Background 
Reliable epidemiological evidence of alcohol use in Sri Lanka is limited. This study addressed this gap using nationally representative data.

Methods 
Data from a 2018/2019 national study of non-institutionalized adults in Sri Lanka were used. Weighted data were analysed using descriptive and logistic regression techniques.

Results  
Among 6473 adults (mean age 43.9 (SD = 16.7); 52.5 % women) surveyed, 53.1 % (95 %CI; 51.9 %, 54.3 %) of men and 2.0 % (95 % CI; 1.9 %, 2.1 %) of women were current (yearly) alcohol users. Per capita consumption of alcohol was 3.12 l for men and 0.028 l for women. Predictors of alcohol use in men included being aged 30–39 years, Sinhalese ethnicity, secondary education, currently married, and being in the middle wealth quintile and in women, being aged 30–39 years, Indian Tamil ethnicity, tertiary education, being a widow or separated, and being in the highest wealth quintile were the significant predictors of current alcohol use. Hazardous drinking (≥21 units per week) was observed only in men: 14.1 %. In men, smoking, elevated blood pressure and low self-rated health were related to higher likelihood of alcohol use. Alcohol use showed protective effects on type 2 diabetes and depression in men.

Conclusions 
Prevalence, distribution and associated factors of alcohol use vary by demographic and health characteristics of Sri Lankan adults. Preventive strategies should be based on population risk stratification of alcohol use.