Background: The annual cost to the NHS of alcoholrelated injury and illness is estimated to be £2.7 billion. Alcohol-related violence has become a concerning public health issue. This study set out to establish the burden of alcohol-related violence in an inner city UK emergency department (ED). Methods: This single centre study was undertaken in the ED of the Bristol Royal Infirmary. This department serves an inner city population. An independent researcher administered a questionnaire to every patient who attended during the study period. A questionnaire was also administered to the treating clinician to ascertain the diagnosis, and whether the patient's attendance was related to alcohol use. Results: 14% (n=111) of participants felt that their attendance at the ED was related to alcohol. 11% of all injured patients felt it was due to alcohol consumption. 3% of patients attended with an alcohol-related illness. The treating clinicians reported that 21% of all patients in this study attended with a problem either directly or indirectly attributable to alcohol. Discussion: The number of attendances attributable to alcohol-related injury and illness was at least 14% of all patients. One third of patients presenting with an alcohol-related illness or injury required admission to hospital. If these figures are extrapolated, the number of patients presenting with alcohol-related injury is in excess of 7000 attendances to the Bristol Royal Infirmary annually, or nearly 2 million ED patients every year in England and Wales, resulting in 640 000 admissions. Copyright © 2013 BMJ Publishing Group Ltd and the College of Emergency Medicine.