The association of alcohol consumption and casualties is compared in probability samples of two culturally diverse emergency room populations: Barcelona, Spain (N = 2972) and Contra Costa County, California (N = 3609). Similar methods and data collection instruments were used to breathalyze and interview patients regarding self-reported alcohol consumption 6 h prior to the injury, usual drinking patterns and alcohol-related problems. Breathalyzer reading was positively associated with injury in both Contra Costa and Barcelona, but at the legal level only in Barcelona. Self-reported alcohol intake within 6 h prior to the event was positively associated with injury only among females in Contra Costa. Frequent light drinking was associated with injuries in Barcelona while heavier drinking was associated with injuries in Contra Costa. Little association was found between social consequences of drinking and injuries in either sample, however, the Contra Costa sample reported significantly higher rates of these problems than Barcelona, among moderate and high quantity drinkers. Although few differences were found between the two samples, findings suggest that usual drinking patterns within a culture may influence the association of alcohol and casualties, and future studies should explore these differences by type and cause of injury.