Introduction: The American College of Surgeons' (ACS) Committee on Trauma recommends drug and alcohol screening as “essential” for level I and II or “desirable” for level III trauma centers. Methods: Trauma centers were surveyed concerning alcohol and other drug testing policies and clinical practices during fiscal year 1989. Results: Surveys were returned from 125 level I, 153 level II, and 38 other centers (n = 316; 47 states and the District of Columbia). Resources to measure blood alcohol concentrations (BAC) and perform urine drug screens were available in 99.4% and 96.8% of centers, respectively. In 63.7% of level I and level II and 47.4% of other centers, BACs were “routinely” obtained. The 63.7% testing rate for level I and level II centers was not significantly higher than a 55.2% rate for such centers documented in a survey conducted 5 years earlier. In 40.0% of level I and level II and 26.3% of other centers, drug screens were obtained routinely. The higher overall BAC testing policy compared with that for other drugs was significant (p < 0.001). Substance abuse counselors were employed at 59.3% of the trauma centers, a rate significantly higher than the 31.8% rate identified in a previous survey (p < 0.001). Conclusion: Despite available resources and repeated ACS recommendations, measurements of BACs and drug screens are routine in only 63.7% of level I and 40.0% of level II trauma centers.