In some cases, when people are struggling alcoholism or compulsive drinking, they may at some point seek out any way possible to experience or prolong their intoxication.1 Though somewhat uncommon, this has led to people trying to consume sources of alcohol quite different from the ethanol found in the drinks such as wine, beer, or spirits.
For some of these individuals, rubbing alcohol may come to mind as a potential intoxicant; it’s relatively inexpensive and easy to get. Though the product formulations may vary, there are a few key differences between this type of alcohol and the kind you can pick up from a liquor store.
The chemical differences create a major risk for the people who attempt to drink rubbing alcohol, intentionally or otherwise.
What is Rubbing Alcohol?
In contrast with the ethanol—or ethyl alcohol—contained in varying amounts in alcoholic beverages, many rubbing alcohol products are contain a high proportion of a substance called isopropyl alcohol (of note: some products used as disinfectants and/or for cleaning may contain some ethyl alcohol). Structurally different from the alcohol we drink, isopropyl alcohol is a synthetic alcohol made from propylene rather than from food sources.2
The chemical structural differences mean that isopropanol-based rubbing alcohol has a different toxicity profile than consumed ethanol and is also metabolized differently by the body, as described in the Clinical Toxicology journal.3
Many store-bought rubbing alcohol products contain roughly 70 percent isopropyl alcohol; if measured similarly to how ethanol-containing drinks are, it would be considered 140-proof. However, isopropanol is a more intoxicating (and immediately toxic) substance than ethanol,1 rendering any given amount of rubbing alcohol more potent and risky than an equivalent amount of a 70-percent ethanol beverage.
Ethanol—the Alcohol People Drink
No matter what the beverage—from beer to wine to hard liquor—the alcohol people are accustomed to drinking contains the same active component: ethanol, which is also known as ethyl alcohol. As described by the National Library of Medicine, ethanol is generally produced through the rapid fermentation of carbohydrates in fruits, vegetables, grains, or other plant sources.4
Ethanol is not just used as an ingredient in alcoholic drinks; it can also be used in solvents, cleansers, and extracts used in food, and as a preservative. When it is used in beverages, it is usually highly dilute; drinking ethanol full strength would more easily result in profound intoxication and increase the risk of alcohol poisoning or even death. According to the National Institute on and Alcohol Abuse and Alcoholism, a “standard” drink contains about 0.6 fluid ounces (or 14 grams) of pure ethanol; however, different beverage types contain varying percentages of pure alcohol, such as:5
- Beer: ~5%
- Standard wines: ~12%
- Fortified wines (e.g., port, sherry): ~17%
- Liqueurs (e.g., cordials, apertifs): ~24%
- Hard liquor (e.g., gin, tequila, vodka, whiskey): ~40%
The Risks of Drinking Rubbing Alcohol
Isopropanol is a powerful central nervous system depressant, with brain stem depression thought to be an important mechanism behind many of its intoxicating effects.1,3 Other toxic effects include:1,2,6
- Headache.
- Dizziness.
- Constricted pupils.
- Stupor, loss of consciousness, coma.
- Gastrointestinal distress—stomach pain, vomiting, diarrhea, etc.
- Gastric irritation, bleeding, vomiting blood.
- Pancreatitis.
- Cardiovascular depression, circulatory system collapse (low blood pressure, hypoperfusion), shock.
- Respiratory depression or failure.
Treatment of Toxic Alcohol Ingestion Involving Rubbing Alcohol
The progressive nature of some of the above physiological effects can lead to death if immediate medical care is not provided. Treatment for isopropyl alcohol toxicity is generally supportive, and will consist of airway management, fluid resuscitation (IV fluids), and management of any GI bleeding.1
Hemodialysis (or, more rarely, peritoneal dialysis as evidenced by case reporting) may be instituted in cases of extremely elevated isopropanol blood levels and significantly life threatening effects. Similarly, blockade of aldehyde dehydrogenase (ADH—the enzyme involved with metabolizing isopropanol to several, additionally toxic metabolites) with fomepizole or an ethanol infusion (to competitively, preferentially “tie-up” the enzymatic activity of ADH) may be utilized in certain clinical situations, though some argue that in slowing the removal of isopropanol, which is directly toxic, these measures should not be used.7,8
Why People Drink Rubbing Alcohol
Given the potential risks, it may be hard to understand why anyone would consider drinking rubbing alcohol. While many toxic isopropanol exposures result from unintentional ingestion, it does occur intentionally for various reasons, which may include:1,6
- Attempts at suicide.
- People who are struggling with alcohol abuse or addiction seeking a source of intoxication out of desperation (i.e., a replacement for ethanol).
- Experimentation by young people who don’t know the difference in alcohol types.
Rubbing alcohol is cheap and easy to get, and the name can confuse people who don’t know that there are different types of alcohol. This may contribute to a number of cases of people trying rubbing alcohol and experiencing isopropyl alcohol poisoning.
People who are dealing with severe depression or suicidal thoughts may attempt to drink large amounts of rubbing alcohol or household chemicals that contain isopropyl alcohol in an attempt to harm themselves.1,6
Help for Rubbing Alcohol Abuse
The risk of injury or death from isopropyl alcohol poisoning is high. If someone has attempted to drink rubbing alcohol as a replacement for ethanol, it is important to get help, both for the acute toxic effects, and for treatment of a potential alcohol use disorder.
A person who has decided to drink rubbing alcohol could be struggling with compulsive, problematic alcohol use. Professional help can be extremely helpful in these situations.
Using various medical detox interventions and evidenced-based behavioral therapies, these experienced facilities can keep you safe throughout withdrawal and provide counseling, learning, and skills that enable people to best avoid relapse to alcohol abuse for long-term recovery.
These programs can also deal with co-occurring disorders like depression, helping the individual to manage those conditions along with substance abuse issues.
References
- Gallagher, N., & Edwards, F. J. (2019). The Diagnosis and Management of Toxic Alcohol Poisoning in the Emergency Department: A Review Article. Advanced journal of emergency medicine, 3(3), e28.
- Toxnet: Toxicology Data Network [toxnet.nlm.nih.gov]. (2012) Isopropanol—Human Health Effects.
- Slaughter, R.J., Mason, R.W., Beasley, D.M., Vale, J.A., Schep, L.J. (2014). Isopropanol Poisoning. Clinical Toxicology, 2014 Jun; 52(5):470-8)
- S. National Library of Medicine, National Center for Biotechnology Information. (2019). Compound Summary—Ethanol.
- Rethinking Drinking—Alcohol and Your Health; National Institutes on Alcohol Abuse and Alcoholism (NIAAA). What’s a “Standard” Drink?
- S. National Library of Medicine, National Center for Biotechnology Information. (2019). Compound Summary—Isopropyl Alcohol.
- LeBlanc, C., & Murphy, N. (2009). Should I stay or should I go?: toxic alcohol case in the emergency department. Canadian family physician Medecin de famille canadien, 55(1), 46–49.
- Kraut, J.A., Mullins, M.E. (2018). Toxic Alcohols. New England Journal of Medicine. 2018; 378:270-280.