Introduction: Alcohol has been shown to have significant negative impacts on communities across the world. This paper will discuss alcohol use and alcohol harm in the context cultures with traditional consumption of alcohol and where alcohol holds a strong place in traditional culture and custom. Methods: This descriptive review of the qualitative literature uses thematic analysis as a method to provide a broad description of this topic. An inductive approach was used to identify themes related to the phenomena after a comprehensive search for relevant published research. Purposive sampling was used to locate primary research articles related to the specific question for this synthesis. Additional papers were included from the reference lists of these studies. Specialists in the field were con-sulted for additional articles and unpublished papers. Results: The literature search found 6 academic papers relevant to the question for the study. The findings from the included studies suggest that, across the world in cultures where traditional production and consumption of alcohol are a feature, alcohol use and alcohol harm is increasing. This is reported to partly due to the availability of cheap, mass produced western style alcohol. Traditional alcohol has also been found to have increased production and availability as a source of income for some indigenous groups. Conclu-sion: The feature that stands out through much of the research looking at this topic is that the harm caused by alcohol is the primary focus. Although this is important, it is not the only aspect that needs to be considered if alcohol-harm reduction is the focus. The individuals and communities in the studies included in this review appear to have a strong connection to their traditional culture and a desire to keep this alive. Bringing to forefront the stories and narratives of the traditional culture may go some way to reintroducing the traditional cultural frames related to alcohol and help to preserve cultures that are perceived to be disappearing. Discussion will focus on how this can change our approach to harm reduction in these communities and how best we can begin to explore and address this in the local context.