A new report from the Society for the Study of Addiction found that alcohol and tobacco are far and away the most harmful substances used around the world. The report culls together data from the World Health Organization, United Nations Office on Drugs and Crime, and Institute for Health Metrics and Evaluation. Even though there are some limitations in the data, the SSA’s report offers a global picture of the mortality and burden of disease associated with alcohol, tobacco, and illicit drug use.

And while cannabis use is up especially in the US and Canada, the real story here is alcohol and tobacco. Researchers measured cannabis dependence at just 259 out of 100,000 people, with more affluent regions having the highest rates.

Alcohol and Tobacco Use Cost Humankind 250,000,000 Life Years In 2015 Alone

Compared to their illicit counterparts (including cannabis and hard drugs like methamphetamine and cocaine), alcohol and tobacco cost the most life years and caused the highest mortality rates, according to a new report from the Society for the Study of Addiction.

Researchers can study the overall harm drug use causes by measuring their impact in “disability-adjusted life years,” or DALYs. This metric takes into account the years people live with cancers, respiratory disease or heart disease. It also tallies deaths from overdoses.

Using DALYs and deaths from substance use, researchers were able to measure the harm alcohol, tobacco and drug use cause in relative and absolute terms. And according to the report’s findings, illicit drugs come nowhere close to the harm alcohol and tobacco cause.

Take a look at the raw numbers, beginning with substance-attributable mortality rates. Tobacco use killed the most people, 110.7 deaths per 100,000 people. Alcohol, by comparison, is only about a third as lethal. Drinking caused 33.0 deaths out of 100,000 people.

From there, the numbers drop off sharply. Combined, illicit drug use accounts for 6.9 deaths per 100,00 people.

But it’s the loss in disability-adjusted life years (DALYs) that’s most striking. Alcohol and Tobacco use cost humankind 250,000,000, or a quarter of a billion years globally. Illicit drug use cost just a fraction of as many years. But they still added tens of millions more lost DALYs to the pile.

Once again, tobacco was king, costing 170.9 million DALYs. Runner-up was alcohol, costing 85.0 million years. Comparably, illicit drugs cost 27.8 million.

Africa and the Middle East Have Lowest Levels Of Harm While Europe Suffers Most From Its Habits

The SSA’s report also paints a picture of the global distribution of the harm caused by alcohol, tobacco, and illicit drugs. But this is admittedly where the researchers’ data sets are the most incomplete.

Still, the report found that Eastern Europe had the both the highest mortality rates and DALYs for alcohol and illicit drugs. Oceania, which includes New Zealand, Australia and a host of Pacific island nations, had the highest mortality rates and DALYs for tobacco.

Europe also suffered worse in low income and middle-income countries. In absolute terms, mortality rates were greatest there. But data is also sparsest from these regions.

In North Africa and Southwest Asia, however, alcohol use is the lowest globally at less than a liter per capita. The lowest smoking rates were in Western sub-Saharan Africa.

“We think of ourselves as bastions of civilization, but on this particular area we’re doing worse than the developing world,” Professor Robert West of University College London, one of the report’s co-authors, told the Independent in reference to the prevalence of substance use in Europe and North America.

More Accessible, More Harmful

While the SSA’s new report may show an upward trend of years and lives lost to alcohol, tobacco, and illicit drugs, it shows that nothing has changed in terms of which substances are the most harmful, or where people use them most.

Compared with illicit drugs, “smoking and alcohol are always well ahead,” said Professor West. “There’s nowhere that it even comes close.”

But considering how many more people use alcohol and tobacco compared with amphetamines, cocaine and opioids, that makes sense. The more people who drink and smoke, the greater the harm.