Impaired driving continues to be a major factor in many injuries and fatalities on our nation's highways. In 1998, alcohol was involved in 38% of all fatal crashes, contributing to 15,935 deaths. The combination of improved public awareness and strong legal sanctions for driving under the influence has been shown to reduce the incidence of impaired driving. A few states have instituted new statutes for mandatory health care reporting of impaired drivers who have been involved in motor vehicle crashes. Current research into establishing emergency department-based effective, efficient, and "user-friendly" methods for screening, intervention, and referral on behalf of the problem drinker offers promise for emergency physicians to become empowered to better manage this individual and public health problem. Emergency physicians may soon need to reassess their role in reducing the occurrence of alcohol-related motor vehicle crashes through widespread screening, intervention, and referral of these patients.