Many patients visiting hospital emergency departments (EDs) or admitted to trauma centers have alcohol problems. Therefore, it is plausible that all ED and trauma patients should be screened for unhealthy alcohol use so that optimal care can be provided and treatment initiated, if necessary, for these patients. In addition, brief interventions offered directly in the ED or trauma unit could be useful for many patients. Some studies have found such interventions to be feasible and effective in this setting. However, all efforts in this regard must take into consideration the specific challenges associated with screening and intervention in EDs, such as time constraints, ethical and legal issues, and concerns regarding insurance coverage. Innovative approaches to screening may address at least some of these problems, although more research is needed to determine how screening can be better incorporated and implemented in the ED setting.