In the last years, numerous studies have been performed on neurobiological mechanisms in alcohol craving. Changes in the hypothalamic cortisol pathway and the leptin metabolism, which is also associated with pharmacological interventions, have been of special interest. With acamprosate and naltrexone two substances exist for pharmacotherapy, but recent results about the efficacy are controversial. The clinical profit of disulfiram has been shown, at least in a subgroup of patients. Besides, there are several promising candidate substances. Current investigations focus on a differentiated pharmacotherapy of alcohol dependence, including psychological and genetic factors.