High alcohol use remains a public health challenge worldwide, with deaths and disability-adjusted life-years (DALYs) attributable to it showing a decreasing trend globally. Despite this global progress, Iran continues to face challenges in reducing high alcohol use-related health issues. This study aimed to report the national and subnational burden of diseases and injuries attributable to high alcohol use in Iran over 1990-2021 by age, sex, socio-demographic index (SDI), and underlying cause. Data on death and DALY numbers, as well as age-standardized rates of conditions attributable to high alcohol use, were extracted from the Global Burden of Disease 2021 study. High alcohol use was defined as drinking above the theoretical minimum risk exposure level, which is the amount that minimizes overall risk. In 2021, the age-standardized DALY and death rates attributable to high alcohol use were 105.7 and 2.1 per 100,000, respectively. The age-standardized DALY rates increased by 24.9% over 1990-2021. Males had higher rates than females. The burden was highest in the 95 + age group. Substance use disorders were the leading condition associated with just high alcohol use. Sistan and Baluchistan had the greatest burden in 2021. SDI was generally positively associated with the alcohol-attributable burden. The burden of alcohol-attributable conditions in Iran has increased over the past 32 years. Targeted prevention and harm reduction strategies are recommended to address this rising burden.