The incidence of alcohol-involved highway crashes (those in which a driver or nonoccupant had been drinking) was estimated from federal data bases. The estimates were adjusted for police underreporting of alcohol involvement. In 1990, 22% of motor vehicle crash victims—1.2 million—were injured in crashes involving alcohol. Over 22,000 of these victims were killed. The comprehensive cost of alcohol-involved crashes was $148 billion in 1990, including $46 billion in monetary costs and $102 billion in lost quality of life. This represents $1.09 per drink of alcohol consumed. Crashes where blood alcohol concentration (BAC) exceeded .10% accounted for 32% of comprehensive crash costs, and crashes with lower positive BAC accounted for another 8%. Excluding drunk drivers and drunk nonoccupants, alcohol-involved crashes caused 8,500 deaths and left 21,000 people permanently disabled and another 605,000 less seriously injured. Averaged across all drinks, other people collectively pay $0.63 in crash costs every time someone takes a drink. A combination of increased public awareness and strong legal sanctions has been effective in reducing the incidence of alcohol-involved driving. The proportion of injuries in crashes that police reported were alcoholinvolved dropped by 37% between 1982–1984 and 1990