To assess the role of alcohol and alcoholism in motor vehicle and other accidental deaths, New Jersey State Medical Examiner cases from Essex County aged 16 or older during a 4-year period, October 1981 to September 1985, were analyzed. Cases were classified as alcoholics according to the following criteria: (1) autopsy findings of liver change or pancreatitis due to alcoholism or (2) any case record report of drinking problems. There were 467 age-eligible cases whose certified manner of death was an accident for which the decedent may have had some responsibility. The study sample of 300 cases with blood or brain alcohol levels (BALs) obtained within 6 h after injury, including 96 motor vehicle drivers, 78 pedestrians in motor vehicle accidents, 38 fire victims, and 33 fall victims. In the study sample, 23% were classified as alcoholics, 47% had positive BALs, and 36% had levels of 0.10% or more. Alcoholics much more often than nonalcoholics had positive BALs and levels of 0.20% or more. Accidental nontraffic deaths were significantly more often associated with both alcohol use and alcoholism than were traffic deaths.