Aim. To reveal the patho- and morphogenesis of microvascular injury, cardiac and vascular changes in individuals with alcohol use disorder (AUD) and the role of cardiovascular pathology in the thanatogenesis of patients with chronic alcohol intoxication.Material and methods. The study was carried out using the data of 1118 autopsies of patients with AUD. We used histological, immunohistochemical, electron microscopic and biochemical methods, as well as morphometrics with statistical processing of the results.Results. Most patients with binge drinking developed alcoholic cardiomyopathy, cardiac hypertrophy, myocardial fatty degeneration, microvascular arteriolosclerosis and hyalinosis, diffuse focal sclerosis, as well as mitochondrial swelling and fragmentation of cristae in cardiomyocytes (CMC). The proportion of damaged CMC was 30,9±0,6%. Sclerosis affected 20,1±0,9% of the stroma. If alcohol was abandoned or consumed within the basal metabolic rate, these changes were reversible. With alcoholism, alcoholic cardiomyopathy, arteriosclerosis and arteriolosclerosis progressed. Compared with the binge drinking, the proportion of damaged CMC (44,8±1,1%) and the cardiosclerosis area (28,1±0,5%) significantly increased. Mallory bodies with autoantigen properties were detected. Morphological changes became irreversible.Conclusion. The data obtained identified the need for AUD isolation as an independent nosological entity with stage-by-stage pathogenesis. In the stage of binge drinking, the compensatory and adaptive capabilities of the body are preserved. With appropriate treatment, this stage of AUD is treatable. In the stage of alcoholism, changes in organs and tissues are irreversible, and it is more advisable for addiction medicine physicians to deal with palliative treatment of such patients.