Alcoholism, a major public health problem throughout the world, causes an enormous damage to health and quality of life and undermines the well being of families and society. It is associated with liver disease, cancer, cardiovascular problems, accidental deaths, suicides, and homicides. Over the last 20 years, a significant progress has been made in the pharmacological treatment of alcoholism owing to the better understanding of the neurobiological substrates of alcohol dependence, including adaptive changes in amino acid neurotransmitter systems, stimulation of dopamine and opioid peptide systems, and, possibly, changes in serotonergic activity. Disulfiram, naltrexone and acamprosate are the only pharmacological agents currently approved for the management of alcohol dependence. Data from studies of ondansetron and topiramate in alcohol dependence are somewhat promising, but it appears that the evidence of efficacy of these drugs in large controlled clinical trials are still lacking. Trials with SSRIs and some antipsychotics have shown disappointing results. Because the biological basis of alcohol dependence appears to be multifactorial, the future of management of alcoholism would involve combination therapy, using drugs acting on different neuronal pathways, such as acamprosate and naltrexone. Pharmacotherapy should be used in association with appropriate psychosocial support and specific treatment for any underlying psychiatric comorbidities.