Cannabis is often compered to alcohol or cigarettes in various articles, studies and campaigns. Alcohol and cigarettes are more familiar to the average person than cannabis and comparing something that is legal, and generally not good for your health, to something that is illegal and generally good for your health, makes sense. Or does it?

Comparing cannabis and alcohol was one of the ways in the Amendment 64 was successfully passed in 2012, making Colorado the first state to legalize cannabis in USA (1). Some of the arguments that they used were:

Similar campaigns was also used in California, Maine and Arizona in the 2016 elections with mostly positive results (2).

Can we really compare these three? In this article, I will try to give you an insight to what the studies and science has to say about these three substances.


When we talk about addiction and the addictive properties of certain drugs, we must first understand what addiction really means. One of the best explanations that I heard was from Dr. Mate Gabor, a world-renowned expert in addiction. He summarizes addiction in this short video:

In the short clip, Dr. Mate mentioned the CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study. This is one of the largest investigations of childhood abuse and neglect and later-life health and well-being. Specific studies have been done on ACE’s correlation with alcohol (3-7), drugs (8) and smoking (9-12).

Understanding this concept is essential for interpreting various number that are given regarding addiction to these substances. Some studies estimate the probability of transition to cannabis dependence being 8,9%, which is lower than alcohol 22,7% and cigarettes 67,5% (13). It is interesting to note, that cannabis is often successfully used to get off other more addictive substances like nicotine (14), alcohol (15-19), cocaine (20, 21), opioids and other prescription drugs (15-18 ).

Health issues

Smoking and alcohol both pose a risk to one’s health, if they are consumed regularly. Alcohol has a negative impact on many body organs (brain, heart, liver and pancreas) and the immune system. Smoking cigarettes is also very deleterious on your body:

Cigarette smoking harms nearly every organ of the body, causes many diseases, and reduces the health of smokers in general.” CDC

Smoking is a leading cause of cancer and death from cancer. Smoking causes heart disease, stroke, aortic aneurysm (a balloon-like bulge in an artery in the chest), chronic obstructive pulmonary disease (COPD) (chronic bronchitis and emphysema), diabetes, osteoporosis, rheumatoid arthritis, age-related macular degeneration, and cataracts, and worsens asthma symptoms in adults. Smokers are at higher risk of developing pneumonia, tuberculosis, and other airway infections. In addition, smoking causes inflammation and impairs immune function.National cancer institute 

It is interesting to note, that cannabis and cannabinoids have been shown to have a beneficial impact on all of the negative effects and diseases caused by alcohol and smoking.  Below I will focus and compare three health issues and that are common to all of the mentioned substances.


Smoking can cause cancer almost anywhere in the body and increases the risk of dying from other diseases in cancer patients and survivors (22). Organs that are exposed to smoke are more susceptible to becoming cancerous (esophagus, larynx, oropharynx, esophagus trachea, bronchus, and lungs) but also other organs can be targeted (liver, pancreas, stomach, kidney, ureter, blood, bladder, cervix, colon and rectum)(23).

Drinking alcohol can also increase the risk of developing certain cancers, mainly cancers of the mouth, throat, esophagus, liver and breast (24).

Based on extensive reviews of research studies, there is a strong scientific consensus of an association between alcohol drinking and several types of cancer. In its Report on Carcinogens, the National Toxicology Program of the US Department of Health and Human Services lists consumption of alcoholic beverages as a known human carcinogen.” (25)

Studies done on cell cultures (in vitro) and on animals (in vivo) have shown that pyhtocannabinoids (found in cannabis), but also endogenous and synthetic cannabinoids, are capable of effectively decreasing tumor growth and invasion, in many types of cancers (26). Sadly, there is a lack of clinical trials on humans, but there are numerous anecdotal testimonials of people, who have successfully treated their cancer with various cannabis preparations (27).

Cardiovascular Disease

Smokers are at greater risk for cardiovascular diseases. Smoking damages the blood vessels, makes them thicker and narrower (peripheral arterial disease). This rises the blood pressure and can form clots that can block the flow of blood (ischaemic stroke) or burst the blood vessel (haemorrhagic stroke). It also affects the heart and can cause the enlargement of the abdominal aorta (abdominal aortic aneurysm) (30, 32).

Cigarette smoke includes more than 4,000 chemical substances, including polycyclic aromatic hydrocarbons and oxidative gases, most of which exert a cardiotoxic effect.” (31)

Alcohol consumption and abuse has been found to increase the risk of heart attack (myocardial infarction) heart failure (congestive heart failure) and atrial fibrillation (abnormal heart rhythm characterized by rapid and irregular beating) (28). You can often hear that moderate alcohol consumption, especially red wine, can be cardio protective, but the evidence from randomized clinical trials suggests that it is not relevant (29).

The recent infatuation with the potential benefits of light-to-moderate drinking for cardiovascular disease protection appears to be based on observational and subtly confounded data, rather than on randomized clinical trials evidence, and perhaps on more than a little wishful thinking.” (29)

Cannabinoids have specific effects on the cardiovascular system. Generally speaking, cannabinoid type 1 receptor (CB1) activation has undesired effects on the cardiovascular system while cannabinoid type 2 receptor (CB2) activation has a cardio-protective role. There have been studies suggesting that cannabis use can increase the chance of having a heart attack (36-39) however, longitudinal studies have shown no relationship between cannabis use, heart attacks and cardio vascular diseases (40-42).

THC activates (partial agonist) both CB1 and CB2 receptors, which does not make it an ideal cannabinoid for cardio protection. It can increase heart rate (tachycardia), increase or lower the blood pressure and it can sometimes cause a sudden fall of blood pressure when suddenly standing up from a lying or sitting position (orthostatic hypotension). On the other hand, in animal studies, THC has also been shown to protect heart cells from lack of oxygen and prevent the progression of atherosclerosis (34, 35).

Cannabidiol (CBD) has shown very positive results (in vivo and in vitro) in preventing cardiac complications and symptoms in diabetes related heart muscle disorder (diabetic cardiomyopathy), reducing vascular inflammation, reducing infarct related cell death and being neuroprotective in strokes (43-52).

Another promising cannabinoid for cardiovascular diseases is THC’s little brother tetrahydrocannabivarin (THCV). It activates the CB2 receptor and blocks the CB1 receptor, which makes it a good candidate for the prevention of negative symptoms from diabetes and metabolic syndrome (53).

Sexual function

There are many factors that can influence ones sexual life. Many disease, such as rheumatic disease (54), diabetes (55) and PTSD (56), and drugs such as opioids (59-61) have been shown to have a negative impact on sexual functioning.

Both alcohol and cigarettes have been linked to sexual dysfunctions, such as difficulty in erection and decreased sexual desire (58). These effects are more pronounced in heavy smokers and heavy drinkers

Episodic erectile failure in alcoholic men is fairly routine, found to be significantly higher in men consuming more than three standard units of alcohol (12 g ethanol) daily and in subjects smoking more than 10 cigarettes/day.“ (57)

Many studies have shown a that cigarette smokers, especially heavy smoking, have a higher risk of having impotence and decrease sexual desire (62-78)

The endocannabinoid system (ECS) is heavily involved in the human (mammalian) reproductive system, modulating several important aspects of the reproductive cycle . Many complications, which some couples have with getting pregnant, might be linked, to incorrect working of the ECS. Clinical trials on humans, investigating the effects of cannabis, are missing and most of the data is from old studies. Most users report a dose dependent beneficial effect on sexual function, reporting increases in sexual desire, sensuality, pleasure, length of intercourse and number of orgasms (79). Recent studies have shown cannabis use increases activity of brain areas (right nucleus accumbens) responsive to visual erotica stimuli. This could be a novel treatment for people with low sexual desire (80).


Worldwide, tobacco use causes nearly 6 million deaths per year (480,000 deaths per year in the USA alone, including more than 41,000 deaths resulting from secondhand smoke exposure) and 3.3 million people die from alcohol-related causes (88,000 deaths in the USA) (81-83). There has not been a documented case of death due to cannabis (84). Ever. Just by comparing these facts, one comes to the conclusion, that cannabis should not be compared to these other substances. While THC, the most abundant cannabinoid in most chemovars, does have some unwanted side effects, these can be successfully mitigated by other cannabinoids (CBD, THCV) and terpenes (alpha-pinene, D-limonene), changing methods of consumption (vaporizing vs. smoking) and adequate dosing regimens (micro-dosing, building tolerance). It is probably still one of the safest active therapeutic substances known to man (85).


1 Joshua Kappel. Legalized it. The beginning of the end of Cannabis Prohibition in the U.S.A.

2 Campaign to Regulate Marijuana Like Alcohol Issues Statement Regarding the Narrow Defeat of Prop. 205

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