AIMS: The study aim was to calculate Irish alcohol-attributable fractions (AAFs) and to apply these measurements to existing data in order to quantify the impact of alcohol on mortality. METHODS: Exposure of the Irish population to alcohol was derived from a national survey and combined with estimates of the alcohol-disease/injury risk association from meta-analyses in the international literature to calculate Irish AAFs. In diseases for which relative risk estimates were not available, such as injury, AAFs were taken directly from Ridolfo and Stevenson [(2001) The quantification of drug-caused mortality and morbidity in Australia, 1998. In Drug Statistics Series no. 7. AIHW cat. no. PHE 29. Australian Institute of Health and Welfare, Canberra]. AAFs were applied to national datasets to calculate alcohol-attributed mortality caused or prevented and potential years of life lost (PYLL) or saved. RESULTS: In Ireland, over the 5-year period from January 1, 2000 to December 31, 2004, alcohol was estimated to have caused 4.4% (6584) of deaths and 10.8% (131,245) of all-cause PYLL. Alcohol was estimated to have prevented 2.7% (3967) of deaths and 1.5% (18,285) of all-cause PYLL. This resulted in an estimated net effect of 1.8% (2616) of deaths and 9.3% (112,959) of all-cause PYLL. Chronic conditions were responsible for 69% of alcohol-attributable deaths and acute conditions for 31%. Conditions not wholly attributable to alcohol accounted for 83% of deaths as opposed to 17% for conditions wholly caused by alcohol. CONCLUSIONS: This study showed for the first time the full magnitude of deaths from alcohol in Ireland and revealed that while young people and those dependent on alcohol are at high risk of negative outcomes due to alcohol, particularly acute injuries, at an individual level, at a population level it is in fact moderate drinkers and chronic diseases, not wholly attributable to alcohol, that are associated with most alcohol-attributed deaths. The findings of this study suggest that policies focusing on the whole population attitude to alcohol, and chronic conditions and conditions partially attributable to alcohol, would yield considerable public health benefits. [Author's abstract]