Aims and objectives Social media platforms such as YouTube allow adolescents and young adults to document substance use and share related beliefs with large audiences. This study primarily aimed to identify and describe hazardous alcohol consumption methods depicted in highly viewed YouTube videos. Secondary exploratory objectives were to characterize the apparent demographic characteristics of on-screen performers, quantify video popularity and engagement, and evaluate the quality, reliability, and scientific accuracy of alcohol-related information presented in these videos. Methods We conducted a retrospective content analysis of YouTube videos identified between January and March 2025 using 48 search terms related to hazardous alcohol use. Key variables included the number of views, the number and apparent characteristics of participants, and the method of alcohol consumption depicted. Video content and quality were assessed using the global quality score (GQS) and a modified DISCERN reliability score, and explicit scientific claims were classified as substantiated or unsubstantiated by two board‑certified toxicologists. Results A total of 278 videos involving 15 distinct methods of alcohol consumption were analyzed, most of which met predefined criteria for hazardous use. Risky practices included alcohol inhalation, alcohol enemas, vodka eyeballing, drunkorexia, funneling, drinking hand sanitizer, marijuana moonshine, and alcohol‑soaked tampons, among others. Only three videos (1.1%) contained trigger warnings. Collectively, the videos were viewed 75 million times (mean 269,784 views) and liked five million times, and they featured 722 participants or observers, predominantly male, Caucasian, and aged 21-25 years. The median GQS and reliability scores were 1 (interquartile range or IQR 2-3) and 1 (IQR 1-2), respectively, and 78.7% (159/202) of scientific claims in informational videos conflicted with published toxicology literature. Interrater agreement was subs Video content and quality were assessed using the global quality score (GQS) and a modified DISCERN reliability score, and explicit scientific claims were classified as substantiated or unsubstantiated by two board‑certified toxicologists. Results A total of 278 videos involving 15 distinct methods of alcohol consumption were analyzed, most of which met predefined criteria for hazardous use. Risky practices included alcohol inhalation, alcohol enemas, vodka eyeballing, drunkorexia, funneling, drinking hand sanitizer, marijuana moonshine, and alcohol‑soaked tampons, among others. Only three videos (1.1%) contained trigger warnings. A single trained coder applied a predefined codebook to assign comments to thematic categories, with ambiguous cases discussed among investigators to ensure consistent Each distinct statement was coded separately, and multiple claims could occur within a single video. Both toxicologists participated in protocol training before the project began, along with the rest of the research team members, and independently reviewed the claims using predefined criteria. Unsubstantiated claims were identified using criteria shown in Table 1 , including absence of supporting evidence, contradiction with scientific consensus, reliance on low-quality sources, lack of reproducibility, and ambiguity or exaggeration. To assess interrater reliability, faculty physicians independently reviewed a random sample of 10% of included videos. Agreement statistics for key coding dimensions-hazardous alcohol method classification, GQS score, modified DISCERN score, and the presence or absence of misinformation-were calculated using Cohen’s kappa. These kappa values were derived from the subsample rather than the full dataset. Furthermore, to ensure quality control and reduce interobserver variation, an additional faculty member reviewed the collected data sheets. Results During the study period, 278 YouTube videos were analyzed. These videos described 15 different methods of consuming alcohol. The more dangerous practices described were alcohol inhalation, alcohol enemas, vodka eyeballing, drinking hand sanitizer, marijuana moonshine, alcohol-soaked tampons, and inhaling alcohol powder through the nose. Eight behaviors were hazardous because they promote rapid or excessive consumption, social pressure to drink beyond personal limits, or engagement in risky dares or competitions, thereby increasing the likelihood of acute intoxication, injury, impaired judgment, or other adverse outcomes beyond typical social drinking (Table 2 ). Clearly hazardous / medically dangerous routes or products a Alcohol inhalation (Vapor, Vaportini, Smoking alcohol) Alcohol enemas ((Butt chugging, Boofing, Booty bumping) Eyeballing (Vodka eyeballing) Drinking hand sanitizer Cannabis/alcohol infusion (Marijuana moonshine) Alcohol-soaked tampons (Slimming) Alcohol powder (Snorting alcohol) Hazardous binge/intoxication patterns or “challenges” (behaviorally high risk) b Drunkorexia Funneling (Beer bong) Borg (Blackout rage gallon) PK (Player-knockout) Rainbow drink challenge (Drink the rainbow) Drunken gummies (alcohol gummies) Neknominate (Necking, Neknomination Or Neck nomination) First drink, Last drink challenge Only three of these videos (1.1%) posted trigger warnings intended to warn users that website content was inappropriate for some users. Table 4 Categories of alcohol-related misinformation in YouTube videos Metabolism and toxicity claims Statements that alcohol “leaves your system faster” with certain tricks (e.g., energy drinks, cold showers, specific foods). Claims that non‑oral routes (inhalation, enemas, eyeballing) are “less toxic” because they “bypass the liver.” Safety of alternative consumption methods Asserting that inhaling, insufflating, or rectal use of alcohol is “safer” because it avoids calories or stomach irritation. Reassurances that these methods are “just a different way to get the same buzz” without added risk.