Despite the public health importance of alcohol misuse by early problem drinkers, treatment efforts for those with alcohol problems have focused largely on individuals with already established alcohol dependence. This article discusses screening tools commonly used to identify a variety of early problem drinkers, biological markers of heavy drinking and a framework by which to approach alcohol misuse. The results of 4 meta-analyses of brief intervention are also summarised. While all meta-analyses showed that some type of brief intervention decreased alcohol consumption for all, or a subset of, early problem drinkers, it is yet to be agreed as to what type of drinker can benefit from what type of brief intervention.The implementation of these research findings into clinical practice has been inconsistent as physicians often fail to identify alcohol problems in their patients. Compared with other chronic medical illnesses, physicians do not diagnose or treat addictive disorders with the same accuracy or effectiveness. Barriers to the implementation of screening and brief interventions by the physician include a lack of time and diagnostic skills, negative attitudes and the perception that diagnosing problem drinkers is not part of the physician's role.As research determines which subgroups of drinkers are most likely to respond best to specific types of brief intervention, this approach is likely to gain a more stable and defined place in the behavioural healthcare system. Nonetheless, incorporating existing findings into the healthcare professional's practice remains a challenge.