Drinking increases motor vehicle crash likelihood starting at blood alcohol levels as low as .02 mmol/L. Clinical experience tells us that drunken drivers "cycle through" the system many times, presenting opportunities for intervention. We describe the drunken driver's risk of occurrence at each juncture in the cycle and emphasize the opportunity for intervention. Patients injured in motor vehicle crashes should be screened for alcohol abuse in the emergency department and referred for treatment if it appears warranted.