We analyzed data from 1253 HIV-positive injection drug users (IDUs) entering detoxification or methadone maintenance treatment in New York City between 1990 and 2004 to assess HIV risk behaviors and their association with at-risk drinking (defined as more than 14 drinks per week for males or 7 drinks per week for females) and intoxication. Most (81%) of the participants were male, 50% were Hispanic, and 36% African American. The average age of respondents was 40 years. Injection risk behaviors that were examined were distributive sharing of needles/syringes and distributive sharing of needles/syringes with multiple IDUs. Sexual risk behaviors included multiple sex partners, engaging in unprotected sex, and among women, engaging in trade sex. After adjusting for the effects of other variables, at-risk drinking among cocaine injectors was associated with distributive sharing of needles/syringes. At-risk drinkers were also more likely to engage in unprotected sex with a casual partner. Finally, among cocaine injectors alcohol intoxication during the most recent sex episode was associated with unprotected sex with a casual partner. These observations indicate that among HIV-positive IDUs at-risk drinking is associated with higher rates of injection and sexual risk behaviors and that alcohol intoxication is related to unprotected sex.