BackgroundThis is the first major study of alcohol‐associated unnatural deaths in Thailand and in South East Asia, an 11‐nation bloc that encompasses approximately one‐quarter of the world's population. Thailand leads South East Asia in per capita alcohol consumption. Objectives were to determine incidence of alcohol‐associated unnatural deaths in terms of post‐mortem blood alcohol concentration (BAC); to investigate correlations between BAC and selected demographic variables and assess instances of potential societal significance; and to evaluate incidence of co‐use of alcohol and illicit substances.MethodsCore study sample (n=77,006) was derived from Thai government computerized database of unnatural‐death autopsies.ResultsTotal autopsy sample was alcohol‐positive (BAC ≥ 0.20 g/L) at 32.49%. Male autopsy cases were alcohol positive (35.52%) at approximately twice the rate of female autopsy cases (16.62 %), with significantly higher median BAC levels,1.64 g/L and 1.31 g/L, respectively. Incidence of female alcohol‐positive cases with extremely high BACs (≥ 3.50 g/L) was comparable to male alcohol‐positive autopsies. Victims of accidents, homicides, and suicides were alcohol‐positive at 42.44%, 38.81%, and 33.25%, respectively. Drowning fatalities had the highest rate of alcohol detection (49.12%) and highest median BAC (2.47 g/L). Next highest (48.47%) were alcohol‐positive road traffic fatalities (RTFs, BAC 1.92 g/L), which accounted for about one‐half of all RTFs and one‐third of all alcohol‐positive autopsies. Of total alcohol‐positive population, 8.33% tested positive for illicit substances, most commonly methamphetamine/amphetamine.ConclusionsBAC results for majority of male and female alcohol‐positive victims exceeded generally accepted threshold for Heavy Episodic Drinking (0.8 g/L) and provided rare BAC‐documented (≥3.50 g/L) example of gender parity in incidence of high alcohol consumption. Median BAC value for alcohol‐positive RTFs (1.92 g/L) was about 10% higher than similar studies in most other countries and about four times greater than Thai legal limit for motor‐vehicle operation (0.50 g/L).