Alcohol abuse by adolescents is widespread in the United Kingdom, has complex cultural, economic and biological origins and is associated with adverse health consequences. Affected young people present medically with intoxication or its immediate consequences such as injury or self-harm. A significant number also suffer adverse psychosocial effects and longer-term adverse outcomes. Even some younger patients are now presenting with evidence of physiological dependence. Interpretation of the literature and clinical experience suggests that practitioners have greater capacity to respond effectively than they may believe. Modest concerted effort could make the medical profession much more relevant to the needs of these, often troubled, young people.