Alcohol consumption is the leading single cause of the disease burden in eastern Europe and is one of the top three risk factors, along with high blood pressure and overweight or obesity, in much of Latin America, where it ranks ahead of smoking. The effects of alcohol on population health are greatest in Russia and some other former Soviet republics. Though recorded per capita alcohol consumption in Russia is the same as or only slightly higher than consumption in western European countries, the health effects are substantially larger. In traditional wine-producing countries, most alcohol is consumed as wine during meals, in relatively modest daily amounts, by a large proportion of the population. In contrast, in Russia and neighboring countries, men (especially those of low socioeconomic status) consume very large amounts of spirits, either as a regular daily habit or by binge drinking. A substantial proportion of consumed alcohol is from unrecorded and nonbeverage sources such as medicinal and industrial ethanol. Alcohol consumption may be responsible for one third to one half of deaths among young and middle-aged men in Russia. In contrast to the current, enormous death toll, mortality declined temporarily in the 1980s, when policies introduced under Mikhail Gorbachev reduced alcohol consumption by about one half (Figure 3).