The contribution that alcohol has made to the large fluctuations in mortality in Russia in recent years is now widely recognized. An association between heavy drinking and Russia is part of popular culture. But what is the reality? This paper reviews the evidence on historical patterns of consumption in Russia, highlighting the difficulties of obtaining valid statistics during the Soviet period (1917-1991). It notes how the state, at various times, encouraged alcohol sales. By the early 1980s, the social cost of heavy drinking was becoming apparent. This led, in 1985, to the imposition of the wide-ranging and initially highly effective anti-alcohol campaign by Mikhail Gorbachev. The features of this campaign and of its subsequent collapse are described. In the 1990s, consumption of alcohol increased rapidly. There has, however, been a recent reduction in alcohol-related deaths. It is concluded that heavy drinking is not an inevitable feature of Russian life and that, as the state has done much to create the present problem, it also has a role to play in resolving it.