Abstract Background: This study aimed to identify subgroups of childhood cancer survivors at highest risk of consuming alcohol, consuming above recommended weekly levels, and consuming potentially harmful amounts and compare survivor risks with those expected from the general population. Methods: Using the British Childhood Cancer Survivor Study, a population-based cohort of 17,981 individuals diagnosed with childhood cancer (1940-1991) and surviving ≥5 years, 14,836 were eligible for a questionnaire that ascertained drinking behavior, as previously ascertained in the 2002 General Household Survey throughout Britain. Results: Of 10,389 survivors who responded, 77.2% were alcohol drinkers, 23.8% consumed over weekly recommendations, and 3.9% consumed potentially harmful amounts. Survivors were less likely than the general population to be a current drinker {odds ratio [OR; 99% confidence interval (CI)]: 0.52 (0.46-0.60)}, consume over weekly recommended levels [OR (99% CI): 0.65 (0.58-0.73)], and consume harmful amounts [OR (99% CI): 0.40 (0.32-0.49)]. Survivors of a central nervous system neoplasm or leukemia, particularly those treated with brain irradiation, were the least likely to have adverse drinking behaviors when compared with the general population. However, survivors of Hodgkin's lymphoma, non–Hodgkin's lymphoma, Wilms' tumor, bone sarcoma, and soft tissue sarcoma had adverse drinking behaviors at levels expected from the general population. Conclusion: Overall adverse drinking behaviors were less frequent in survivors than expected from the general population, but subgroups with adverse drinking behaviors were identified, and it is these subgroups who are most in need of intervention. Impact: UK clinical follow-up guidelines for childhood cancer survivors need strengthening in relation to alcohol consumption. Cancer Epidemiol Biomarkers Prev; 19(5); 1174–84. ©2010 AACR.