The report estimates that the total cost of alcohol use by youth was $52.8 billion in 1996. The costs associated with youth alcohol use included more than $19 million from traffic crashes, more than $29 billion from violent crime, $189 million from burns, $426 million from drowning, $1.512 billion from suicide attempts, $493 million from fetal alcohol syndrome, $340 million from alcohol poisonings. Alcohol poisonings in 1994 included 10 fatal cases and 40,000 cases, although these poisonings were probably heavily underreported because physician reports often omitted the mention of alcohol in patient records to avoid family embarrassment. Individuals under age 21 accounted for 9.4 percent of the persons treated for only alcoholism and 16.2 percent of the persons treated for alcohol and other drug abuse. The drug treatment costs did not include costs related to work loss or pain and lost quality of life and thus were understated. Nevertheless, it is important to keep in mind that many effective tools are available to prevent and reduce underage drinking and that the reduction in traffic fatalities since 1975 is a result of the increase in the minimum drinking age and has saved society $53.6 billion. Further progress requires making preventing underage drinking a high social and political priority. Figures, appended methodological information, and 22 reference notes