A clear understanding of the scope of alcohol (ethanol)-related problems is important for effective diagnosis and treatment of alcoholism. The focus of medical treatment has long been on patients with severe alcohol dependence. These patients constitute only 5 to 6% of the adult population. However, approximately 20% of the adult population can be classified as ‘problem drinkers’, who are not alcohol dependent and yet consume alcohol at levels that may result in hazardous medical and psychosocial sequelae.Evaluation of alcohol-related problems should be viewed as an integral part of a medical assessment in all patients. The ideal strategy should incorporate the findings of clinical interviews, physical examinations, questionnaires and laboratory tests.There has been important progress in the pharmacotherapy of alcoholism, particularly for alcohol withdrawal and reduction of alcohol consumption. Benzodiazepines are currently the first-line therapy for the treatment of the alcohol withdrawal syndrome. Pharmacotherapy has been improved and simplified with the use of long-acting benzodiazepines via a loading dose technique.Selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) and other agents modulating serotonergic function are currently the most promising agents for the reduction of alcohol consumption. In short term clinical trials, SSRIs, such as zimeldine, viqualine, citalopram and fluoxetine, decreased alcohol consumption by averages of 14 to 20% from baseline. Reductions of up to 60% were observed in some patients. Citalopram and fluoxetine also decreased the desire for alcohol, and may be useful for prevention of relapse after detoxification. The combination of SSRIs and psychosocial interventions may be more beneficial than either therapy alone.Future developments in understanding the neurobiological mechanisms of alcohol dependence may further improve the pharmacological treatment of alcoholism.