There are substantial regional differences in drinking alcohol in Russia, both at the population and individual levels. However, the causes of these differences have not been studied yet. The goal of our study was to examine the effect of regional living conditions on individual alcohol consumption by the population of Russia. For the analysis, we used data from a cross-sectional epidemiological study conducted in 2013‒2014. The final analytical sample included 18,130 people aged 25‒64 years. We conducted the interviews face to face, based on which any drinking in the last year, as well as alcohol abuse, were considered as a response. Alcohol abuse was recorded when the respondent consumed 5.75 or more grams of pure ethanol per day (75th percentile of average daily alcohol consumption among alcohol drinkers). The assessment of the regional living conditions was accomplished via integral indexing, which was previously performed based on publicly available data for 2010–2014. Associations were assessed using generalized scoring equations with unchanging standard errors. The associations were expressed by odds ratios (OR) and 95% confidence intervals (CI). Deterioration of social conditions and increase in demographic depression in the region of residence increased the odds of any drinking (OR 1.51, 95% CI: 1.33 to 1.72, P < 0.001 and OR 1.22, 95% CI: 1.05 to 1.41, P = 0.009, respectively). The odds of alcohol abuse increased with the deterioration of social living conditions and the growth of the industrial development in the region: OR 1.35, 95% CI: 1.14 to 1.59, P < 0.001 and OR 1.16, 95% CI: 1.05 to 1.28, P = 0.002, respectively. Our analysis allowed assessing the impact of the regional living conditions on individual drinking alcohol in the population of Russia.