Aaron Carroll, a pediatrician who blogs at the Incidental Economist, had a piece published a few weeks ago in the New York Times concluding that adolescents and college kids would be better off — given a choice of illicit substances — opting for marijuana over alcohol.  Of course, he would prefer that his kids chose neither.  But he is a pragmatist.  Kids will smoke and drink and have sex and engage in other forms of risky behavior no matter how many dire warnings and admonishments you subject them to.  That’s the nature of adolescence and young adulthood.  But some vices are worse than others.  Obviously, we don’t want our young people frequenting crack houses or getting laced up with unclean heroin.  But perhaps for too long we have adopted a too naive tolerance  (hey, kids will be kids!) of youth alcohol abuse.  Our parents drank in college.  We binged on kegs at fraternity parties.  What harm is there in that?  We turned out OK, right?

Dr. Carroll outlines the many deleterious effects of alcohol abuse:

Every year more than 1,800 college students die from alcohol-related accidents. About 600,000 are injured while under alcohol’s influence, almost 700,000 are assaulted, and almost 100,000 are sexually assaulted. About 400,000 have unprotected sex, and 100,000 are too drunk to know if they consented. The numbers for pot aren’t even in the same league.

Binge drinking accounted for about half of the more than 80,000 alcohol-related deaths in the United States in 2010, according to a 2012 report by the Centers for Disease Control and Prevention. The economic costs associated with excessive alcohol consumption in the United States were estimated to be about $225 billion. Binge drinking, defined as four or more drinks for women and five or more drinks for men on a single occasion, isn’t rare either. More than 17 percent of all people in the United States are binge drinkers, and more than 28 percent of people age 18 to 24.

But adding alcohol to drug use increased the odds of a fatal crash by more than 2,200 percent. A more recent study found that, after controlling for various factors, a detectable amount of THC, the active ingredient in pot, in the blood did not increase the risk of accidents at all. Having a blood alcohol level of at least 0.05 percent, though, increased the odds of being in a crash by 575 percent …

I think about which substance might put young people at risk for being hurt by others. That’s where things become even more stark. In 1995 alone,college students reported more than 460,000 alcohol-related incidents of violence in the United States. A 2011 prospective study found that mental and physical dating abuse were more common on drinking days among college students. On the other hand, a 2014 study looking at marijuana use and intimate partner violence in the first nine years of marriage found that those who used marijuana had lower rates of such violence. Indeed, the men who used marijuana the most were the least likely to commit violence against a partner…..

When someone asks me whether I’d rather my children use pot or alcohol, after sifting through all the studies and all the data, I still say “neither.” Usually, I say it more than once. But if I’m forced to make a choice, the answer is “marijuana.”

He makes a pretty powerful argument.  But I’ll go Dr. Carroll one further.  Given a choice of substances, a physician looking for mind-altering relaxation (non-call night of course)  either with friends or otherwise ought to consider lighting up a finely packed joint or packing a bowl rather than reaching for the bottle of Jack Daniels or beer number four.  The life of a doctor is a life of extreme stress and pressure.   The use of alcohol as your default elixir at the end of a work day can have major deleterious consequences.  Depression afflicts physicians to a much higher extent than the general population.  Male doctors are 70 percent more likely to kill themselves; women an astounding 350 to 400 percent more likely to commit suicide than women outside the medical field.  In many cases, these acts of desperation are committed while under the haze of alcohol induced inebriation  (one-third of suicides are legally intoxicated at the time of death).  The association between marijuana and alcohol is actually inversely related — i.e., suicide rates have been shown to decrease in states where medical marijuana was legal.

Furthermore, alcohol lingers.  No one feels great waking up at 5:30 a.m. for early rounds after having had one too many drinks the night before.  The hungover doctor is far more likely to be impatient, irritable, more apt to overlook details.  Patient care could be compromised.  On the home front, alcohol abuse correlates with domestic violence and higher divorce rates.  Relationships with one’s children can be undermined.  The worn down, sleep deprived physician who grabs a few drinks after office hours puts herself at risk for a DUI.  The long-term health effects of chronic alcohol use are well described (cirrhosis, heart disease, obesity, etc.).  It’s all no good.

Alcohol can be enjoyed in moderation to good effect — a single ice cold martini in the company of friends and/or family is sometimes just what the doctor ordered — but it is a drug that too easily gets away from us, especially when burning the candle at both ends to the extent that a career in medicine demands.  One drink too easily turns into six.

Dr. Carroll would prefer that his kids didn’t use any drugs at all.  Similarly, I recognize that it would be best if physicians didn’t resort to ingesting mind-altering substances as a way to “decompress.”  It would be far better if we all got on our treadmills for 90 minutes every night or listened to an hour of opera arias or tilled our gardens while reciting epic poetry under our breaths.  But we don’t always have it in us.  We are human.  Sometimes we’re just tired as all hell.  Sometimes it’s nice to let go for a while, to release ourselves from the occasionally oppressive weight of sober consciousness.  Given the fatigue and strain and pressure most physicians experience, perhaps it would be better if we veered away from the default pathway of alcohol and the self-destructiveness it tends to release.

Maybe we ought to be making a few more road trips to Colorado dispensaries instead.

Jeffrey Parks is a general surgeon who blogs at his self-titled site, Jeffrey Parks, MD.

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