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Background Implementation of effective policies to reduce harmful alcohol consumption requires both a good understanding of the policy development process and which strategies are likely to work. Aims To contribute to this understanding by reviewing four specific policy development initiatives that have taken place in South Africa between 1994 and 2009: restrictions on alcohol advertising and counter-advertising, regulation of retail sales of alcohol, alcohol taxation and controls on alcohol packaging. Methods Material was drawn from a record of meetings and conferences held between 1994 and 2009 and a database of reports, newspaper clippings and policy documentation. Findings When the policy process resulted in a concrete outcome there was always a clear recognition of the problem and policy alternatives, but success was more likely if there was an alignment of ‘political’ forces and/or when there was a determined bureaucracy. The impact of the other factors such as the media, community mobilization, non-governmental organizations (NGOs), the liquor industry and research are also discussed. Future avenues for policy research are identified, including the need for more systematic studies that give greater consideration to economic factors. Conclusions Alcohol policy development in South Africa takes place in a piecemeal fashion and is the product of various competing influences. Having a comprehensive national alcohol strategy cutting across different sectors may be a better way for other developing countries to proceed. [ABSTRACT FROM AUTHOR]