Alcohol-related death rates are six times higher in the poorest areas of Scotland than in the wealthiest, figures have shown.
The NHS Health Scotland report highlighted inequalities, with alcohol-related stays in hospital nearly nine times higher in the 10% most-deprived areas than in the 10% least deprived areas in 2015/16.
It showed that in 2015, an average of 22 people per week died in Scotland due to an alcohol-related cause, 54% higher than in England and Wales.
The alcohol-related death rate was more than twice as high in men as in women, with 30 deaths per 100,000 population in men compared with 13.8 deaths for women.
Last year 10.5 litres of pure alcohol were sold per adult in Scotland, equivalent to 20.2 units per adult per week.
This means that enough alcohol was sold in 2016 for every adult to exceed the weekly guideline of 14 units by 44%, every week of the year.
However, mean weekly alcohol consumption by drinkers in Scotland fell from 16.1 units in 2003 to 12.9 units in 2015.
Public health intelligence adviser Lucie Giles, lead author of the report, said: "It is worrying that as a nation we buy enough alcohol for every person in Scotland to exceed the weekly drinking guideline substantially.
"This has harmful consequences for individuals, their family and friends as well as wider society and the economy.
"The harm that alcohol causes to our health is not distributed equally; the harmful effects are felt most by those living in the most disadvantaged areas in Scotland."
The report authors highlighted some encouraging findings, with self-reported consumption data showing the proportion of people drinking at harmful levels has fallen while the proportion of non-drinkers has risen.
Meanwhile, the proportion of children reporting drinking in the last week has fallen over time, according to the study.
For 13-year-olds, it has dropped from 23% in 2002 to 4% in 2015, and for 15-year-olds from 46% in 2002 to 17% in 2015.
Rates of driving under the influence have fallen consistently over time, from 21.8 per 10,000 population in 2004/05 to 10.2 per 10,000 population in 2015/16.
Public health minister Aileen Campbell said: "This report shows that, whilst some progress has been made in tackling alcohol misuse, we need to do more.
"Over the last few years, more than half of alcohol sold in supermarkets and off-licences was sold at less than 50p per unit and enough alcohol was sold in the off-trade alone to exceed the weekly drinking guideline by a considerable amount.
"That is why we need minimum unit pricing, which will largely impact on the off-trade and will increase the price of the cheap, high-strength alcohol."
Alcohol Focus Scotland chief executive Alison Douglas said: "Alcohol is so cheap and widely available that it's easy to forget how it can damage our health.
"We need to introduce this long-delayed policy as soon as possible to improve Scotland's health, cut crime and save lives."