This article looks at the impact of multilevel governance structures on state-society relations. It contends that rather than focusing on relations between state actors and societal actors, it is more useful to look at shifts between competing advocacy coalitions in a given issue area. It argues that the impact of multilevel governance structures on domestic advocacy coalitions depends on the political opportunity structure provided at the international level, the types of policy outputs international institutions can deliver, and the extent to which members of an advocacy coalition have the organizational capacities to be active at the international level. These factors are explored in two cases of public health policy: anti-smoking policy and alcoholism policy. Moreover, both cases show that multilevel governance structures offer better opportunities for challengers than for defenders of the domestic status quo.