A cross-sectional analytical study was conducted amongst farm workers in the deciduous fruit industry in South Africa to assess levels of alcohol consumption and abuse, and to explore the impact of the DOP system, whereby farm workers are paid in part with alcohol, on indicators of alcohol consumption. High levels of alcohol consumption were found. On the CAGE and a shortened version of the MAST questionnaires, 87 and 65%, respectively, had responses indicating problem drinking. Close to half of the sample consumed more grams of alcohol per week than considered safe drinking (210 g) and 9.3% consumed amounts in excess of dangerous drinking (>490 g/week). Almost one-fifth (19.4%) of workers interviewed reported current use of the DOP system, and 47.8% of workers had experience of one or more farms in the past where the DOP system had been used. Workers with past experience of the DOP system were 9.8 times less likely to be asbstainers than colleagues without exposure to the DOP system. The pervasive effects of excessive alcohol consumption, and its relationship to past and current DOP practices pose substantial public health challenges to the transformation of health services currently underway in South Africa.