It was the aim of this study to estimate effects of alcohol abuse on early retirement and premature death in the working population with special emphasis on alcohol related absenteeism from work and inpatient treatment.

Sample consisted of 125.019 resp. 128.001 health insurance clients up to age 58 resp. 74 were used. Mean follow-up period was 6.4 years. Excess risks were calculated with Cox regression models adjusted for age, gender, education and job classification.

Both alcohol-related absenteeism from work (without inpatient treatment) and detoxification treatment were associated with higher risks of early retirement (RR 2.59, CI 2.21–3.04, p < 0.001; RR 2.29, CI 1.99–2.62, p < 0.001) and premature death (RR 3.26 CI 2.74–3.88, p < 0.001; RR 4.41, CI 3.90–4.98, p < 0.001).

Further analysis showed higher risks of early retirement for males. Females who sought inpatient treatment for alcohol abuse/addiction had the highest risk of premature death (RR 7.75, CI 5.61–10.68, p < 0.001). Marked increases of the risks for permanent disablity and death during the follow-up period could also be oberserved after all-cause inpatient treatment in patients with a comorbid alcohol problem.

The detrimental effect of alcoholism on life expectancy and capacity to work is considerable after absenteeism from work, psychiatric treatment and all-cause inpatient treatment. While female patients in detoxification wards are a minority, they may be more strongly affected by the somatic complications of alcohol abuse. Nevertheless, strong selection biases in this subsample need to be considered and the data interpreted with caution.