Advanced alcoholic liver disease (ALD) represents a substantial public health burden, threatening the lives of more than ten million people in the United States. Although the direct harmful effects of alcohol in the liver are nearly universally recognized, emerging evidence suggests alcohol also adversely affects other organs such as the intestine, skeletal muscle, adipose tissue, and likely many other tissues. In fact, the extrahepatic effects of alcohol clearly converge to impact the morbidity and mortality associated with chronic alcohol abuse. In the intestine alcohol consumption can profoundly impact both gut barrier function as well as reorganizing intestinal microbial communities. In the skeletal muscle, chronic alcohol consumption promotes sarcopenia by altering protein homeostasis or proteostasis. In parallel, alcohol can impact the normal endocrine and metabolic function of adipose tissue. Collectively, chronic alcohol abuse sustains an interorgan cross talk that provides the multiple hits necessary for progression to end stage liver disease. Here we briefly highlight several recent examples of interorgan cross talk underlying the morbidity and mortality associated with alcohol abuse, and discuss how these recent advances have the potential to impact therapeutic strategies for those suffering with ALD.