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Alcohol (drug)

This article is about ethanol as a psychoactive or recreational substance. For pharmacodynamics and pharmacokinetics of ethanol, see Pharmacology of ethanol. For the class of chemical compounds, see Alcohol (chemistry). For types and characteristics of alcoholic beverages from a cultural perspective, see Alcoholic beverage. For the substance in general, see Ethanol.

Ethanol
Skeletal formula of ethanol
Ball-and-stick model of ethanol Space-filling model of ethanol
Clinical data
Pronunciation/ˈɛθənɒl/
Other namesAbsolute alcohol; Alcohol (USPTooltip United States Pharmacopeia); Cologne spirit; Drinking alcohol; Ethanol (JANTooltip Japanese Accepted Name); Ethylic alcohol; EtOH; Ethyl alcohol; Ethyl hydrate; Ethyl hydroxide; Ethylol; Grain alcohol; Hydroxyethane; Methylcarbinol
Pregnancy
category
  • X (Contraindicated in pregnancy)
Dependence
liability		Physical: Very High Psychological: Moderate[1]
Addiction
liability		Moderate (10–15%)[2]
Routes of
administration		Common: Oral
Uncommon: suppository, inhalation, ocular, insufflation, injection[3]
Drug classAnalgesic; Anaphrodisiac; Anxiolytic; Depressant; Euphoriant; General anesthetic; Sedative
ATC code
Legal status
Legal status
  • AU: Unscheduled
  • BR: Unscheduled
  • CA: Unscheduled
  • DE: Unscheduled
  • NZ: Unscheduled
  • UK: General sales list (GSL, OTC)
  • US: Unscheduled
  • UN: Unscheduled
  • EU: Unscheduled
  • In general: Legal for recreational use, except in Muslim countries of Middle East and parts of North Africa, and South Asia
Pharmacokinetic data
Bioavailability80%+[4][5]
Protein bindingWeakly or not at all[4][5]
MetabolismLiver (90%):[6][8]
• Alcohol dehydrogenase
• MEOS (CYP2E1)
MetabolitesAcetaldehyde; Acetic acid; Acetyl-CoA; Carbon dioxide; Ethyl glucuronide; Ethyl sulfate; Water
Onset of actionPeak concentrations:[6][4]
• Range: 30–90 minutes
• Mean: 45–60 minutes
• Fasting: 30 minutes
Elimination half-lifeConstant-rate elimination at typical concentrations:[7][8][6]
• Range: 10–34 mg/dL/hour
• Mean (men): 15 mg/dL/hour
• Mean (women): 18 mg/dL/hr
At very high concentrations (t1/2): 4.0–4.5 hours[5][4]
Duration of action6–16 hours (amount of time that levels are detectable)[9]
Excretion• Major: metabolism (into carbon dioxide and water)[4]
• Minor: urine, breath, sweat (5–10%)[6][4]
Identifiers
  • ethanol
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
PDB ligand
Chemical and physical data
FormulaC2H6O
Molar mass46.069 g·mol−1
3D model (JSmol)
Density0.7893 g/cm3 (at 20 °C)[10]
Melting point−114.14 ± 0.03 °C (−173.45 ± 0.05 °F) [10]
Boiling point78.24 ± 0.09 °C (172.83 ± 0.16 °F) [10]
Solubility in waterMiscible mg/mL (20 °C)
  • CCO
  • InChI=1S/C2H6O/c1-2-3/h3H,2H2,1H3
  • Key:LFQSCWFLJHTTHZ-UHFFFAOYSA-N

Alcohol, sometimes referred to by the chemical name ethanol, is one of the most widely consumed psychoactive drugs in the world and falls under the depressant category.[11][12] The term "Alcohol and Other Drugs" (AOD) emphasizes this inclusion by grouping alcohol with other substances that alter mood and behavior. It is classified by the World Health Organization (WHO) as a toxic, psychoactive, dependence-producing, and carcinogenic substance.[13]

While the terms "drug" and "medicine" are sometimes used interchangeably, "drug" can have a negative connotation, often associated with illegal substances like cocaine or heroin,[14] which is why the alcohol industry may argue that "alcohol is not a drug" (Room et al. 2007).[15]

The normalization of alcohol consumption,[16] along with past misconceptions about its health benefits, also promoted by the industry,[17] further reinforces the mistaken idea that it is not a "drug". Even within the realm of scientific inquiry, the common phrase "drugs and alcohol" persists. However, this phrasing implies that alcohol is somehow separate from other drugs.

Paradoxically, despite being legal, alcohol, scientifically classified as a drug, has demonstrably been linked to greater social harm than most illegal drugs.[18][19] This contradicts the perception some hold of alcohol being a harmless substance.

Alcohol is found in fermented beverages such as beer, wine, and distilled spirit[20] – in particular, rectified spirit,[21] and serves various purposes; it is used as a recreational drug, for example by college students, for self-medication, and in warfare. It is also frequently involved in alcohol-related crimes such as drunk driving, public intoxication, and underage drinking. Some esoteric religions and schools incorporate the use of alcohol for spiritual purposes.

For roughly two decades, the International Agency for Research on Cancer (IARC), a World Health Organization (WHO) agency, has classified alcohol as a Group 1 Carcinogen.[22] In 2023, the WHO declared that there is "no safe amount" of alcohol consumption without health risks.[13] This reflects a global shift in public health messaging, aligning with the long-standing views of the temperance movement, which advocates against the consumption of alcoholic beverages. This shift aligns with the global scientific consensus against alcohol for pregnant women due to the known risks of miscarriage, fetal alcohol spectrum disorders (FASDs) and sudden infant death syndrome (SIDS), as well as for individuals under the legal drinking age.

WHO also highlighted a statistic: nearly half of all alcohol-attributable cancers in the WHO European Region are linked to alcohol consumption, even from "light" or "moderate" drinking – "less than 1.5 litres of wine or less than 3.5 litres of beer or less than 450 millilitres of spirits per week".[13] This new information suggests that these consumption levels should now be considered high-risk. Many countries exceed these levels by a significant margin. Echoing the WHO's view, a growing number of national public health agencies are prioritizing complete abstinence (teetotalism) and stricter drinking guidelines in their alcohol consumption recommendations.

Alcohol has a variety of short-term and long-term adverse effects on health.

Short-term effects from moderate consumption include relaxation, decreased social inhibition, and happiness while binge drinking may result in generalized impairment of neurocognitive function, blackout, and hangover. Excessive alcohol intake causes alcohol intoxication characterized by unconsciousness or, in severe cases, death; in 2016, excessive alcohol use was responsible for 3.0 million deaths worldwide.[23]

Long-term effects are considered to be a major global public health issue and includes alcoholism, abuse, withdrawal, fetal alcohol spectrum disorder (FASD), liver disease, hepatitis, cardiovascular disease (such as cardiomyopathy), polyneuropathy, hallucinosis, long-term impact on the brain (such as brain damage and dementia), and cancers such as breast cancer and head and neck cancer (especially laryngeal cancer).

Despite being a widespread issue, social stigma around problematic alcohol use or alcoholism discourages over 80% from seeking help.[24]

Alcohol works in the brain primarily by increasing the effects of γ-Aminobutyric acid (GABA),[25] the major inhibitory neurotransmitter in the brain; by facilitating GABA's actions, alcohol suppresses the activity of the CNS.[25]

  1. ^ WHO Expert Committee on Problems Related to Alcohol Consumption : second report. Geneva, Switzerland: World Health Organization. 2007. p. 23. ISBN 978-92-4-120944-1. Retrieved 3 March 2015. ...alcohol dependence (is) a substantial risk of regular heavy drinking...
  2. ^ Vengeliene V, Bilbao A, Molander A, Spanagel R (May 2008). "Neuropharmacology of alcohol addiction". British Journal of Pharmacology. 154 (2): 299–315. doi:10.1038/bjp.2008.30. PMC 2442440. PMID 18311194. (Compulsive alcohol use) occurs only in a limited proportion of about 10–15% of alcohol users....
  3. ^ Gilman JM, Ramchandani VA, Crouss T, Hommer DW (January 2012). "Subjective and neural responses to intravenous alcohol in young adults with light and heavy drinking patterns". Neuropsychopharmacology. 37 (2): 467–77. doi:10.1038/npp.2011.206. PMC 3242308. PMID 21956438.
  4. ^ a b c d e f Principles of Addiction: Comprehensive Addictive Behaviors and Disorders. Academic Press. 17 May 2013. pp. 162–. ISBN 978-0-12-398361-9.
  5. ^ a b c Holford NH (November 1987). "Clinical pharmacokinetics of ethanol". Clinical Pharmacokinetics. 13 (5): 273–92. doi:10.2165/00003088-198713050-00001. PMID 3319346. S2CID 19723995.
  6. ^ a b c d Pohorecky LA, Brick J (1988). "Pharmacology of ethanol". Pharmacology & Therapeutics. 36 (2–3): 335–427. doi:10.1016/0163-7258(88)90109-x. PMID 3279433.
  7. ^ Becker CE (September 1970). "The clinical pharmacology of alcohol". California Medicine. 113 (3): 37–45. PMC 1501558. PMID 5457514.
  8. ^ a b Levine B (2003). Principles of Forensic Toxicology. Amer. Assoc. for Clinical Chemistry. pp. 161–. ISBN 978-1-890883-87-4.
  9. ^ Iber FL (26 November 1990). Alcohol and Drug Abuse as Encountered in Office Practice. CRC Press. pp. 74–. ISBN 978-0-8493-0166-7.
  10. ^ a b c Haynes WM, ed. (2011). CRC Handbook of Chemistry and Physics (92nd ed.). Boca Raton, FL: CRC Press. p. 3.246. ISBN 1-4398-5511-0.
  11. ^ Crocq MA (June 2003). "Alcohol, nicotine, caffeine, and mental disorders". Dialogues in Clinical Neuroscience. 5 (2): 175–185. doi:10.31887/DCNS.2003.5.2/macrocq. PMC 3181622. PMID 22033899.
  12. ^ Costardi JV, Nampo RA, Silva GL, Ribeiro MA, Stella HJ, Stella MB, et al. (August 2015). "A review on alcohol: from the central action mechanism to chemical dependency". Revista da Associacao Medica Brasileira. 61 (4): 381–387. doi:10.1590/1806-9282.61.04.381. PMID 26466222.
  13. ^ a b c "No level of alcohol consumption is safe for our health". World Health Organization. 4 January 2023.
  14. ^ Zanders ED (2011). "Introduction to Drugs and Drug Targets". The Science and Business of Drug Discovery: 11–27. doi:10.1007/978-1-4419-9902-3_2. ISBN 978-1-4419-9901-6. PMC 7120710.
  15. ^ Farrell M (2007). "The alcohol industry: Taking on the public health critics". BMJ : British Medical Journal. 335 (7621): 671. doi:10.1136/bmj.39337.431667.4E. PMC 1995479.
  16. ^ Sznitman SR, Kolobov T, Bogt TT, Kuntsche E, Walsh SD, Boniel-Nissim M, et al. (November 2013). "Exploring substance use normalization among adolescents: a multilevel study in 35 countries". Social Science & Medicine. 97: 143–151. doi:10.1016/j.socscimed.2013.08.038. PMID 24161099.
  17. ^ Sellman D, Connor J, Robinson G, Jackson R (September 2009). "Alcohol cardio-protection has been talked up". The New Zealand Medical Journal. 122 (1303): 97–101. PMID 19851424.
  18. ^ Cite error: The named reference Nutt_2010 was invoked but never defined (see the help page).
  19. ^ Cite error: The named reference pmid17382831 was invoked but never defined (see the help page).
  20. ^ Collins SE, Kirouac M (2013). "Alcohol Consumption". Encyclopedia of Behavioral Medicine. pp. 61–65. doi:10.1007/978-1-4419-1005-9_626. ISBN 978-1-4419-1004-2.
  21. ^ Różański M, Pielech-Przybylska K, Balcerek M (September 2020). "Influence of Alcohol Content and Storage Conditions on the Physicochemical Stability of Spirit Drinks". Foods. 9 (9): 1264. doi:10.3390/foods9091264. PMC 7555269. PMID 32916918.
  22. ^ "Agents Classified by the IARC Monographs, Volumes 1–111" (PDF). Archived from the original (PDF) on 25 October 2011 – via monographs.iarc.fr.
  23. ^ Park SH, Kim DJ (October 2020). "Global and regional impacts of alcohol use on public health: Emphasis on alcohol policies". Clinical and Molecular Hepatology. 26 (4): 652–661. doi:10.3350/cmh.2020.0160. PMC 7641561. PMID 33053937.
  24. ^ Mekonen T, Chan GC, Connor J, Hall W, Hides L, Leung J (October 2021). "Treatment rates for alcohol use disorders: a systematic review and meta-analysis". Addiction. 116 (10): 2617–2634. doi:10.1111/add.15357. PMID 33245581. S2CID 227180779.
  25. ^ a b Lobo IA, Harris RA (July 2008). "GABA(A) receptors and alcohol". Pharmacology Biochemistry and Behavior. 90 (1): 90–94. doi:10.1016/j.pbb.2008.03.006. PMC 2574824. PMID 18423561.

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