Alcohol-related motor vehicle crashes are a major preventable cause of death in the United States. One potential factor that may modulate the influence of alcohol intoxication on driving-related decision-making is posttraumatic stress. The current study evaluated the influence of induction of acute trauma-related stress (via script-driven imagery) during alcohol intoxication (.06% BrAC) on driving-related risky decision-making – willingness to drive, driving-related decision-making (i.e., attempted red light runs), and driving-related reaction time (i.e., braking latency) – among 56 trauma-exposed (currently symptomatic) adult drinkers from the community (M = 25.32; 46.4% female). Results indicated that trauma-related stress may exacerbate willingness to drive during a state of acute alcohol intoxication, but, alternatively, may have only a minimal-to-moderate effect on performance-based, driving-related decision-making (i.e., red light runs), and a potentially mitigating impact on driving-related reaction time (i.e., braking latency) under the influence of alcohol. Generally, results suggest that trauma-related stress may differentially impact varying aspects of driving-related risky decision-making, above and beyond the influence of alcohol. Implications for theoretical modeling for driving-related decision-making during acute intoxication and for the advancement of education and intervention efforts, as well as suggestions for future directions, including methodological and procedural improvements, are discussed.