Alcohol usage is an integral causal factor in all types of trauma. Additionally, both the acute and to a much greater extent chronic usage of alcohol impair the body's normal physiologic responses to injury. Emergency physicians are painfully aware of the relationship between alcohol and trauma. However, we occasionally fail to appreciate the body's altered response and physical state due to alcohol. We frequently fail to use this opportunity to confront patients with the fact that they have a problem and refer them appropriately to rehabilitation programs.