Introduction: Alcohol consumption has been steadily increasing in East Asia, however, there is comparatively little regional data of alcohol‐related harms. This study examines the alcohol‐related harms prevalence and risk factors in Hong Kong, a high population density city with limited alcohol regulation. Methods: A cross‐sectional telephone survey was conducted in 2019 on Chinese adults aged 18–74 (n = 3200). Respondents were asked about various past‐year first‐hand drinking harms (after one's own drinking), second‐hand harms (harms from other people's drinking) and views of neighbourhood alcohol outlet regulation. Results: Of drinkers, 21.1% reported first‐hand alcohol harms, with physical/mental health harms (15.7%) most commonly reported. Younger‐aged drinkers (adjusted odds ratios [AOR] 2.64, 95% confidence interval [CI] 1.63, 4.48) and heavy drinkers (AOR 2.34, 95% CI 1.55, 3.55) were more likely to report first‐hand harms. Of the sample, 18.2% experienced past‐year second‐hand harms, with public harms (12.9%) most commonly reported. Young age (AOR 1.88, 95% CI 1.43, 2.49), higher education (AOR 1.44, 95% CI 1.13, 1.83), past‐year binge drinking (AOR 4.29, 95% CI 3.04, 6.05) and communal living (AOR 2.04, 95% CI 1.13, 3.75) predicted greater likelihood of second‐hand alcohol harms. Higher neighbourhood alcohol outlet density was not associated with any first‐hand harms and only significantly predicted being inconvenienced by drinkers. Although victims of second‐hand alcohol harms were more supportive of regulating outlet density, 93.3% of respondents were opposed to such policies. Discussion and Conclusions: Although high levels of alcohol‐related harms were not reported by Hong Kong adults, regulations should target young drinkers and binge drinkers who are most likely to experience drinking‐related harms. [ABSTRACT FROM AUTHOR]