High risk drinking is linked with high rates of physical harm. The reported incidence of alcohol – related trauma among Aboriginal and Torres Strait Islander people in the Northern Territory is the highest in the world [1]. Facial fractures frequently require surgical treatment [2] and are common among young Aboriginal and Torres Strait Islanders. They are often linked with misuse of alcohol in the Northern Territory and are frequently secondary to assault [1]. This review focuses on alcohol-related trauma in the Territory and draws attention to an urgent need for preventative health approach to address this critical issue.