To determine the extent and nature of alcohol screening and referral services provided by college health centers, the authors conducted a state-stratified, random sampling of 25% of 327 4-year accredited US colleges and universities with health centers. Of the 249 survey respondents, 32% routinely screened students for alcohol use. Urban, public, and large institutions were most likely to screen routinely. Only 11.7% of the sample reported they used standardized instruments, predominantly the CAGE. The health centers used an average of 3.4 referral options, but only 27.5% offered students access to campus programs specifically designed for students who are substance abusers. Findings suggest that the majority of college health centers are not providing routine alcohol screening for students or using standardized screening instruments. In addition, students are often referred to services that may be inappropriate or ineffective in addressing the needs of college drinkers.