Conclusions Unhealthy alcohol use is common in hospitalized patients, with a high prevalence of severe alcohol problems among those with unhealthy use. Detection should include the use of a validated screening instrument to determine the presence of unhealthy use, and assessment of alcohol-related consequences in patients with positive screening results to categorize the severity of unhealthy use. Based on current evidence, patients without an alcohol use disorder should receive a brief intervention to target reduced drinking. Acute care issues for patients with alcohol use disorders have been well described and are standards of care. Additional research is needed to guide discharge planning for inpatients with an alcohol use disorder, but management should include referral to outpatient addiction treatment if available, consideration of medications to prevent a return to heavy drinking, and explicit follow-up on alcohol use in the ambulatory medical setting. JCAHO has advanced SBIRT for unhealthy alcohol use as a quality measure, and barriers to implementation are mainly generic factors rather than specific to SBIRT. Continued research is needed across the spectrum of unhealthy alcohol use to further demonstrate the benefits of hospital-based SBIRT, refine the process, and improve care for hospitalized patients.