Context: Information on the pattern of mortality among alcohol users is important for advocacy and planning. The proportion of deaths attributed to alcohol is often underestimated. Aim: We determined the risk of mortality among alcohol using adult males compared with adult male nonalcohol users. Settings and Design: Cohort study was conducted in the population registry of lifestyle diseases cohort in a rural block in Kerala, India. Materials and Methods: During 2002-2007, trained field workers conducted interviews, and underlying cause of death was coded by local physicians trained in verbal autopsy. Statistical Analysis: Risk ratios of death among men using alcohol and not using alcohol were calculated. Risk ratio of alcohol for various causes of mortality across various age groups was also determined. Log-rank test was done to compare the mortality of adult men using and not using alcohol. Results: Risk ratios of all-cause mortality in alcoholic men were 1.87 (1.45, 2.4) in 20-44 age group, 1.3 (1.07, 1.57) for 45-59 age group. Relative risks of alcohol use status for coronary heart disease mortality were 2.91 (1.67, 5.05) among 20-44 years and 1.49 (1.09, 2.03) among 45-59 years. Conclusion: Young and middle-aged male alcohol users (20-59 years) showed significantly increased risk ratio of death. Alcohol users have a higher risk of coronary artery disease mortality and mortality from injuries. The results support a restrictive alcohol policy and screening for coronary artery disease in men using alcohol seeking care in treatment facilities.