OBJECTIVE: To examine recent trends in alcohol-related harm and risky drinking in Victoria, Australia. METHODS: The study compiled eight measures of alcohol-related harm from published and unpublished sources, covering data relating to health, crime, alcohol treatment and traffic crashes for the financial years 1999/2000 to 2007/08. In addition, published estimates of short and long-term risky drinking from three-sets of surveys between 2001 and 2007 were examined. RESULTS: Six of the eight harm indicators substantially increased, while only alcohol-related mortality and single-vehicle night-time crashes remained relatively stable. In particular, rates of emergency presentations for intoxication and alcohol-related ambulance attendances increased dramatically. Contrastingly, survey-derived estimates of the rate of risky-drinking among Victorians were stable over the time-period examined. CONCLUSIONS: Evidence across the data examined suggests significant increases in alcohol-related harm taking place during a period of relatively stable alcohol consumption levels. This disparity may be accounted for by changing drinking patterns among small, high-risk, subgroups of the population. IMPLICATIONS: The sharply increasing rates of alcohol-related harm among Victorians suggest that changes to alcohol policies focusing on improving public health are necessary.