This paper estimates total and unit costs of alcohol-involved crashes in the U.S. in 2010. With methods from earlier studies, we estimated costs per crash survivor by MAIS, body part, and fracture/dislocation involvement. We multiplied them times 2010 crash incidence estimates from NHTSA data sets, with adjustments for underreporting of crashes and their alcohol involvement. The unit costs are lifetime costs discounted at 3%. To develop medical costs, we combined 2008 Health Care Utilization Program national data for hospitalizations and ED visits of crash survivors with prior estimates of post-discharge costs. Productivity losses drew on Current Population Survey and American Time Use Survey data. Quality of life losses came from a 2011 AAAM paper and property damage from insurance data. We built a hybrid incidence file comprised of 2008-2010 and 1984-86 NHTSA crash surveillance data, weighted with 2010 General Estimates System weights. Fatality data came from the 2010 FARS. An estimated 12% of 2010 crashes but only 0.9% of miles driven were alcohol-involved (BAC > .05). Alcohol- involved crashes cost an estimated $121 billion. That is 24% of the societal cost of all crashes. Alcohol-attributable crashes accounted for an estimated 22.5% of US auto liability insurance payments. Alcohol-involved crashes cost $0.84 per drink. Above the US BAC limit of .08, crash costs were $8.12 per mile driven; 1 in 788 trips resulted in a crash and 1 in 1,016 trips in an arrest. Unit costs for crash survivors by severity are higher for impaired driving than for other crashes. That suggests national aggregate impaired driving cost estimates in other countries are substantial underestimates if they are based on all-crash unit costs.