Alcohol-associated liver disease (ALD) is a significant cause of chronic liver disease worldwide, encompassing a spectrum of disorders from simple steatosis to more severe conditions like steatohepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Despite substantial progress in the field over the past two decades, the pathogenesis of ALD remains poorly understood, and there are currently no FDA-approved treatments. This review discusses recent insights into the pathogenesis and therapeutic targets of ALD, utilizing multiomics and other advanced technologies. It highlights the potential translation of these findings into clinical practice and therapy, including preclinical models, the interplay between ALD and metabolic dysfunction, alcohol-associated liver cancer, and the heterogeneity of ALD. The review also explores potential translational research prospects, emphasizing the importance of understanding the gut-liver axis, organ crosstalk, and the role of inflammation in ALD progression. Additionally, it addresses genetic heterogeneity, differences in alcohol metabolism between Eastern and Western populations, and sex disparities in ALD. The authors conclude by outlining future research directions, including the development of biomarkers for early diagnosis and personalized treatments.Alcohol-associated liver disease (ALD) is a significant cause of chronic liver disease worldwide, encompassing a spectrum of disorders from simple steatosis to more severe conditions like steatohepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Despite substantial progress in the field over the past two decades, the pathogenesis of ALD remains poorly understood, and there are currently no FDA-approved treatments. This review discusses recent insights into the pathogenesis and therapeutic targets of ALD, utilizing multiomics and other advanced technologies. It highlights the potential translation of these findings into clinical practice and therapy, including preclinical models, the interplay between ALD and metabolic dysfunction, alcohol-associated liver cancer, and the heterogeneity of ALD. The review also explores potential translational research prospects, emphasizing the importance of understanding the gut-liver axis, organ crosstalk, and the role of inflammation in ALD progression. Additionally, it addresses genetic heterogeneity, differences in alcohol metabolism between Eastern and Western populations, and sex disparities in ALD. The authors conclude by outlining future research directions, including the development of biomarkers for early diagnosis and personalized treatments.