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To evaluate the impact of excessive alcohol consumption on the health-related quality of life of patients receiving methadone treatment for opioid dependence.A cross-sectional survey.One hundred and ninety-two patients attending out-patient methadone clinics in the south-east of England, United Kingdom.Quality of life (QoL) was assessed using the Medical Outcomes Study: General Health Survey, Short Form (SF-12). Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT).Approximately one-third of the sample (57/192) were AUDIT-positive (score ≥ 8) and 20 of the 135 AUDIT-negative patients reported past history of alcohol problems. AUDIT-positive patients were less satisfied with their methadone dose than AUDIT-negative patients (P= 0.002), despite having a higher dose. AUDIT-positive patients reported more physical (P= 0.020) and psychological (P= 0.034) health problems and poorer QoL (P= 0.008) with an estimated effect size of 0.46. Lower QoL scores for AUDIT-positive patients affected both ‘physical’ (P= 0.009) and ‘psychological’ (P= 0.012) health domains with poor role functioning (‘role limitation’ due to physical health, P < 0.001 and to emotional health, P = 0.009), social functioning (P= 0.015) and self-perceived general health (P= 0.029).Excessive alcohol consumption may be associated with a distinctive pattern of QoL impairment in methadone patients. In addition to advising methadone patients regarding their alcohol consumption, comprehensive care plans should seek to restore normal personal, family and social role functioning through the provision of appropriate health and social care.