The relation of alcohol to social and casualty problems is considered, with particular attention to patterns in developing societies. Potential problems for the drinker include accidental and intentional injuries; problems in major social roles: in the family, at work and in public roles; and problems from the reaction of others to the drinking. Potential problems for those in the drinker's environment include mental health problems, injuries and social problems from role failure. Potential problems for a society or collectivity include social disintegration, and aggregate-level equivalents of the problems for the drinker and those around the drinker. Cultures vary in the dominant type of drinking pattern and, accordingly, in the extent and mixture of alcohol-related social and casualty problems. A series of cultural factors influencing the relation between drinking patterns and problems are considered.