Is Objective Risk All That Matters When It Comes to Drugs?

Mokdad et al. (2004) estimate that each year in the United States, 435,000 people die from tobacco use, 85,000 from alcohol, and 17,000 from all illicit substances combined. Yet American public appears far more concerned about illegal drugs than it is about tobacco and alcohol use, driving expansions in control efforts far beyond that which is part and parcel of prohibition. The central thesis of this paper is that some of this mismatch in concern may stem from differences in the types of deaths created, with deaths associated with illicit drugs being, on average, “scarier” to the public than are the deaths associated with legal substances in a way that can be grounded in the risk perception and communication literatures. We summarize literature documenting that people care about more than actual death risk. Factors such as voluntariness, control, and familiarity also play a crucial role in determining the perceived risk of an event, and some of those factors seem to be more salient for the illicit drugs than for tobacco and alcohol. Social amplification of risk may also play a role in explaining these perceptions, but may not by itself be the full explanation. We conclude that the mismatch between actual risks and public concern is not necessarily entirely wrong or irrational, but rather may, to some extent, embody stable preferences that should be reflected in policy.