming a legal substance at levels well above health guidelines, your GP can help you assess the risk specific to your situation. You do not need to be breaking any law to need, or benefit from, support. In the US, SAMHSA’s National Helpline (1-800-662-4357) offers free, confidential referral. In the UK, your GP is a good starting point. If you are in distress, call or text 988 in the US, or contact Samaritans on 116 123 in the UK and Ireland.