Ethyl alcohol kills large numbers of Americans every day (about 200), almost all legally.

Tobacco kills large numbers of Americans every day (about 1,200), almost all legally.

Americans also use many illegal psychoactive drugs and some of these also kill, but the numbers are much smaller. We don’t know what the effect on American mortality figures would be if these illegal psychoactive drugs were legalized or decriminalized, but it is a topic worth discussing.

Over the last 40 years, we have had major success at cutting down on tobacco use but the percentage of Americans who smoke now seems stuck around 20.

Our success with prevention of alcohol deaths has been mostly confined to limiting drunk driving.

Both the nicotine in tobacco and the alcohol itself are addicting agents. The key to improving our public health success with both alcohol and tobacco lies in preventing the initiation of its use by really young people.

There are good data that demonstrate that for every year of age from young teens up into the 20s that we delay the first use of either drug, we can substantially decrease the likelihood of addiction.

For tobacco, lifelong addiction is a risk for almost anyone beginning at successful inhalation. Very much like with shooting heroin, I say “don’t even try it once.”

With alcohol, for every 10 who drink, one becomes an alcoholic or problem drinker. And for every 10 who become addicted to alcohol, one becomes an alcoholic the first time they ever get drunk.

But we don’t yet know who that one in 100 may be.

I like it that the Department of Health and Human Services and FDA have decided to use scare tactics to prevent tobacco use. The same should be done for alcohol.

Scare tactics DO WORK when they are obviously, provably true, like telling a child to not sit on the railroad tracks when a train is coming.

Scare tactics DON’T WORK when they are patently false (think “Reefer Madness”).

Let’s do it. Let’s use actual images to scare the kids and the teenagers as much as possible to try to prevent them from beginning to use addicting agents at a young age.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more primary care news.