Excessive alcohol consumption is a leading cause of disease and premature mortality worldwide. Harmful alcohol use costs 3 million lives a year globally, is the seventh most important risk factor for mortality overall, and the number one risk factor for people aged 15–49 years. Excessive alcohol consumption increases the risk of a wide range of diseases, including cardiovascular diseases, liver disease, and cancers, and it can severely impact mental health and become a source of addiction. Despite the evident harms, it remains a major public health issue. The research in this issue of The Lancet Public Health highlights the danger that unmitigated growth in excess drinking poses to population health and explores some of the sociodemographic complexities of its impact.