This project aimed to compare psychosocial features, assessment, treatment and proposed after care of adolescent patients presenting with alcohol intoxication or self-harm at an emergency department (ED) in Leeds, West Yorkshire. Literature shows adverse effects on physical development and psychological wellbeing, as well as increased risks of intentional and unintentional injury and suicide in adolescents who binge drink. EDs don’t appear to manage the assessment and care of intoxicated adolescents as well as for those adolescents who self-harm and local and national policies in the area of mental health do not seem to reflect the risks of binge drinking in adolescence. This research used a comparative case note analysis to evaluate the differences and/or similarities between adolescent self-harm and alcohol patients at a Leeds ED. Psychosocial data, level of alertness, triage category, admission data and proposed after care were compared between the self-harm and alcohol groups. Groups were separated based on their presenting complaint at the time of ED attendance, but data for adolescents who also used alcohol as part of a self-harm episode was also included in the analysis. A total of 127 cases for a 6 month period were analysed using SPSS. Comparative statistics were undertaken in the form of contingency tables and chi squared tests for the categorical data. The total sample for both groups was dominated by females and the alcohol group-despite being a significant proportion of the sample- received less psychosocial assessment, proposed mental health care and hospital admission than did the self-harm group. Adolescents presenting with alcohol intoxication at a Leeds ED during the 6 month period were not admitted to hospital as often as adolescents who self-harmed, and they did not receive the same proposed after care by mental health services as young people who presented with self-harm, despite a similar psychosocial background.