The purpose of this review is to synthesize the prevalence data from five national surveys and local surveys on alcohol use in South Africa over the past 12 years. Systematic review. Results indicate that life time, current (past month) use and binge drinking remained similar over the years for both adolescents and adults. Binge drinking was between 7-11% and risky drinking also remained stable over the years (6%) with larger sex, geographic and racial differences. Risky drinking in pregnant women was 2.5% nationally but particularly high among urban dwellers (4.1%), Coloureds (11.6%) and in the Northern Cape province (24.9%). Local surveys among adolescents, university students, clinic populations and mine employees seem to all generally indicate higher levels of risky drinking than in the national surveys. The burden of alcohol was found to be high: Hazardous or harmful drinking and binge drinking were associated with multiple/indiscriminate (irregular) sex partners among persons living with HIV; alcohol related death in transport and homicide of 50% and fetal alcohol syndrome from 10-74 per 1000 in local surveys. Alcohol production/per capita remained stable with 8 litres but there is relatively high alcohol consumption considering an additional 3-4 litres unrecorded production/consumption, and that high amounts are consumed by a small population since most abstain from drinking in South Africa.Although no significant increase of alcohol use over the past 12 years was found, a high burden of alcohol abuse was found.