Alcohol consumption in excess affects the brain negatively, both immediately and in the long-term. Brain lesions in alcohol abusers are multiple and are multifactorial in origin. The toxic effect of ethanol, withdrawal from alcohol, nutritional deficits, and electrolyte disturbances, as well as liver damage, may contribute to the ethiopathogenesis of brain injury. The susceptibility of the brain to the negative effects of alcohol may be influenced by sex and age. The role of genetic factors and interactions of several licit and illicit drugs with alcohol needs further investigation.