Aims: To assess the prevalence and determinants of binge drinking in the middle-age population of transitional post-communist Albania, for which data were previously unavailable. Methods: A population-based sample aged 35-74 years, interviewed and examined in Tirana in 2003-2006, included 450 men and 235 women for whom data on alcohol intake were collected (65.5% response). Multivariable-adjusted logistic regression was used to assess the association of drinking patterns with sociodemographic, socioeconomic and psychosocial characteristics and coronary risk factors. Results: Age-standardized to the 2005 census, 9.2% (95% confidence interval, CI = 6.5-11.9%) and 10.3% (95% CI = 7.4-13.1%) of men reported two to three or more annual episodes of drunkenness and hangovers, respectively. In women, the prevalence of both these markers of binging was 1.4% (95% CI = 0-3.1%). Among men, 8.9% (95% CI = 6.2-11.6%) reported drinking >= 60 g alcohol per session. In multivariable-adjusted models in men, binge drinking was related to low educational level (odds ratio, OR = 1.8, 95% CI = 1.0-3.3), financial loss in the pyramid collapse (OR = 1.6, 95% CI = 1.0-2.5) and religiosity (inversely) in both Muslims and Christians (OR = 0.2, 95% CI = 0.1-0.4). Conclusions: Among men in this transitional Southeast European country, social disadvantage and financial stress appear to promote alcohol abuse (which is rare in women), and traditionalism may be protective.