While, historically, alcohol production and sale were local matters, commercialised and industrialised alcohol has supervened, globalised initially through European empires, transforming alcohol’s place in everyday life. But alcohol was not included in the current international drug control system, initiated in 1912. In the current “UN system” of 35 intergovernmental agencies, alcohol has been a recurrent concern in the work only of the World Health Organization (WHO). Examples are given of the sporadic involvement in alcohol issues of other agencies, and the history of WHO’s involvement between 1950 and early 2020 is briefly described. At WHO, the place of alcohol programming in its structure and which other topics it is linked with have been recurrent issues. Civil society support for alcohol initiatives has been comparatively weak, and alcohol industry counter-pressure has been strong. Alcohol issues have thus received less attention at the intergovernmental level than the harm would justify. Constraining factors have included not only lobbying by industry interests, but also the multi-sectoral nature of alcohol problems and the international cultural position of alcohol as a luxury good served at gatherings of political and media elites.