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Low- and middle-income countries face a rapidly escalating, alcohol-related public health crisis spanning cancer, injury, liver disease, mental health disorders and the complications of human immunodeficiency virus infections. Despite compelling evidence that alcohol is a leading risk factor for premature death and disability, few countries include comprehensive alcohol control policies in their public health agenda. This gap between evidence and policy is critical because evidence-based interventions could decrease the alcohol-attributable disease burden by up to 30% within a decade. We conducted a policy analysis to synthesize evidence from low- and middle-income countries and propose a comprehensive multicomponent framework for alcohol control adapted from experience with tobacco control. Documented achievements show that simultaneously integrating alcohol control into the existing health-care system, introducing regulation, and building institutional capacity can reduce consumption and generate substantial economic returns. However, interference from the alcohol industry in policy, mirroring the historical approach of the tobacco industry, underscores the need for explicit protections. Evidence-based recommendations on implementing alcohol control policies are presented for international agencies, national governments, health-care systems and civil society. These recommendations also draw on global lessons from the World Health Organization's Framework Convention on Tobacco Control. Today, the convergence of robust scientific evidence, proven interventions, successful implementation models and growing political support present an opportunity to advance alcohol control in low- and middle-income countries. The question is not whether comprehensive alcohol control is feasible in resource-constrained settings but whether the global health community will act decisively on the evidence available.