Alcohol intoxication is the leading risk factor for injury.” This opening statement in the report by Gentilello et al1 punctuates the important link between alcohol and injury, as more than 50% of trauma is alcohol related. According to the National Highway Traffic Safety Administration, more than 17,500 people died nationwide in alcohol-related motor vehicle crashes in 2002, which represents 41% of all traffic deaths.2 The incidence of alcohol involvement in fatal traffic crashes exceeds 50% in those 20 to 44 years old. More than two thirds of children 14 years of age and under who die in motor vehicle accidents were riding with a drinking driver, and they were only wearing safety restraints one third of the time, further evidence of the impaired judgment imposed by excessive alcohol consumption. Each of our communities has suffered the loss of innocent children and talented young adults from accidents due to alcohol. We have witnessed unsuspecting police officers, emergency services personnel, and highway workers seriously injured or killed by drunk drivers while fulfilling the obligations of their jobs. Binge drinking among older teenagers and young adults has never been more common. Drunk and unruly fans at sporting events make headlines for their bad behavior. We see this occurring in the world around us but do little to combat the root cause: overuse of alcohol is the leading preventable cause of injury. Grass roots organizations such as Mothers Against Drunk Driving have promoted “designated driver” campaigns and lower limits for the legal definition of intoxication. Their efforts have helped considerably, but they often run up against a backlash from others who ignore the physical and judgmental impairments of alcohol in favor of individual rights. Some have even found a way to deflect the blame. They sue the bartender who served the booze to the drunk who later killed or injured someone! Gentilello and colleagues1 have presented a compelling cost-benefit analysis of the efficacy of screening injured adults for alcoholism and offering a brief intervention. Their analysis is well done and uses conservative estimates of intoxication, as well as liberal cost figures to demonstrate a reduction in healthcare costs due to a lower number of recidivism-related injuries. Their previously reported experience at a single urban trauma center supports this cost-benefit model.3 There is little doubt that the benefits of screening and intervention in the acute-care setting would also reduce the number of alcohol-related deaths. So if brief interventions work and are effective, why aren't they being used more often? There are still significant impediments to the wholesale adoption of this preventive strategy, even though a large number of randomized trials have demonstrated its effectiveness. It makes sense that insurers would support the use of brief interventions, particularly if there is almost a 4-fold savings for every dollar spent on screening. However, most states still allow insurers to deny payments on personal claims when alcohol use has been documented. This practice discourages some trauma centers from checking blood alcohol concentrations, lest they be left holding the bag for insurer-denied costs. Insurers and disbelieving legislators may only support this change when there are more hard facts to support the model proposed in this paper. And it likely will take physicians or others to champion this cause for any legislative change to succeed. Where do trauma surgeons weigh in on this matter? When trauma surgeons were surveyed about their practices of screening for alcohol problems in the injured, less than 20% stated that they routinely screened trauma patients for alcoholism, even though nearly all understood its association with injury. Most of the nonscreeners stated they were “too busy” or “not interested,” and they frequently thought that it was someone else's responsibility to perform screening in the setting of injury. These same surgeons believe that screening does not effectively identify problem drinkers, and 30% were concerned that patients would be offended by questioning.3 A later survey indicates that only one third of trauma surgeons routinely check a blood alcohol concentration in trauma victims and just 25% use a screening questionnaire. Some even admit to concerns about payment denials if alcohol use is documented.4 Are we are too worried about the lost revenue related to the current injury to implement routine alcohol screening and brief interventions, particularly given the long-term cost savings? Are we too busy? Is it really someone else's responsibility? All of these are convenient excuses, but in reality we are ducking the issue. It may not be practical for surgeons to initiate brief interventions, but we should recognize that it is our responsibility to put these systems in place. Surgeons are often impassioned in their care of the injured. We must now find the same passion for prevention.