In "Phishing for Phools", George Akerlof and Robert Shiller suggest that:
...the harms of alcohol could be comparable to the harms of cigarettes, affecting not just 3 or 4 percent of the population, as a chronic life-downer, but, rather, affecting 15 to 30 percent; the higher number especially if we also include the alcoholics' most affected family members.
Akerlof and Shiller liken their position to "burping in public". In fact the only thing radical about their position is the way that they defend it.
Yes, it is true - or was true when the WHO last published its Global Health Risks report in 2009 - that tobacco kills more people than does alcohol:
But alcohol makes more people miserable, in the sense of causing disability (again according to the World Health Organization).
Alcohol causes so much more disability than cigarettes in part because more people use it - according a 2012 WHO study, about 25% of the world's adults (those over 15) have used tobacco within the past month, while 42% have consumed alcohol within the past year. Also, tobacco kills relatively quickly. The smoker who suffers a massive heart attack ups the death numbers, but not the disability numbers.
So it's not that hard to show alcohol is more harmful than tobacco. The trick is to focus on total harm, as opposed to harm per user, and on measures of morbidity, rather than mortality.
The belch in Akerlof and Shiller's argument is that they mostly ignore this evidence on disability, focussing instead on a radically different type of harm: "loss of affect" or "loss of capacity for intimacy". Alcohol, they argue, causes "subjective, hard-to-observe changes in personality", and leads to divorce and the break up of relationships. The major piece of evidence backing up this position is the Harvard Grant Study, which tracked Harvard students from the classes of 1939 to 1944, and found that those abused alcohol at some point in their lives (23%) died young. Moreover, "alcohol wrecked their ability to relate to others."
Making any kind of statement about the psychological impacts of alcohol is hard, because so many people use alcohol to self-medicate. As Eric Crampton has argued here, alcohol abuse can be symptom of depression, anxiety, or other personality disorders, rather than a cause. Akerlof and Shiller argue that the alcoholics in the Harvard Grant study were, at the start of the study, "no different from their more sober peers" in terms of their personalities and family backgrounds. Instead, "alcoholism had changed their personalities." This reading of the evidence seems to seriously underrate the ability of present or future alcoholics, and their families, to lie and dissemble, and seriously overrate the assessment abilities of late-1930s social scientists. I can believe that alcohol use impacts people's personalities. But I find it hard to believe that, absent alcohol use, alcohol abusers would be just like anyone else.
Akerlof and Shiller's lack of hard evidence is frustrating in part because the point that they are making is so important. As a utilitarian, I believe that what ultimately matters is whether or not people are happy. And intimacy is one if the big predictors of happiness. According to the World Happiness Report, "Marriage is one of the unambiguous, universally positive and statistically significant correlates of life satisfaction." (Of course the report then goes onto argue that one of the benefits of marriage is a lower risk of substance abuse - somewhat contradicting Akerlof and Shiller's arguments - but I figure that, overall, the evidence that having someone to hug causes people to be happier is pretty good).
Drug and alcohol regulation decisions tend to be made on the basis of whether or not a substance can be proved to cause physical harm. Yet emotional and psychological harm is just as real and just as debilitating. If alcohol really does destroy capacity for intimacy, it is wrecking untold numbers of lives - and that should be a serious matter of policy concern, and a priority for health research.
So I'm torn. Are Akerlof and Shiller doing good by drawing attention to the potential psychological harms caused by alcohol use? Or are they doing harm by backing a largely unsubstantiated position with their formidable professional reputations?
I don't know. Mostly, like others, I'm profoundly disappointed that two Nobel laureates didn't do better (see, e.g. Alex Tabarrock, the Economist). There's a crucial methodological point to be made here: happiness matters, and so harms should be assessed in terms of their impact on happiness. This point does not come through in Phishing for Phools, and that makes me sad.
p.s., in response to Nick's question in the comments, here's a graph using data from gapminder.org.