Since the mid-1970s, there have been substantial declines in liver cirrhosis deaths in many Western countries following a long period of increases. There is variability in the pattern of changes observed: in a sample of 29 countries between 1974 and 1982-83, seven countries showed a significant linear decline, three revealed a curvilinear pattern, increases were observed in six and the rest (13) showed no notable changes. Although reductions in per capita consumption of alcohol may be a contributing factor, these reductions do not seem to account for all of the decreases in cirrhosis deaths that have been observed. Among other factors that might contribute, changes or increases in treatment for alcohol abuse and AA membership have been most strongly linked to these declines; changes in patterns of consumption, dietary habits, prevention efforts and reduced exposure to predisposing factors may also be involved. In view of the importance of these declines for the understanding and prevention of alcohol problems, further research on this issue, perhaps involving international collaborative studies, is needed.