Purpose <p>To evaluate alcohol intake patterns, and identify factors associated with alcohol use in early survivorship among breast cancer survivors, as well as associations with changes in alcohol consumption in early survivorship.</p> Methods <p>Patients diagnosed with breast cancer (stages 0–3) between 2014 and 2022 were surveyed regarding their average alcohol intake near the time of diagnosis and at approximately one year post-diagnosis. Alcohol intake was categorized into four levels and associations with demographic, clinical, and behavioral factors were assessed using bivariable and multivariable models. Changes in alcohol intake over time were examined using McNemar’s and Bowker’s tests and multinomial logistic regression.</p> Results <p>In this cohort of 2080 participants, the proportion of participants consuming at least one drink per week decreased from 71.2% at diagnosis to 39.8% at one year post-diagnosis, while the proportion reporting less than one drink per week increased from 28.9 to 60.2%. Reduction in alcohol intake at one year post-diagnosis was more likely among those experiencing financial difficulty, receiving chemotherapy, reporting lower physical health, and current or never smokers compared to former smokers. Better physical health, engagement in moderate-intensity exercise, and current smoking were associated with higher cross-sectional alcohol intake at one year post-diagnosis.</p> Conclusions <p>Alcohol consumption declined significantly in early survivorship. Financial, behavioral, and treatment-related factors played key roles in shaping these patterns.</p> Implications for Cancer Survivors <p>Our findings underscore the importance of targeted interventions to support personalized counseling on alcohol intake, particularly for individuals with better physical health, greater financial stability, or co-occurring risky behaviors like smoking.</p>