AIM: To investigate the association between patterns of alcohol consumption and self-reported physical and mental health in a population with a high prevalence of hazardous drinking. DESIGN: Cross-sectional study of an age-stratified random sample of a population register. SETTING: The city of Izhevsk, The Russian Federation, 2008-9. PARTICIPANTS: 1031 men aged 25 to 60 years (68% response rate). MEASUREMENTS: Self-reported health was evaluated with the SF12 physical (PCS) and mental (MCS) component summaries. Measures of hazardous drinking (based on frequency of adverse effects of alcohol intake including hangover, excessive drunkenness and extended episodes of intoxication lasting two or more days) were used in addition to frequency of alcohol consumption and total volume of beverage ethanol per year. Information on smoking, and socio-demographic factors were obtained. FINDINGS: Compared with abstainers, those drinking 10-19 L of beverage ethanol per year had a PCS score 2.66 (95%CI = 0.76; 4.56) higher. Hazardous beverage drinking was associated with a lower PCS score (mean diff: -2.95 (95%CI = -5.28; -0.62)) and even more strongly with a lower MCS score (mean diff: -4.29 (95%CI = -6.87; -1.70)), with frequent non-beverage alcohol drinking being associated with a particularly low MCS score (-7.23 (95%CI = -11.16; -3.29)). Adjustment for smoking and socio-demographic factors slightly attenuated these associations, but the same patterns persisted. Adjustment for employment status attenuated the associations with PCS considerably. CONCLUSION: Among working age male adults in Russia, hazardous patterns of alcohol drinking are associated with poorer self-reported physical health, and even more strongly with poorer self-reported mental health. Physical health appears to be lower in those reporting complete abstinence from alcohol compared with those drinking 10-19 L per year.