Purpose <p>Despite extensive research, links between individuals’ environments and alcohol use remain inconsistent. This has renewed interest in neighbourhood determinants of alcohol use. We examined whether neighbourhood characteristics are related to alcohol use in urban and rural areas, and whether physical activity modifies associations.</p> Methods <p>Cross-sectional study utilised 46-year follow-up data from the population-based Northern Finland Birth Cohort 1966 (<i>n</i> = 6,655). Alcohol use was classified into abstinence, moderate (&gt; 0 ≤ 30/20&#xa0;g/day men/women), and heavy use (&gt; 30/20&#xa0;g/day). Neighbourhood characteristics were derived from national geographic data sources using residential coordinates. Physical activity was assessed through self-reports and accelerometry. Multinomial logistic regression analyses were conducted to examine relationships between neighbourhood characteristics and alcohol use in urban and rural areas, adjusting for socio-demographic factors and physical activity.</p> Results <p>Heavy use was common in urban areas, while abstinence was more common in rural areas. In urban areas, greater proportions of rented housing, more bus stops and grocery stores, and longer pedestrian/cycle paths were associated with heavy alcohol use. Greener environments were associated with lower levels of heavy use. In rural areas, a higher proportion of rented housing was associated with higher likelihood of abstinence. In both areas, living in more advantaged neighbourhoods was associated with lower likelihood of abstinence. Physical activity generally did not modify associations between neighbourhood characteristics and alcohol use.</p> Conclusion <p>Neighbourhood characteristics are associated with alcohol use among middle-aged individuals, showing different patterns in urban and rural areas. These findings highlight the importance of considering neighbourhood characteristics in public health strategies for reducing alcohol use.</p>