Alcohol consumption variables predictive of casualties are compared in probability samples of emergency room (ER) patients in two countries with different drinking patterns; (1) Spain, where frequent light drinking is the typical pattern (N = 2,072), and (2) the U.S. (i.e., California), where less frequent heavier drinking is more typical (N = 1,756). Logistic regression was used to evaluate the predictive value of breath-analyzer readings, drinking patterns and problems, time and place of injury, and demographic characteristics on ER admission for injuries vs noninjuries and for alcohol-related injuries vs non-alcohol-related injuries. Quantity and frequency of drinking, time and place of injury, and feeling drunk at the time of the event were predictive of casualties in California. Drinking patterns were less predictive of injury occurrence and of alcohol-related injury in Spain. One possible explanation for this difference may be that drinking is integrated into society as part of the wine drinking culture in Spain, while in the U.S. drinking occasions are more circumscribed by appropriateness of time and place.