Objective: Alcohol use disorders (AUDs) are associated with high social and health care costs. We compare the direct social and health care costs of patients with AUDs, according to four service use profiles: (a) AUD treatment, (b) mental health (MH) treatment, (c) AUD + MH treatment, (d) no treatment. A separate analysis of the costliest 10% is included. Furthermore, the association between the service user profile and the risk of death is examined. Method: Direct unit service costs were retrieved from the electronic health record system and supplemented with patient grouping–based costs for primary and secondary care services, to examine the yearly mean cost per patient in the AUD cohort (N = 5,136; 71.1% male). We used data collected in the North Karelia region of Finland between 2014 and 2018. Results: Total costs of care for the cohort during the 5-year follow-up were 126 million Euros, and the percentage of the costliest 10% (n = 521) was 51.7% (65 million Euros). Total costs were 12,778 Euros lower if the person received AUD treatment only, compared with those not in treatment. For those receiving MH treatment only, the total costs were 1,819 Euros higher, and costs were 1,523 Euros higher for those receivingAUD + MH treatment. Receiving any treatment was associated with a diminished risk of death (AUD: Odds ratio [OR] = 0.56; MH: OR = 0.63; AUD + MH: OR = 0.41). Conclusions: Receiving only AUD treatment was associated with the lowest cost of care. Our results support the early identification of AUDs and provision of treatment in specialized addiction services to lower the costs of care and improve care outcomes. (J. Stud. Alcohol Drugs, 81, 144–151, 2020).