Alcoholic liver disease (ALD) is a common and serious liver condition that poses a significant global public health challenge. The pathogenesis of ALD is intricate and not yet completely elucidated, and there is a notable absence of effective targeted interventions. The prevention and treatment of ALD constitute an urgent priority that necessitates significant breakthroughs. This review systematically examines the pathological mechanism underlying ALD by synthesizing pertinent domestic and international literature. It highlights key drivers across various stages of the disease, including disorders of alcohol metabolism, oxidative stress, inflammatory responses, immune dysregulation, and gut dysbiosis. The review delineates intervention strategies including lifestyle modifications focused on abstinence, pharmacological approaches aimed at reducing inflammation and promoting hepatocyte regeneration, and dietary functional components such as flavonoids, polysaccharides, and peptides. It aims to offer guidance for the development of combined intervention protocols for ALD and the implementation of phased and multi-targeted clinical interventions.