Before a school-based substance abuse prevention program was introduced, students in grades 5 through 12 in a northcentral Wisconsin county completed a questionnaire on their experience with tobacco, alcohol, and other drugs. Alcohol abuse was widespread, even among the youngest students surveyed. Commencement of alcohol use in the 5th grade or earlier appears to be increasing in recent years. There was a dose response relationship observed between the amount of alcohol consumed and the reported frequency of poor grades, thoughts and attempts of suicide, driving after drinking, remorse, and memory loss. Physicians caring for adolescents need to consider the possible role of alcohol abuse in a number of clinical situations. Because of their unique expertise and stature in the community, physicians also have an important role in community-oriented substance abuse prevention programs.