In a 20-year follow-up the association between alcohol consumption, social and personal background factors and mortality was studied in a cohort of 49,464 Swedish conscripts. The relative risk of death among high consumers (those consuming more than 250 g alcohol/week at conscription) was 2.8 (95% confidence interval 2.2-3.7) compared with moderate consumers (1-100 g/week). Deaths caused by direct toxic effects of alcohol were few, less than 5%. Instead suicides and accidents predominated. Abstainers had a slightly lower mortality than moderate consumers, with a relative risk of 0.8 (0.6-1.1), due to a significantly lower risk for traffic deaths. High consumers of alcohol had more than twice as many social and personal risk factors for premature death compared with the cohort as a whole. Yet presence of social risk factors added little to the already increased relative risk of death among high consumers.