OBJECTIVES: To examine use, timing and cost of Emergency Department (ED) visits by those of college age (17-22 years) for acute alcohol intoxication. METHODS: Cases were identified from Massachusetts 2002 ED and hospital databases using ICD-9 principal diagnosis codes 305.00-305.09. Hospital cases were limited to those admitted via ED. Cost estimates include facility, accommodations and ancillary services, reported in 2002 USD. Charges were adjusted using a 0.55 cost-to-charge ratio. RESULTS: Of 1803 cases identified, 52% were male and 55% were less than 20-years old. Ambulances were used to transport 54%; law enforcement was involved in 1.5% of cases. The majority (69%) arrived between 10:00 PM and 4:00 AM, and 70% of all visits occurred Friday through Sunday. Significantly (p=0.004) more visits occurred in September and October than any other month. The majority (94%) were treated and released from ED, 1% was hospitalized, 2% eloped or left AMA, 2% were transferred and 1% was recorded as unknown. Mean duration of ED visit was 5.4 hours (median: 4). Mean cost per ED visit was $482 (median: $382) for those treated and released, and $537 (median: $460) for those hospitalized. On average, those admitted (n=20) spent 2.5 days (median: 1) in the hospital at a cost of $4540 (median: $2154). The cumulative hours of ED time used in one year for treating alcohol intoxication in this age group was 8254. Cumulative cost of ED and inpatient care for the year was roughly $938,000. Managed care organizations and commercial insurers were the responsible payers for most cases (60%). Self-pay was noted for 24%. CONCLUSIONS: Acute alcohol intoxication among those of college age results in a substantial direct medical cost, as well as an opportunity cost for ED resources during the year, particularly at the start of the school year.