Introduction: Chronic alcohol consumption is a known cause of peripheral polyneuropathy, which can clinically mimic or mask the symptoms of compression neuropathy. Consequently, surgeons may hesitate to perform Open Carpal Tunnel Release (CTR) in this demographic, fearing that systemic nerve toxicity will limit the benefits of local decompression. This review aims to determine if alcohol use disorder compromises the objective functional recovery and symptom resolution following open CTR. Methods: PROSPERO Protocols and PRISMA Guidelines were utilised to perform a systematic review. Study selection included English language randomised controlled trials, cohort longitudinal studies, and case series on adults published between 2015 and 2025. ROBINS-I was utilised for a risk of bias assessment. Functional outcomes, including the Boston Carpal Tunnel Questionnaire (BCTQ), Kelly Score, and palmar pain, were stratified and analysed. Results: 8 studies were eligible for inclusion. Despite the established physiological impact of alcohol on nerve health, analysis revealed no statistically significant difference in post-operative functional improvement between alcohol users and non-users. Specifically, there was no evidence that alcohol impeded improvements in BCTQ scores (p = 0.16), resolution of palmar pain (p = 0.27), or subjective numbness (p = 1.00). Furthermore, global assessment via the Kelly Score showed identical outcomes (p = 1.00). While large-scale data indicates a higher risk of superficial infection in this group, the functional utility of the procedure remains preserved. Conclusion: Alcohol use disorder does not appear to diminish the functional efficacy of open CTR. Patients with a history of alcohol consumption derive equivalent symptomatic relief and functional restoration compared to non-users, suggesting that local decompression remains a valid therapeutic intervention despite the presence of systemic risk factors. Surgeons should not withhold surgery based on alcohol history alone, provided perioperative infection risks are managed.