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This study examined the association of hostility to drinking pattern and whether this association mediated the relation of hostility to mortality.Subjects were 3326 current drinkers from the Vietnam Experience Study cohort who were followed for vital status.United States.Hostility was measured by an abbreviated version of the Cook–Medley Hostility Scale (ACM). The alcohol variables were total monthly intake of alcohol, drinking frequency, drinks per drinking day and drinking ≥ 5 drinks on at least one occasion in the past month (i.e. heavy episodic drinking).Regression analyses showed associations between the ACM and total monthly intake of alcohol (P < 0.0001), drinks per drinking day (P < 0.0001) and heavy episodic drinking (P < 0.0001), but not with frequency of drinking days. Hostility, drinks per drinking day, heavy episodic drinking and total monthly alcohol intake were also associated with all-cause mortality (all Ps < 0.0001). Further analyses showed that drinking pattern, particularly drinks per drinking day, may account partially for the relation of hostility to mortality.High hostility is associated with elevated mortality and a deleterious drinking pattern characterized by relatively high intake per drinking occasion. Drinking pattern could help explain the relationships between hostility and health.