Problems of alcohol misuse are increasingly common and it is estimated that at least 2% of the population are dependent on alcohol, or drinking at a level which will lead them to develop alcohol-related problems. Further, even for those who are not sufficiently dependent or do not drink consistently enough to cause problems, there are occasions when drinking will lead to difficulties in individuals' lives, such as coming into contact with the law through drunkenness, or becoming injured. For generations, accident and emergency departments have experienced the problem of drunkenness among patients. In rare instances, accident and emergency departments have access to detoxification centres, where drunken patients can be admitted directly. Thus, during 1983, the Withington Hospital Accident and Emergency Department admitted to the Withington Hospital Detoxification Centre 121 patients. However, there are only two such purpose-built centres in England and Wales, and generally accident and emergency departments are left to deal with these problems on their own. It is the aim, however, of this article not to discuss the problems created by such patients, nor essentially their management, but to examine ways to improve the detection of those individuals who are alcoholic or alcohol dependent among attenders of accident and emergency departments. The term alcohol dependence refers to a disorder believed to contain psychological and physical factors, characterized by abnormal patterns of drinking and at its more advanced stage, the presence of a physiological disturbance on withdrawal from alcohol (alcohol withdrawal syndrome). The patterns of abnormal drinking are either the loss of consistency to control alcohol intake and/or inability to abstain. The former refers to that awareness on the part of individuals that when they drink they cannot guarantee to control their drinking on all occasions. On some occasions, control may be possible, as may be abstinence, but the ability to control drinking on all occasions is diminished. The inability to abstain refers to that difficulty to do without alcohol when one wishes to. The alcohol withdrawal syndrome is characterized in its early stages, (that is, 6-8 hours after reducing alcohol intake), by sweating, nausea, retching and tremulousness. The advanced stage of the syndrome is characterized by a confusional state, together