Introduction and Aims.Eastern Europe is known to suffer from a large burden of alcohol-related mortality. However,persisting unfavourable conditions at the national level mask variation at the sub-national level. We aim to explore spatialpatterns of cause-specific mortality across four post-communist countries: Belarus, Lithuania, Poland and Russia (Europeanpart).Design and Methods.We use official mortality data routinely collected over 1179 districts and cities. The analysisrefers to males aged 20–64 years and covers the period 2006–2014. Mortality variation is mainly assessed by means of thestandardised mortality ratio.Getis-Ord Gi*statisticis employed to detect hot and cold spots of alcohol-related mortality.Results.Alcohol-related mortality exhibits a gradient from very high levels in northwestern Russia to low levels in southernPoland. Spatial transitions from higher to lower mortality are not explicitly demarcated by national boundaries. Within thesecountries, hot spots of alcohol-related mortality dominate the territories of northwestern and western Russia, eastern and north-western Belarus, southeastern Lithuania, and eastern and central Poland.Discussion and Conclusions.The observedmortality gradient is likely associated with the spread of alcohol epidemics from the European part of Russia to the other coun-tries, which appears to have started more than a century ago. Contemporary socioeconomic and demographic factors should betaken into account when developing anti-alcohol policies. The same is true for the peculiarities of culture, norms, traditionsand behavioural patterns observed in specific geographical areas of the four countries. Reducing alcohol-related harm in theareas identified as hot spots should be prioritised.