We conducted a controlled trial of two interventions to increase the number of patients receiving alcohol counseling in an academic, general medicine clinic. Ongoing randomization yielded similar groups of patients and providers. By applying a two-item alcoholism-screening instrument incorporated into the routine intake process, nursing staff were successful in screening 90.4% of the 1,328 eligible patients seen during a 4-month study period. Of the patients screened, 428 (35.6%) were found to be positive. In those groups where nurses were allowed to refer directly on the basis of a positive screening result, over four times as many patients (10.8% versus. 2.3%) accepted appointments for counseling, as did patients seen by physicians providing standard care. Patients who were briefly introduced to the alcohol counselor at the time referral were no more likely to keep their first, formal appointments than were patients scheduled in the usual manner. Patients who did receive counseling had their diagnoses confirmed by the 25-item Michigan Alcoholism Screening Test. We conclude that the adoption of an alcohol screening program in our clinic increased the number of patients appropriately referred for counseling.