Alcohol misuse, when combined with the right circumstances, culminates in a "Perfect Storm" that has catastrophic results. Alcohol misuse impairs judgment and increases the likelihood of serious injury. Once injured, the intoxicated patient is more likely to be hypotensive and less likely to be able to protect his or her airway. Alcohol also impairs multiple compensatory responses to injury that are critical to survival, thereby increasing the likelihood of serious complications. When complications do occur, they may be more severe for intoxicated patients because both acute and chronic ethanol use adversely affect immunity. Thus, all phases of trauma care are potentially affected by excessive alcohol use. This paper presents facts about trauma care and the physiologic consequences and clinical implications of alcohol intoxication. Further, it shows how health-care costs increase when evaluating and managing an intoxicated trauma patient. This financial burden further escalates in the surgical ICU because the care of an intoxicated patient falls outside the realm of standard care. Trauma surgeons, perhaps more than other health-care providers, have a unique opportunity and a responsibility to address potential alcohol misuse with their patients. They witness the Perfect Storm almost daily and are fully aware of the short- and long-term consequences of alcohol misuse. A trauma center visit provides an opportune time and place to incorporate alcohol screening and brief interventions as a part of standard trauma care.