Alcohol consumption and its association with health or illness states are of great interest from the nutritional genomics point of view. This interest is centered not only on investigating the genetic variants that can modulate the effects of alcoholic beverages on different intermediate and final disease phenotypes (mainly cardiovascular diseases and cancer), but also on finding out how the genome influences the amount of alcohol consumed and consumption habits. This chapter reviews the latest findings on alcohol consumption trends, the methodological limitations in the analysis of alcohol consumption, and the main genes and polymorphisms related to alcohol intake, including the inconsistent results from genome-wide association studies (GWASs). It also reviews the effects of alcohol consumption on cardiovascular diseases and cancer and the studies analyzing the interactions between different genetic polymorphisms and alcohol in phenotypes related to these diseases, discussing the studies' advantages and limitations as well as future research perspectives.