Drawing on 33 ethnographic studies of drinking in low- and middle-income countries around the world, this paper describes common themes pertaining to economic development, alcohol consumption and related harms. Three crosscutting themes emerged that shed light on why alcohol consumption and problems tend to increase during periods of economic development. First, from the perspective of the global alcohol industry, developing countries often become viewed as emerging consumer markets. Commercially produced alcohol tends to gain a higher status than traditional locally produced beverages, replacing them as resources allow. Drinking and beverage choices thus both symbolize new social divisions and help create them. Second, economic relations change whereby women’s interests often lose ground as men’s drinking increases. Commercialization of production may mean that women lose control over what was traditionally a home-produced supply. Resources that once stayed in the family or community may be exported as commercial profits. Third, alcohol often becomes both a source and symbol of political tensions and class divisions. Governments may become dependent on commercial alcohol revenues and willing to tolerate high levels of alcohol-related harm. In response, social and cultural movements, often promulgated by women, spontaneously emerge from within developing societies to counterbalance elite interests in the alcohol trade and push against external market forces.