Alcohol abuse is the single most important aggravating factor in trauma and the severity of injuries sustained therefrom. The role of alcohol in fatal vehicular crashes is well recognized but is equally great or greater in falls, choking, drowning, burns, and assaults. Since the problem drinker is implicated in most serious highway crashes and since human behavior related to the use of alcohol tends to be constant across situations, persons who violate generally recognized norms of alcohol use in one context are likely to do so in others. The physician involved in the care of the acutely injured problem drinker has an obligation to the patient to save life and limb but also an obligation to society to prevent further injury to others. Blood alcohol concentration (BAC) should be measured in all injured patients regardless of cause. The problem drinker warrants appropriate referral after injuries have been treated. Follow-up liaison with the local Alcohol Safety Action Program may enhance recognition of recidivism and sensitize local judicial agencies to the need for more aggressive rehabilitation and law enforcement.