Purpose of Review <p>This review provides a comprehensive overview of alcohol-associated liver disease (ALD), focusing on the spectrum of ALD, the utility of non-invasive diagnostic tests, and risk stratification for hepatocellular carcinoma (HCC) in ALD patients. Special attention is given to a newly recognized disease entity, metabolic dysfunction associated steatotic liver disease (MASLD) with increased alcohol intake, also known as MetALD.</p> Recent Findings <p>The concept of MetALD has expanded our understanding of how alcohol use and metabolic traits interact to influence liver disease and HCC risk. Various non-invasive methods and risk scores have been developed using clinical factors, imaging, blood work, and genetic data to stratify HCC risk in ALD.</p> Summary <p>Multiple risk factors contribute to the development of HCC in ALD through synergistic or additive effects. In addition to established risk factors, genetic variants such as PNPLA3 rs738409 and TM6SF2 rs10401969 further increase HCC risk. Clinical factors like obesity and diabetes, when combined with alcohol consumption, have a synergistic effect on HCC development. Advanced fibrosis is a major risk factor for HCC and can be assessed using imaging tests or blood-based fibrosis biomarkers. While prediction models and polygenic risk scores exist, their applicability to ALD-related HCC remains limited. Furthermore, patients with alcohol-related HCC are often diagnosed at more advanced stages due to inconsistent screening practices, highlighting the need for improved surveillance strategies in this population.</p>