Key PointsQuestionIs a brief automated bilingual computerized alcohol screening and intervention (AB-CASI) health information technology tool superior to standard care in reducing alcohol consumption and alcohol-related adverse health behaviors and consequences among US Latino emergency department (ED) patients?FindingsIn this randomized clinical trial of 840 self-identified adult Latino ED patients with unhealthy drinking, the number of binge drinking episodes within the last 28 days was significantly lower in the AB-CASI group compared with the standard care group (3.2 episodes vs 4.0; 7.7 episodes at baseline in both groups) at 12 months after randomization.MeaningThese findings suggest that AB-CASI is a viable approach to addressing alcohol-related health disparities in the ED, a setting that serves as a national health care front line and safety net.