Alcohol is ranked as the fourth most harmful drug behind heroin, crack cocaine, and crystal meth, but ahead of cocaine, nicotine, ecstasy, and cannabis.
The ranking is based on a survey of almost 300 health and social care professionals in Scotland and published as part of a paper in the British Medical Journal.
Irish health experts and campaigners said the research highlighted again the need for Government action on alcohol.
However, industry groups said it was a selective survey with no reference to Ireland and that alcohol was consumed responsibly by the "overwhelming majority" of drinkers.
According to the survey of 19 legal and illegal substances:
Heroin is first for pers-onal harm, social harm, and combined harm;
Crack cocaine is ranked second for personal and combined harm and third for social harm;
Crystal meth is third for personal and combined harm, and fourth for social harm;
Alcohol is ranked fourth for personal and combined harm and second for social harm, ahead of crack.
Cocaine is ranked sixth, nicotine seventh, benzodiazepines (legal tranquillisers) eighth, amphetamines 11th, and codeine (a prescribed painkiller) 13th. Ecstasy is 16th and cannabis last, at 19th.
The authors said one of the strengths of the study was the large number (292) of health and social work professionals involved.
"Alcohol was the only drug to rate higher on social harm than personal harm, reflecting the enormous burden to the healthcare system posed by alcohol and also the negative effects on rates of crime, workplace absences and on family life, including domestic violence," said the study.
The authors said the harm ratings did not take into account the availability or cost of a substance, which, it said, could explain why alcohol was so high up.
It stressed caution over the cannabis ranking, saying the survey was conducted before the widespread availability of high-potency cannabis.
"This is more evidence suggesting, from the views of people dealing with the problem, that stricter regulation of alcohol would be better," said Dr Joe Barry, public health specialist.