Given the tremendous financial and human costs of alcohol abuse and dependence, physician competency in alcohol related issues must be increased. Alcohol competency is essential to evaluate the risks and to detect alcohol problems early in the course of alcohol abuse and dependence. But, are medical students and physicians adequately trained in alcohol-related issue to give appropriate advice about alcohol? Are they trained to use an office visit to promote health, identify early abuse and dependence, intervene, and make recommendations? Several studies suggest that they are not. We have recent data that provide further evidence that future and current physicians may not be sufficiently competent in alcohol issues to counsel their patients about alcohol. Medical school curriculum and Continuing Medical Education on alcohol abuse and addiction should be required of all students and physicians so they can be best prepared to prevent problems and identify and treat those for whom prevention has failed.