Black women at Historically Black Colleges and Universities (HBCUs) have drinking patterns and lived experiences worth documenting on their own terms, not only as a comparison point for predominantly White institutions. These women drink less, on average, than women at predominantly White institutions and national benchmarks, but that pattern sits on specific pathways, including adverse childhood experiences, depression, coping motives, gender-differentiated religiosity and ethnic identity, and sexual victimization, that put a meaningful minority at real risk. Drawing on 17 peer-reviewed articles, this review also covers mental health service utilization, polysubstance use, and morbidity and mortality patterns among Black women broadly, framing alcohol misuse as a social problem tied to social work’s Grand Challenges. It closes with limitations, gender-responsive prevention and telehealth recommendations, and a call for parallel research at other Minority-Serving Institutions, including Predominantly Black, Hispanic-Serving, Tribal, and Native American- and Asian American-serving campuses.