Alcohol use is an important part of the health profile of older adults, and little is known about the prevalence and correlates of drinking among this population in Ghana and South Africa. This study aimed to describe and compare the prevalence and correlates of drinking patterns among adults aged 50 and above in Ghana and South Africa, and to determine which correlates explain differences in drinking patterns between the two countries. We used data from the WHO Study on global AGEing and adult health (SAGE) conducted in Ghana and South Africa. The sample of participants aged 50+ was 4289 in Ghana and 3666 in South Africa. Alcohol measures included a self-report of the number of standard drinks consumed over the previous 7 days, from which we constructed the mutually exclusive drinking categories of lifetime abstainers, low risk and at risk drinkers by gender. We used multivariate analysis to identify independent correlates for the different drinking patterns and those contributing to drinking differences between countries. Lifetime abstainers comprised 41.9% and 74.6% of the Ghana and South Africa samples, respectively. Among current drinkers, there were significantly more at risk drinkers among both genders in South Africa compared to Ghana. Factors independently associated drinking patterns differed between countries and by gender, although similarities included religion and smoking. Smoking status contributed to the difference in drinking patterns between Ghana and South Africa more than socio-demographics. Different patterns of drinking and associated correlates exist among older adults between Ghana and South Africa, and differences in drinking patterns were more strongly associated with smoking than socio-demographics. Drinking may increase in Ghana as economic development continues, although other health behaviors such as smoking may also play an important role and should be monitored in future surveys.