Alcohol – Overview

Introduction/Background

Alcohol is a naturally occurring liquid substance (ethanol) obtained through the fermentation of vegetable matter rich in sugar or through distillation. Alcohol is included in the make-up of alcoholic beverages, which are consumed for their euphoric and disinhibiting effects. Alcohol is not digested: it passes directly from the digestive tract into the blood vessels. After a few minutes, the blood transports it to all parts of the body.

Its consumption may lead to a strong psychological and physical dependence with symptoms of craving when withdrawn, which can result in hallucinations (delirium tremens). There are multiple toxic effects, such as liver cirrhosis, liver cancer, cardiovascular diseases, cancer of the upper aero-digestive tract, etc.

Production/Sale

Wine represents 52% of the total amount of pure alcohol sold (compared with 25% for beer and 21% for spirits). As reported by the population aged 15 years or older, the quantities of pure alcohol sold in 2022 represent an average equivalent to 2.4 standard glasses of alcoholic beverages per person daily (a standard glass contains 10 g of pure alcohol).

By comparison with the early 1960s, the consumption of alcoholic beverages (the equivalent in pure alcohol) has reduced by more than half in France, this decrease being mainly due to a decline in the consumption of wine.

Prices related to all alcoholic beverages remained more or less stable between 2000 and 2010 but increased by 7.5% between 2011 and 2019. They then decreased by 2.6% between 2019 and 2022.

• Alcohol consumption and its consequences in France in 2022. OFDT briefing paper, 2023, 9 p.

Use in the adolescent population

Among college and high school students

Alcohol is the main psychoactive substance experimented with during adolescence. In 2022, four middle school students out of ten had already drunk more than one alcoholic beverage more than once during their lifetime (43.4%). This rate of experimentation with alcohol has decreased by 17 points compared with 2018 (60.0%). Recent and occasional uses have remained stable, respectively at 21.9% and 2.1%. Drunkenness, which affected one middle school student out of ten, also remained stable.

Alcohol is also the most widely used substance in high school, which is a time at which practices are established and set. A significant decrease in consumption levels has nevertheless been noted between 2018 and 2022. Lifetime use and alcohol use in the last month decreased from 85.0% to 68.3% and from 62.1 % to 49.3% respectively. Occasional consumption of alcohol has fallen to a third moving from 16.7 % to 5.3%. Furthermore, 34.5% of high school students admitted to heavy episodic drinking (HED), which consists of drinking at least 5 glasses of alcohol on a single occasion in the month prior to the survey. The circumstances around the consumption of alcohol depends on the social background and gender during adolescence.

• Psychoactive substance use among middle school and high school students: results of the EnCLASS 2022 survey. OFDT briefing paper, 2024, 17 p. 

At 17 years old

In 2022, the Survey on health and use on call-up and preparation for defence day (ESCAPAD) carried out on young people aged 17 years, shows that alcohol remains the substance most frequently experimented with, even though its decline has been ongoing for a decade (80.6% vs. 85.7% in 2017, 89.3% in 2014 and 92.6% in 2008). At age 17, alcoholic beverages are still very often consumed communally: almost six young people out of ten drank in the last month (58.6% vs. 66.5% and 72.0% in 2014). Regular use (10 times per month) decreased by more than one percentage point (7.2% down from 8.4 % in 2017).

As regards to heavy episodic drinking (HED), 36.6% of young people admitted to this behaviour during the previous month in 2022. This was 44.0% in 2014. Repeated HED (at least three episodes during a month) also decreased (13.6%, compared with 16.4% in 2017), while so-called “regular” HED (at least ten times) as compared to 2017, only affected a very small proportion of adolescents (2.1%).

• Drug use in French 17-year-olds: analysis of the 2022 ESCAPAD survey. Tendances n°155, 2023, 8 p.

Use in the adult population

According to the Barometer survey of Santé publique France, the part of the population aged from 18 to 75 years indicating having drunk alcohol during the year decreased slightly (decreasing from 86.5% in 2017 to 85% in 2021). Out of the overall population of this age group, 8.0% of people surveyed declared having drunk alcohol daily, and this type of consumption was encountered almost exclusively in people over the age of 50.

Regardless of age, women overall constituted a smaller number of consumers and this difference is all the more pronounced the higher the frequency of consumption (12.6% of men consumed alcohol daily compared with 3.8% of women).

By contrast, the proportion of women declaring having indulged in HED one or more times in the year and the proportion of those declaring at least one episode of HED per month have significantly increased: moving from 21.4% to 23.0% and from 7.6% to 8.6% between 2017 and 2021 respectively.

Impacts

The consumption of alcoholic beverages causes health and social harms. The health harms can be defined as illnesses and injuries resulting from the consumption of alcohol. Alcoholism can also have negative repercussions on the social life (relationships with loved ones, work, crime) of consumers and people who have contact with them, which also lowers their quality of life and creates harms for the community.

Health harms

Health adverse effects associated with alcohol consumption depends on the quantities consumed, methods of use, and a number of environmental and individual factors. These risks can arise when consumption is long-term, which is to say generally daily, but also when occasional.

Risks associated with long-term consumption

Long-term consumption of alcohol increases the risk of suffering from a large number of illnesses. This risk usually increases with the amount of alcohol consumed (even if the level for minimal risk of harm is zero standard glasses per week).

In addition to its role in the appearance and development of liver diseases and certain cancers, alcohol is also a neurotoxin when consumed occasionally or chronically. The manifestation of lesions and diseases (peripheral neuropathies, encephalopathies, cognitive difficulties) resulting from this latter mode of consumption may be the consequence of alcoholism or withdrawal and their repetition (withdrawal epilepsy). The dependence which can develop in some alcohol users is another manifestation of the toxicity of alcohol on the central nervous system. Furthermore, alcohol and depression are often closely linked.

Finally, alcohol consumption by a pregnant woman, can result in different disorders, varying according to the method of consumption of the mother, her sensitivity to alcohol as well as that of the foetus, varying from slight impairment in the behaviour of the child to be born to severe developmental anomalies (foetal alcohol syndrome). Disorders mainly affects the central nervous system.

Risks associated with occasional consumption

Consumption of a very large quantity of alcohol can result in an alcoholic coma which, in certain instances, can entail a vital prognosis. On average, an adult suffers from an alcoholic coma at doses of more than 3 grams of pure alcohol per litre of blood (the fatal dose varies according to the individual and their degree of addiction to alcohol).

However, most frequently, during an episode of acute intoxication, harm is caused by a loss of control of the intoxicated person which may result in accidents and immediate exposure to danger capable of resulting in injuries including the death of the consumer or a third party.

Mortality and morbidity attributable to alcohol

The latest figures for mortality attributable to alcohol in France are those of 2015: 41 000 deaths per year, of which 30 000 are among men and 11 000 are women, being respectively 11% and 4% of mortality in adults aged fifteen years and above.

The largest proportion of cancers caused by alcohol relate to the oesophagus and the liver. Cancers of the breast, the oral cavity, the oropharynx, the hypopharynx and colorectal cancer contribute the most to new cancer cases attributable to alcohol.

Seeking care

People in difficulty with alcohol may consult different structures (hospitals, general practionners, medico-social structures specialising in addiction, self-help associations). To follow recent developments, data is available only for hospitals and specialised drug treatment centres (CSAPA).

As regards hospitalisations, the number of stays corresponding to the different categories of diagnoses mentioning alcohol in their title were 228 000 in 2022, of which 51% for dependence and withdrawal, 31% for acute intoxication, 15% for the long-term effects of alcoholism.

The CSAPA welcome those people with excessive alcohol consumption, most often dependent on alcohol (2/3 patients) or with harmful use, or at risk. There were 389 CSAPAs in 2022 with outpatient admissions of about 211 000 users, of which 37% for a problem with alcohol (almost half of them were seen for the first time in 2022).

Harm to third parties

In 2022, 759 people were killed in an accident involving alcohol, which represents 23% of people killed in accidents with a known link to alcohol. Extrapolating from all accidents (including those where blood alcohol level is unknown), the National Interministerial Road Safety Observatory (ONISR) estimated that 996 people were killed in 2022 in an accident with a drunk driver, compared with 1 052 in 2019.

There were 87 900 convictions for driving under the influence of alcohol in 2019, excluding fixed penalty notices, a procedure which enable the prosecutor to propose an intermediary measure between prosecution and closing of the case without further action.

• Alcohol consumption and its consequences in France in 2022. OFDT briefing paper, 2023, 9 p.
• The social cost of drugs: an estimation in France in 2019. OFDT briefing paper, 2023, 15 p.

Perceptions/Opinions

According to the Survey on Representations, Opinions and Perceptions regarding Psychoactive Drugs (EROPP), alcohol is rarely perceived as a “drug”. Unlike illicit products, only a minority of those surveyed (10%) perceived it as dangerous from initial consumption. It is mainly daily use that was cited as dangerous by 79% of respondents. For 56% of those surveyed, offering or drinking alcohol forms part of the rules of good manners.

More than a third (36%) have never noticed the presence of a logo advertising the dangers of alcohol for pregnant women on bottles of alcohol. Almost a quarter (23%) of respondents remembered having seen or heard an advertisement for an alcoholic beverage during the last week. Finally, almost the majority of the population (45%) consider that it is acceptable to drink your first glass of alcohol before the age of 18 years.

• Drugs: perceptions of substances, public policies and users. Tendances n°131, 2019, 8 p.

Legal framework and recent public guidelines

For tax and public order reasons, the sale and distribution of alcohol have been regulated for several centuries. The public health preoccupations of the legislature have resulted in the introduction of a relatively recent legal framework (legislative orders of 1960 on combating alcoholism, the Évin Act of 10 January 1991, the Hospital, Patients, Health and Territories Act (HPST) adopted on 21 July 2009) which is frequently subject to challenges.

The public debate contrasts alcohol and addiction professional discourses against the demands of winegrowers, producers and distributors, business operators. Public opinion is also divided.

In comparison with other European countries

The enlarged EU is the area with the highest alcohol consumption in the world (11.3 litres of pure alcohol per year and per inhabitant aged 15 and over).

Despite convergences, which are the result of sustained efforts towards an integrated European policy, there are still significant differences in the ways in which alcohol is regulated, and the policies followed in the different EU countries. Besides the historical and cultural determinants that explain some of the differences between policies, it is also necessary to underline the significance of economic interests.

Policies to reduce harmful alcohol consumption in the different EU countries are still far from being standardised. Reports published by the World Health Organization can be an incentive for policy convergence. However, this requires the information provided in these reports to be sufficiently disseminated and publicised.

• National legislation and policies to reduce alcohol-related harm in the European Union. OFDT briefing paper, 2020, 16 p.

To go further

Stanislas Spilka, head of the OFDT's DATA unit comments on alcohol, tobacco and cannabis uses among young and adults in France in the last 25 years. The three products' dynamics are quite divergent: tobacco smoking has declined but new patterns of alcohol consumption appeared and cannabis use increased gradually.