Alcohol has the longest history of any drug of abuse. Since it is so easy to produce it is easily available worldwide. There are wide variations in alcohol use across countries, cultures and religions. In the USA and European countries it is the most widely used drug of abuse. Alcohol related problems are proportional to the amount consumed and excessive alcohol use contributes to about 3% of preventable deaths. Alcohol related problems increase with the amount consumed. There is a J shaped curve where 1-2 drinks per day may reduce overall mortality but over 2 drinks per day for females and 3 drinks per day for males there is a clear dose related increase in overall mortality the more the individual drinks. In the USA 50% of alcohol consumption is either illegal (underage drinking) or harmful. Economic factors such as advertising increase alcohol consumption and the cost of alcohol treatment is rising. There is variation in alcohol consumption across the racial and ethnic groups with the largest alcohol related problems being found in Native Americans.