The small number of studies on alcohol use among adults with intellectual disabilities shows their usage is significantly less than average, with very high levels of abstinence. Despite this, the literature focuses almost to exclusion on the very small number of people who do have problems, and neglects to question the possible reasons for this differential pattern of consumption. This article reviews the extant literature, showing that it constructs an inherently pathological view of drinking in people with intellectual disabilities, framing it entirely within a discourse of risk and as a personal behaviour, rather than as a social and cultural one. As a counter to this perspective, the article opens up new lines of exploration around the significance of abstinence, why it might occur to such a high degree and whether, in fact, it might itself be and also point towards the cultural exclusion of people with intellectual disabilities.