Objectives This study investigated alcohol-related hospital utilization and alcohol-related mortality according to occupation among men and women. Whether increased rates of alcoholism in some occupations result from circumstances within the occupation or from selective recruitment of persons prone to alcohol misuse was studied.Methods All Swedish residents were included who reported an occupation in the censuses of 1985 and 1990 and were born in . The relationships between occupation and hospitalization due to an alcoholism diagnosis in 1991-1994 and alcohol-related mortality in 1991-1995 were studied among stable workers (those who held the same occupation in both censuses) and newly recruited workers (those who held different occupations in the two censuses). Incidence and mortality rates were calculated for the different occupations using the person-year method, and standardized rate ratios were used as approximations of the relative risk of disease occurrence and mortality in different occupations as compared with the corresponding statistics of the entire study population.Results Several, mostly manual, occupations showed an increased relative risk of alcoholism diagnoses and alcohol-related mortality. Nonmanual occupations had low risks. Women in male-dominated high-risk occupations often showed increased relative risks. Stable and newly recruited employees in the same occupation showed very similar relative risks.Conclusions New recruits into high-risk occupations often have increased relative risks of at least the same magnitude as persons employed long-term in the same occupations. This finding indicates that the increased relative risk of alcoholism found in some occupations can partly be explained by selective recruitment of heavy drinkers.