There is clear evidence that trauma-related serious injuries and fatalities can be directly linked to alcohol misuse. Because alcohol is a factor in many motor vehicle crashes (the leading cause of death for persons up to age 49), the National Highway Traffic and Safety Administration has set a high priority on decreasing alcohol-related motor vehicle crash injuries. Research now recognizes that most alcohol-impaired drivers who are injured are binge drinkers, not alcoholics. During the past decade, public health and substance treatment researchers have begun to focus on screening and early intervention in clinical settings as a means of reducing alcohol-related injuries. Trauma centers are uniquely positioned to address this problem because of the high percentage of alcohol-impaired patients admitted after motor vehicle crashes. This article discusses the barriers to implementing alcohol screening and intervention programs in trauma centers from the trauma surgeon's perspective.