OBJECTIVES: One in every 13 US adults suffers from alcohol dependence. Information on the economic burden these patients place on health insurers is currently lacking. METHODS: Using a large US health insurance database, we identified all patients with a diagnosis of alcohol dependence syndrome in calendar year (CY) 2004, as well as an age- and sex-matched group of persons without such a diagnosis during this year (“comparison patients”). Healthcare expenditures for the treatment of alcohol-related conditions—including alcoholism and alcoholic disorders, alcohol-related diseases, and alcohol-related injuries—were tallied in CY2004 for alcoholics and comparison patients using plan payments to providers. Expenditures were summarized using means and 95% confidence intervals (CI) estimated via nonparametric bootstrapping. RESULTS: In a population of 4 million covered lives, 11,151 persons had one or more encounters with a diagnosis of alcohol dependence syndrome. Mean (±SD) age of alcoholics was 40 (±14) years, and 67% were male. Expenditures for alcohol-related conditions averaged $5,945 (95%CI $5,598-$6,297) for alcoholics, versus $345 ($273-$438) for comparison patients, a difference of $5,600 ($5,255-$5,963). Differences in mean expenditures increased with age (ages 65 years and older, $13,243), and were similar for men ($5,771) and women ($5,255). CONCLUSION: Healthcare expenditures are substantially higher among patients with encounters for alcohol dependence in comparison with persons without evidence of this problem.