ABSTRACT Aims The estimation of alcohol-related human losses in Russia in the 1980s and 1990s. Design The estimation was made by comparing changes in the total number of deaths and in specific categories, and alcohol consumption in Russia during this time. Setting The anti-alcohol campaign, launched in 1985, and the market reforms launched in 1992 were associated with large and rapid changes of alcohol consumption in Russia. Findings In the early 1980s, the aggregate number of direct and indirect alcohol-related life losses was more than 500 000 per annum, or 32% of total deaths. Half of the alcohol-related human losses in Russia over the period studied were due to accidents, poisoning and violence. Following the anti-alcohol campaign and reduction in annual per capita alcohol consumption from 14.2 (1984) to 10.5 l (1986), mortality decreased from 1161.6 to 1054.0 per 100 000 of the population. It is estimated that from 1986 to 1991 the lives of 1.22 million people were spared; that is, 11.4% of the number of deaths expected without the anti-alcohol campaign. All categories of deaths were reduced with the exception of neoplasms, infectious and parasitic diseases. In the period of the so-called market reforms both alcohol consumption and mortality increased sharply. The total number of alcohol-related deaths for 1994 was 751 000 in the population, or 33% of all deaths (direct and indirect losses). In 1995 alcohol consumption started to decrease. A decrease in mortality was registered despite the sharp deterioration of the quality of life in the country. However, a new growth of total mortality, fatal alcohol poisonings and number of alcohol psychoses began in 1999–2000. Conclusion The results of this study show the enormous scale of alcohol-related mortality in Russia. It has been revealed that alcohol-related deaths are at the top of the hierarchy of all premature deaths in the country. Decreasing alcohol consumption is an important means of decreasing total mortality in Russia.