We analyzed alcohol involvement in 84,005 medically identified live discharges for self-inflicted intentional injuries (typically suicide acts) from hospitals in 20 U.S. states in 1997. Alcohol was involved in 27% of the discharges. Evidence of alcohol was significantly more prevalent in men than women, but generally men drink more than women. Blacks had the highest alcohol involvement in their suicide acts relative to their drinking patterns. Overall, alcohol involvement rose and subsequently fell with age, with involvement above 30% for ages 30–55. Lowering the minimum legal drinking age to 18 from 21 could potentially raise alcohol-involved suicide hospitalizations among youth by an estimated 27%.