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: By mouth
Uncommon: Suppository, inhalation, ophthalmic, insufflation, injection[3]
Drug classDepressant; Anxiolytic; Analgesic; Euphoriant; Sedative; Emetic; Diuretic; General anesthetic
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
  • In general: Legal for all uses
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 (from Arabic al-kuḥl 'the kohl'),[11] sometimes referred to by the chemical name ethanol, is the second most consumed psychoactive drug globally behind caffeine,[12] and one of the most widely abused drugs in the world.[13] It is a central nervous system (CNS) depressant, decreasing electrical activity of neurons in the brain.[14] The World Health Organization (WHO) classifies alcohol as a toxic, psychoactive, dependence-producing, and carcinogenic substance.[15]

Alcohol is found in fermented beverages such as beer, wine, and distilled spirit[16] – in particular, rectified spirit,[17] 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 religions, including Catholicism, incorporate the use of alcohol for spiritual purposes.

Short-term effects from moderate consumption include relaxation, decreased social inhibition, and euphoria, while binge drinking may result in cognitive impairment, blackout, and hangover. Excessive alcohol intake causes alcohol poisoning, characterized by unconsciousness or, in severe cases, death. Long-term effects are considered to be a major global public health issue and includes alcoholism, abuse, alcohol withdrawal, fetal alcohol spectrum disorder (FASD), liver disease, hepatitis, cardiovascular disease (e.g., cardiomyopathy), polyneuropathy, alcoholic hallucinosis, long-term impact on the brain (e.g., brain damage, dementia, and Marchiafava–Bignami disease), and cancers.

For roughly two decades, the International Agency for Research on Cancer (IARC) of the WHO has classified alcohol as a Group 1 Carcinogen.[18] Globally, alcohol use was the seventh leading risk factor for both deaths and DALY in 2016.[19] According to WHO's Global status report on alcohol and health 2018, more than 200 health issues are associated with harmful alcohol consumption, ranging from liver diseases, road injuries and violence, to cancers, cardiovascular diseases, suicides, tuberculosis, and HIV/AIDS.[20] Moreover, a 2024 WHO report indicates that these harmful consequences of alcohol use result in approximately 2.6 million deaths annually, accounting for 4.7% of all global deaths.[21]

In 2023, the WHO declared that 'there is no safe amount of alcohol consumption' and that 'the risk to the drinker’s health starts from the first drop of any alcoholic beverage.'[15] This new global health policy aligns with the scientific consensus regarding the risks of alcohol consumption for pregnant women, particularly due to FASDs, as well as for individuals under the legal drinking age. Additionally, this social change also reflects the temperance movement's opposition to alcohol consumption and is supported by national public health agencies, which increasingly recommend abstinence in their alcohol consumption recommendations while noting that any alcohol intake raises risk levels.[22][23][24]

  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. ^ "The Origin Of The Word 'Alcohol'". Science Friday. Retrieved 30 September 2024.
  12. ^ Song F, Walker MP (8 November 2023). "Sleep, alcohol, and caffeine in financial traders". PLOS ONE. 18 (11): e0291675. Bibcode:2023PLoSO..1891675S. doi:10.1371/journal.pone.0291675. PMC 10631622. PMID 37939019.
  13. ^ "Medscape: Medscape Access". medscape.com. 16 October 2021.
  14. ^ 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.
  15. ^ a b "No level of alcohol consumption is safe for our health". World Health Organization. 4 January 2023.
  16. ^ Collins SE, Kirouac M (2013). "Alcohol Consumption". Encyclopedia of Behavioral Medicine. Springer. pp. 61–65. doi:10.1007/978-1-4419-1005-9_626. ISBN 978-1-4419-1004-2.
  17. ^ 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.
  18. ^ "Agents Classified by the IARC Monographs, Volumes 1–111" (PDF). Archived from the original (PDF) on 25 October 2011 – via monographs.iarc.fr.
  19. ^ Griswold MG, Fullman N, Hawley C, Arian N, Zimsen SR, Tymeson HD, et al. (September 2018). "Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016". Lancet. 392 (10152): 1015–1035. doi:10.1016/S0140-6736(18)31310-2. PMC 6148333. PMID 30146330.
  20. ^ Global status report on alcohol and health (PDF). World Health Organization. 2018. ISBN 978-92-4-156563-9.
  21. ^ "Over 3 million annual deaths due to alcohol and drug use, majority among men". wwho.int.
  22. ^ "Canada's Guidance on Alcohol and Health". ccsa.ca. Archived from the original on 11 September 2023. Retrieved 25 September 2023.
  23. ^ "Empfehlungen zum Umgang mit Alkohol" (PDF). Deutsche Hauptstelle für Suchtfragen (in German). Archived (PDF) from the original on 24 October 2023. Retrieved 30 October 2023.
  24. ^ "What Are the U.S. Guidelines for Drinking? - Rethinking Drinking | NIAAA". rethinkingdrinking.niaaa.nih.gov.