Alcohol vs. THC: What’s the Healthier Option? Here’s Where the Research Stands

As cannabis legalization, decriminalization, and reclassification efforts have made infused products more accessible across the U.S., many people who occasionally indulge in THC and/or alcohol are still trying to figure out which is the healthier option overall.

Part of the reason this is still an open question is cannabis’ status as a Schedule 1 drug, which means that not only is it illegal on the federal level, it is considered to have a “high potential for abuse.” 

“It’s difficult to study cannabis for a few reasons,” says Ryan S. Sultan, MD, director of Integrative Psych and assistant professor of clinical psychiatry at Columbia University Irving Medical Center/New York State Psychiatric Institute. “Because it was classified as a Schedule 1 drug in the 1970s, it has no currently accepted medical use in treatment in the U.S., despite being approved for medical use in the majority of states.”

As a cannabis researcher, Sultan and his team has had to obtain multiple federal approvals to do their work, including ones from the Drug Enforcement Administration (DEA), Food and Drug Administration (FDA), and the National Institute on Drug Abuse to legally conduct cannabis-related research. Ironically, Sultan says that without research, the DEA and FDA will “not consider cannabis to have medicinal value at the federal level.”

Under “Catch-22” in the Oxford Dictionary, “cannabis research in the U.S.” doesn’t appear as an example, but perhaps it should. 

While finding hard and fast answers to any question in which there is a great deal more research on one subject or substance over another is inherently challenging, clues are emerging. It is becoming easier than ever for clued-in consumers who are aware of their own psychological and physical strengths and weaknesses to ascertain whether a cannabis cocktail or a glass of wine might be exactly what the doctor tacitly approves of. 

Cannabis cons 

Cannabis, unlike alcohol, can be ingested in a number of ways. The primary methods include smoking, drinking, or eating it. 

Smoking it, especially via vapes, is inherently dangerous, warns Sultan. 

“The FDA does not regulate cannabis vapes like it regulates pharmaceuticals, tobacco products, or food additives,” says Sultan. “One of the major health risks of vaporized cannabis comes from the risk of inhalation of harmful additives and other chemicals.”

There is no standardization as to what can be added to vape products, so lung damage is a risk factor. 

If your vehicle of choice is a cannabis drink, gummy or edible, the picture is more nuanced. 

“Research on cannabis, and particularly long-term health effects, is limited,” says Ryan Marino, MD, a Cleveland-based medical toxicologist, addiction medicine specialist, and associate professor in the departments of emergency medicine and psychiatry at Case Western Reserve University. “But cannabis use may be associated with things like high blood pressure and heart and vascular disease. However, there is not enough evidence to say one way or another.”

Cannabis use is more strongly associated with psychiatric illness, Marino says, especially in adolescence. Indeed, a study published in Nature Mental Health in May 2025 noted that the rising prevalence of cannabis use and cannabis use disorder increases the risk for psychiatric disorders. 

The Center for Disease Control (CDC) warns that people “who use cannabis are more likely to develop psychosis (not knowing what is real, hallucinations, and paranoia) and long-lasting mental disorders, including schizophrenia.”

The association between cannabis and schizophrenia, the CDC notes, is stronger in people who start using it younger, and use it frequently. 

Alcohol cons 

But alcohol use carries serious risk, too. It is classified as a Group 1 carcinogen by the International Agency for Research on Cancer. 

And the World Health Organization warned in 2023 that “no level of alcohol consumption is safe” for human health, dubbing it a “toxic, psychoactive, and dependence-producing substance.”

Sultan points out that alcohol is “highly addictive, with substance-use disorders that are highly comorbid with psychiatric disorders.”

Comorbidity is a medical term referring to the presence of one or more diseases or disorders, both of which often include overlapping risk factors, with one sometimes causing the other. 

Alcohol is also “pro-inflammatory and it increases the risk of cancer,” says Dr. David Rabin, a board-certified psychiatrist and neuroscientist who studies plant medicines that are not currently regulated on the federal level to better understand their role in mental health. 

Cannabis pros 

One thing is clear, Rabin notes: THC won’t kill you. 

“If you drink a certain amount of alcohol in one day, it will kill you,” says Rabin. “But there is no known quantity of cannabis that will kill a person in one day. The level you would have to ingest would be almost unimaginable and impossible to do. So purely from a safety perspective, cannabis wins by leaps and bounds.”

Low doses of THC in cannabis products can also be a boon for folks with “symptoms of post traumatic stress disorder, and those seeking pain management,” says Sultan. 

Rabin concurs, adding that cannabis could be a long-term partner in the battle against opioids, pointing to a survey published in the Harm Reduction Journal of 2,897 medical cannabis patients that found that of the 34% who used opioid-based pain medication in the prior six months, 97% decreased their opioid consumption with medical cannabis, and 81% said cannabis alone was more effective than cannabis plus opioids. 

“From a biological perspective, the benefits of cannabis are similar to that of alcohol, in terms of helping people relax, and serving as a social lubricant,” says Rabin. “Plus, it can also increase neuroplasticity, without the negatives of alcohol.”

Alcohol pros 

But alcohol, when used responsibly, can also be a healthy addition to your diet of fun and relaxation.

“The benefits with alcohol, seen mainly in light drinkers, are reducing cortisol and producing a calming effect,” says Sultan. 

Marino agrees, noting that despite the health-harming rap alcohol has earned in recent years, people can “safely have one glass of wine or beer,” and that a glass of red wine can in fact have health benefits.

The jury is still out, and both substances, like almost anything, carry respective risk. But Rabin hopes that action is taken on the federal level to make studying cannabis easier and the production of it safer, at the very least. 

“Legalizing cannabis on a state by state level means that there is no federal oversight in the way it is grown, processed, and manufactured,” says Rabin. “With federal guidelines in place, there’d be more consistency, and it would be safer for everyone. Plus, we’d all have the opportunity to study cannabis, and understand its potential role in alleviating opioid addiction, safely managing pain for millions of Americans and helping people with a range of other medical concerns.”