He was born in Castelvetrano in the province of Trapani on Sicily. His grandfather and father were already part of Cosa Nostra. The family originated from Siculiana in the province of Agrigento, and is closely related to the Cuntrera-family through several marriages. Alfonso Caruana married his niece Giuseppina Caruana and has a son and two daughters. When the Caruanas and Cuntreras moved to Montreal in the mid-1960s they became affiliated with Nicolo Rizzuto and his son, Vito Rizzuto. They began to work together in drug trafficking activities.